Atopic dermatitis: Therapeutic concepts evolving from new pathophysiologic insights

Recent insights into the relevance of the epidermal barrier function and its interaction with components of the innate and adaptive immune responses in patients with atopic dermatitis (AD) give rise to a number of novel potential treatment options. In particular, the identification of loss-of-function mutations in the barrier protein filaggrin and of a diminished expression of certain antimicrobial peptides in AD skin stimulates new concepts to think beyond the T_H1/T_H2 paradigm. This review will focus on these most recent discoveries and will discuss new and corresponding proof-of-concept trials in patients with AD. It will further speculate on novel ways to restore the homeostasis among the 3 major components in AD skin suspected to be clinically relevant.

Key words: Atopic dermatitis, skin barrier function, innate immune system, adaptive immune system, filaggrin, T_H2 cells, T_H17 cells, immunotherapy, proof-of-concept trial

Abbreviations used: AD, Atopic dermatitis, DC, Dendritic cell, FLG, Filaggrin, LEKTI, Lymphoepithelial Kazal type inhibitor, MMF, Mycophenolate mofetil, TLR, Toll-like receptor, TSLP, Thymic stromal lymphopoietin, VEGF, Vascular endothelial growth factor