The diagnosis of atopic dermatitisis increasingly being made by dermatologists. Characteristic manifestations of this disease can be observed in the form of morphological changes in the skin, the appearance of itching, a recurrent clinical course, and the complexity of treatment. This pathology usually begins during childhood.
Only in our article on estet-portal.com, find out the latest research in the field of pathogenesis of changes in immunity in the body of a person suffering from atopic dermatitis, which will soon radically change the approach to the treatment of this nosology.
Atopic dermatitis: triggers
Many factors contribute to the tendency to atopy, such as: a burdened family history (registration of cases of atopic dermatitis (AD) in parents), a history of exudative diathesis in a child, artificial feeding, disruption of the endocrine system and metabolism, various food intolerances to products In addition, allergens that implement the development of clinical manifestations of AD can be drugs, food, household dust, house mites.
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The clinic of atopic dermatitis can often be observed in other pathologies, in particular with bronchial asthma, vasomotor rhinitis, and urticaria. It should also be noted that in most patients this dermatitis has heterogeneous immunological tests, indicating the presence of monovalent autoantibodies.
Clinical manifestations of atopic dermatitis
The clinical development of AD is characterized by bouts of debilitating itching, covering fairly large areas of initially completely unchanged skin. In the future, diffuse lichenization and infiltration develop, the skin becomes dry, covered with thin scales, excoriations, and blood crusts. Polygonal papules are grouped on the periphery of the lesions. The course of atopic dermatitis is long, exacerbation occurs mainly in autumn and winter, spontaneous remission often occurs in summer.
Specific immunotherapy makes it possible to forget about atopic dermatitis
The increase in the incidence of atopic dermatitis and high resistance to conventional therapy requires a detailed consideration of the pathogenesis of this dermatosis, in particular, taking into account the latest achievements of medical science in this problem.
Cellular immunity in AD – violations
It is believed, in accordance with the ideas of modern immunity science, that AD can be considered as an immune-dependent dermatosis. This is proven by clinical observations regarding this disease after bone marrow transplantation from patients with atopic predisposition and in patients with severe defects in T-cell immune function.
Filaggrin gene mutations as a cause of atopic dermatitis
It has been proven that in the development of atopic dermatitis, the role of Th1 / Th2 types is not equivalent at various stages of the process − in the acute phase in cells, increased expression of i-RNA IL-13 (typical for Th1 link of cellular immunity), and IL-12 plays a greater role in modulating the chronic process. This can be manifested in blast transformation reactions, by the expression of markers and the activity of some enzymes, and explains the hyperactivation of the humoral link of immunity.
Thus, another important feature of the pathogenesis of atopic dermatitis is the activation of the humoral functioning of the immune system.
Participation of the humoral link of immunity in the development of AD
Synthesis of a specific skin antigen (CLA - cutaneous lymphocyte antigen), which occurs on skin lymphocytes, determines the migration of these cells and ensures the formation of local skin reactions. Interleukins (IL) have one of the main values in the communication links of skin cells. ILs are the most important communicative molecules that have an immunological effect on the cells of the dermis. CLA expression is upregulated by IL-12, TNF and IL-6.
Bacterial superantigens, due to stimulation of IL-12, promote the expression of CLA by lymphocytes, and due to macrophage IL-1 and TNF, E-selectin of endothelial cells. Increased expression of E-selectin and other adhesion molecules under the influence of IL-1 and TNF, as well as active transport of lymphocytes, eosinophils and macrophages to the lesion due to the action of chemokines, leads to damage to keratinocytes and the onset of itching.
Atopic dermatitis – the main factor in reducing skin hydration
When determining the mechanisms of development of atopic dermatitis, attention should be paid to the triggers of pathomorphological reactions of the skin. Quite a lot of data indicate the leading role of the activation of the synthesis of immunoglobulins E, which is also confirmed during skin reactions.
This IgE-dependent reaction can serve as a trigger for pathological changes in the functioning of the cellular and humoral parts of the immune system.
About 20 genes are known to be associated with atopic predisposition. The site on the 5th chromosome (5q), which contains the IL-3, IL-4, and IL-5 gene cluster, deserves special attention. At all stages of AD, T-lymphocytic infiltration of the skin and expression of type 2 cytokines IL-4 / IL-13 are preserved.
The above studies in the field of atopic dermatitis development may further serve to discover new mechanisms of influence on various components of the pathogenesis of this disease.
Is topical treatment of atopic dermatitis effective
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