Faculty of Medicine, National and Kapodistrian University of Athens, Andreas Syggros Hospital, 16121 Athens, Greece.
Department of Dermatology and Venereology, University Hospital of Heraklion, 71110 Heraklion, Greece.
Medicina (Kaunas). 2024 Aug 22;60(8):1376. doi: 10.3390/medicina60081376.
: Atopic dermatitis is a chronic inflammatory skin disorder with a significant burden on patients' quality of life. This systematic review aims to evaluate the restoration of skin barrier abnormalities with interleukin-4/interleukin-13 (IL-4/IL-13) inhibitors and Janus kinase (JAK) inhibitors in atopic dermatitis. : A comprehensive review of the literature was conducted, focusing on studies that assess the use of IL-4/IL-13 inhibitors and JAK inhibitors for atopic dermatitis. We identified eligible studies by searching Medline via PubMed with a special focus on their effect on the restoration of the epidermal barrier. Included studies evaluated the transepidermal water loss (TEWL), the reduction in epidermal thickness (ET), the improvement in ceramide synthesis, and the increase in stratum corneum hydration (SCH) with IL-4/IL-13 inhibitors and JAK inhibitors. The quality of included studies was assessed using the ROBINS-I and the RoB 2.0 tool for assessing the risk of bias. : Ten of the included studies concern dupilumab, while two concern JAK inhibitors. Ten were observational studies and two were randomized controlled trials (RCTs). The total number of included participants was 378 concerning dupilumab and 38 concerning JAK inhibitors. Five studies did not include any comparison group, three included healthy volunteers, two were conducted versus placebo, and two compared dupilumab with other treatments. The follow-up period ranged between 29 days and 32 weeks. The results demonstrated a significant decrease in transepidermal water loss (TEWL) and an increase in SCH on eczematous lesions for patients with sustained response to dupilumab treatment and observed improvements in ET and filaggrin (FLG) staining, which further support the efficacy of JAK inhibitors in enhancing skin barrier function. : This review underscores the efficacy of IL-4/IL-13 inhibitors in improving skin barrier function. However, the limited number of studies focusing on JAK inhibitors and the overall lack of RCTs highlight the need for further research to establish the definitive role of IL-4/IL-13 inhibitors and JAK inhibitors in the restoration of the skin barrier.
特应性皮炎是一种慢性炎症性皮肤疾病，对患者的生活质量有重大影响。本系统综述旨在评估白细胞介素 4/13（IL-4/IL-13）抑制剂和 Janus 激酶（JAK）抑制剂治疗特应性皮炎时对皮肤屏障异常的恢复作用。
我们进行了全面的文献综述，重点关注评估 IL-4/IL-13 抑制剂和 JAK 抑制剂治疗特应性皮炎的研究。我们通过 Medline 下的 PubMed 进行了有针对性的检索，以确定符合条件的研究，并特别关注它们对表皮屏障恢复的影响。纳入的研究评估了 IL-4/IL-13 抑制剂和 JAK 抑制剂对经皮水分丢失（TEWL）、表皮厚度（ET）减少、神经酰胺合成改善和角质层水合（SCH）增加的影响。使用 ROBINS-I 和 RoB 2.0 工具评估偏倚风险来评估纳入研究的质量。
纳入的研究中有 10 项涉及度普利尤单抗，2 项涉及 JAK 抑制剂。其中 10 项为观察性研究，2 项为随机对照试验（RCT）。涉及度普利尤单抗的纳入研究总人数为 378 人，涉及 JAK 抑制剂的为 38 人。5 项研究没有包括任何对照组，3 项研究纳入了健康志愿者，2 项研究与安慰剂进行了比较，2 项研究比较了度普利尤单抗与其他治疗方法。随访时间范围为 29 天至 32 周。结果表明，在对度普利尤单抗治疗有持续反应的患者的湿疹病变中，TEWL 显著降低，SCH 增加，并且 ET 和丝聚合蛋白（FLG）染色得到改善，这进一步支持 JAK 抑制剂增强皮肤屏障功能的疗效。
本综述强调了 IL-4/IL-13 抑制剂在改善皮肤屏障功能方面的疗效。然而，由于针对 JAK 抑制剂的研究数量有限，且总体缺乏 RCT，因此需要进一步研究来确定 IL-4/IL-13 抑制剂和 JAK 抑制剂在恢复皮肤屏障方面的明确作用。
