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Abstract
Atopic dermatitis is a chronic relapsing eczematous dermatosis, which usually starts in childhood, and various causes are intricately associated with the development of the disease. Recently, various abnormalities in barrier function have been identified as the cause of atopic dermatitis. Loss-of-function mutation of filaggrin, a significant constituent of skin barrier, has been revealed as a cause for atopic dermatitis, and factors like enhanced protease activity, and decreased synthesis of the lipid lamellae especially ceramides also plays an important role in barrier dysfunction. Not only these genetic causes but also environmental factors are associated in barrier dysfunction, such as soap or detergents which increases skin pH, or proteases of dust mites or cockroaches which enhances epidermal barrier breakdown. Lately, skin barrier dysfunction is also thought to play an important role in the early stage of other allergic diseases such as asthma. Therefore, comprehension of the function of skin barrier can provide help in understanding various allergic diseases.
Figures and Tables
Fig. 1
Normal skin anatomy. (A) Normal skin is composed of five distinct layers: stratum basale, stratum spinosum, stratum granulosum, and stratum corneum. Among these five parts, the uppermost layer-stratum corneum- is responsible for skin barrier's function and supplements the functions of tight junction in the granular layer. (B) The brick and mortar model. When the granular layer is observed closely, it is composed of stacked up bricks of corneocytes made up of proteins and lipids surrounded by lipid-renriched intercellular matrix like a mortar. (C) The cornified envelope. The protein layer of the cornified envelope is composed of proteins such as involucrin, loricrin, and small proline-rich (SPR). Filaggrin, which binds keratin fibers, also plays an important role in the skin barrier function. The lipid layer of corneocyte is usually composed of lipid substances that are attached to involucrin.
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