Published online Aug 2, 2017. doi: 10.5314/wjd.v6.i3.42
Peer-review started: February 15, 2017
First decision: March 7, 2017
Revised: March 14, 2017
Accepted: April 4, 2017
Article in press: April 5, 2017
Published online: August 2, 2017
The skin facilitates a number of key roles but its functioning can be impaired by disease. Atopic eczema is a chronic inflammatory disease where the skin barrier has become leaky, and inflammation occurs. It affects up to 20% of children and 3% of adults worldwide, manifesting as red itchy patches of skin with varying severity. This review aims to investigate the leaky skin barrier and immune mechanisms from the perspective of potential novel treatments. The complexity of atopic eczema as a disease is what makes it difficult to treat. Genome-wide association studies have highlighted possible genetic variations associated with atopic eczema, however in some cases, individuals develop the disease without these genetic risk factors. Loss of function mutations in the filaggrin gene are one of these associations and this is plausible due to its key role in barrier function. The Th2 immune response is the link with regards to the immune mechanisms as atopic inflammation often occurs through increased levels of interleukin (IL)-4 and IL-13. Eczematous inflammation also creates susceptibility to colonisation and damage by bacteria such as Staphylococcus aureus. Potential novel treatments are becoming ever more specific, offering the hope of fewer side effects and better disease control. The best new treatments highlighted in this review target the immune response with human beta defensin 2, phosphodiesterase-4 inhibitors and monoclonal antibodies all showing promise.
Core tip: Atopic eczema (atopic dermatitis) is an itchy inflammatory skin disease with complex aetiology, including impairment in barrier function and concomitant inflammation. Increased understanding of the molecular mechanisms in eczema pathogenesis has opened up opportunities for new therapeutic targets. This review summaries current understanding and highlights some novel treatments in development.