Laboratory for Analytical Chemistry, Department of Chemistry and Biochemistry, Faculty of Food Technology and Biotechnology, University of Zagreb, Zagreb, Croatia.
Department of Dermatology and Allergy, National Allergy Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
Exp Dermatol. 2018 Aug;27(8):909-914. doi: 10.1111/exd.13704.
Skin diseases represent one of the most common work-related diseases and may have a detrimental effect on social, personal and occupational aspects of life. Contact dermatitis (CD), which comprises predominately irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD), accounts for vast majority of occupational skin diseases, especially in occupations associated with frequent skin contact with irritants and contact allergens. Although ICD and ACD have similar clinical manifestation, their pathophysiology and the role of the skin barrier are different. In ICD, perturbation of the skin barrier is the primary event which sets into motion diverse metabolic processes and triggers activation of innate immunity without the involvement of adaptive immune system. In ACD, a type IV hypersensitivity reaction induced by contact allergens, the skin barrier impairment may evoke innate signalling pathways during the sensitization phase required for the activation of T-cell adaptive response. Thus, skin barrier impairment may increase the risk of ICD or ACD not only because of enhanced permeability and ingress of irritants and allergens but also by the generation of innate immune signal needed for the induction of allergic response. Hence, an efficient way to prevent CD is to avoid skin barrier damage in the workplace. This review focuses on the skin barrier, how it is affected by skin irritants and how its impairment contributes to the development of ICD and ACD.
皮肤疾病是最常见的职业病之一，可能对社会、个人和职业生活方面产生不利影响。接触性皮炎（CD）主要包括刺激性接触性皮炎（ICD）和过敏性接触性皮炎（ACD），占职业性皮肤病的绝大多数，尤其是在那些经常与刺激性和接触性过敏原接触的职业中。虽然 ICD 和 ACD 具有相似的临床表现，但它们的病理生理学和皮肤屏障的作用是不同的。在 ICD 中，皮肤屏障的破坏是引发各种代谢过程并触发固有免疫激活的首要事件，而无需适应性免疫系统的参与。在 ACD 中，接触过敏原引起的 IV 型超敏反应，在致敏阶段，皮肤屏障的损伤可能会引发固有信号通路，从而激活 T 细胞适应性反应。因此，皮肤屏障的破坏不仅会增加 ICD 或 ACD 的风险，因为它会增加刺激性和过敏原的通透性和进入，而且还会产生诱导过敏反应所需的固有免疫信号。因此，预防 CD 的有效方法是避免工作场所的皮肤屏障损伤。本文综述了皮肤屏障，它如何受到皮肤刺激物的影响，以及其损伤如何导致 ICD 和 ACD 的发展。
