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The treatment of atopic dermatitis with topical immunomodulators

  • Nordwig S Tomi
    Affiliations
    Department of Dermatology, Mt. Sinai School of Medicine, New York, New York, USA
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  • Thomas A Luger
    Correspondence
    Address correspondence to Thomas A. Luger, MD, Department of Dermatology and Ludwig Boltzmann Institute of Cell Biology and Immunobiology of the Skin, University of Münster, Von-Esmarch-Strasse 56, Muenster, 48149, Germany.
    Affiliations
    Department of Dermatology and Ludwig Boltzmann Institute of Cell Biology and Immunobiology of the Skin, University of Münster, Münster, Germany.
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      Atopic dermatitis (AD) is a common, chronic or chronically relapsing, inflammatory dermatosis that often presents in early childhood and may continue on into later life.
      • Rudikoff D
      • Lebwohl M
      Atopic dermatitis.
      Usually occurring in a personal or family setting of atopy,
      • Coca A.F
      • Cooke R.A
      On the classification of the phenomenon of hypersensitiveness.
      it is considered an immune–mediated condition with a predominance of CD4+LT2 helper lymphocytes,
      • Leung D.Y
      • Bhan A.K
      • Schneeberger E.E
      • Geha R.S
      Characterization of the mononuclear cell infiltrate in atopic dermatitis using monoclonal antibodies.
      hyperstimulatory high-affinity IgE receptor (FceRI)–expressing Langerhans cells,
      • Taylor R.S
      • Baadsgaard O
      • Hammerberg C
      • Cooper K.D
      Hyperstimulatory CD1a+CD1b+CD36+ Langerhans cells are responsible for increased autologous T lymphocyte reactivity to lesional epidermal cells of patients with atopic dermatitis.
      ,
      • Bieber T
      • Rieger A
      • Neuchrist C
      • et al.
      Induction of Fc epsilon R2/CD23 on human epidermal Langerhans cells by human recombinant interleukin 4 and gamma interferon.
      macrophages, and inflammatory dendritic epidermal cells,
      • Wollenberg A
      • Kraft S
      • Hanau D
      • Bieber T
      Immunomorphological and ultrastructural characterization of Langerhans cells and a novel, inflammatory dendritic epidermal cell (IDEC) population in lesional skin of atopic eczema.
      as well as effector cells such as eosinophils
      • Leiferman K.M
      • Ackerman S.J
      • Sampson H.A
      • et al.
      Dermal deposition of eosinophil-granule major basic protein in atopic dermatitis comparison with onchocerciasis.
      and mast cells.
      • Damsgaard T.E
      • Olesen A.B
      • Sorensen F.B
      • et al.
      Mast cells and atopic dermatitis stereological quantification of mast cells in atopic dermatitis and normal human skin.
      In addition, patients with AD have abnormal skin barrier function
      • Werner Y
      • Lindberg M
      Transepidermal water loss in dry and clinically normal skin in patients with atopic dermatitis.
      and epidermal lipid abnormalities.
      • Hara J
      • Higuchi K
      • Okamoto R
      • et al.
      High-expression of sphingomyelin deacylase is an important determinant of ceramide deficiency leading to barrier disruption in atopic dermatitis.
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