The immunology of atopic dermatitis and its reversibility with broad-spectrum and targeted therapies.
The immunology of atopic dermatitis and its reversibility with broad-spectrum and targeted therapies.
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DOI：
10.1016/j.jaci.2017.01.011
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发表时间：
2017-04
期刊：
影响因子：
--
通讯作者：
Leung DY
中科院分区：
文献类型：
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作者：
Brunner PM;Guttman-Yassky E;Leung DY
特应性皮炎（AD）是最常见的慢性炎症性皮肤病，由终末角化细胞分化缺陷和强烈的2型免疫反应共同驱动。与慢性斑块型银屑病相比，AD现在被认为是一种异质性更强的疾病，根据疾病的亚型，Th22、Th17/IL-23和Th1细胞因子通路会被额外激活。在这篇综述中，我们讨论了我们目前对早发性和慢性疾病中AD免疫图谱的理解。使用广泛和靶向治疗的临床研究有助于阐明各种免疫轴对疾病表型的贡献。重要的是，免疫激活远远超出了病变性AD，因为非病变性皮肤和血液成分含有AD特异性炎症变化。由于这个原因，未来的治疗方法将需要集中在系统性治疗方法上，特别是对患有中重度疾病的患者。
Atopic dermatitis (AD), the most common chronic inflammatory skin disease, is driven by both terminal keratinocyte differentiation defects and strong type 2 immune responses. In contrast to chronic plaque-type psoriasis, AD is now understood to be a much more heterogeneous disease, with additional activation of Th22, Th17/IL-23 and Th1 cytokine pathways, depending on the subtype of the disease. In this review, we discuss our current understanding of the AD immune map in both early-onset as well as chronic disease. Clinical studies using broad and targeted therapeutics have helped to elucidate the contribution of various immune axes to the disease phenotype. Importantly, immune activation extends well beyond lesional AD, as non-lesional skin and the blood component harbor AD-specific inflammatory changes. For this reason, future therapeutics will need to focus on a systemic treatment approach, especially in patients suffering from moderate-to-severe disease.