You Huayan, Liang Yunsheng
Hunan Key Laboratory of Medical Epigenomics & Department of Dermatology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
Clin Rev Allergy Immunol. 2025 May 14;68(1):49. doi: 10.1007/s12016-025-09057-y.
Atopic dermatitis (AD) is a chronic inflammatory skin disease that is prevalent worldwide with complex etiology. Skin barrier defects and abnormal immune activation are crucial in the occurrence and development of AD. In the classic model of the skin barrier, lipids are essential for the formation and maintenance of this barrier as a "mortar" component. However, abnormally activated immune responses promote the lipid barrier deficiency through the secretion of various types of immune mediators directly or indirectly. In this review, we first introduce the skin lipid barrier (SLB) under both normal and abnormal conditions, highlighting the contributions of lipids derived from keratinocytes and sebaceous glands (SGs). Subsequently, the relationships between the immune mediators of Th1, Th2, Th17, Th22, and other types (adipokines, prostaglandins, leukotrienes) and SLB are elaborated in turn. Finally, the therapies for restoring SLB to treat AD are summarized, with a focus on the restoration effect of dupilumab on SLB. We hope that this review will offer a comprehensive perspective for understanding the pathogenesis of lipid metabolism disorders and SLB deficiency caused by immune mediators in AD. It also aims to provide guidance for further research on targeting inflammatory mediators to restore SLB.
特应性皮炎（AD）是一种慢性炎症性皮肤病，在全球范围内普遍存在，病因复杂。皮肤屏障缺陷和异常免疫激活在AD的发生发展中起关键作用。在经典的皮肤屏障模型中，脂质作为“灰浆”成分，对该屏障的形成和维持至关重要。然而，异常激活的免疫反应通过直接或间接分泌各种免疫介质，促进脂质屏障缺陷。在这篇综述中，我们首先介绍正常和异常情况下的皮肤脂质屏障（SLB），重点阐述角质形成细胞和皮脂腺（SGs）来源的脂质的作用。随后，依次阐述Th1、Th2、Th17、Th22及其他类型（脂肪因子、前列腺素、白三烯）的免疫介质与SLB之间的关系。最后，总结恢复SLB以治疗AD的疗法，重点关注度普利尤单抗对SLB的恢复效果。我们希望这篇综述能为理解AD中免疫介质引起的脂质代谢紊乱和SLB缺陷的发病机制提供全面的视角。它还旨在为进一步研究靶向炎症介质以恢复SLB提供指导。
