Role of the permeability barrier in contact dermatitis

Abstract

An intact skin barrier prevents the penetration of harmful substances from the environment into the skin and prevents occupational skin diseases. In contact dermatitis, the first step in pathology is the disruption of the skin barrier. The skin barrier often gets disrupted by chronic exposure to water plus detergents or solvents. Thereafter, irritants may penetrate into the skin and induce injury to the keratinocyte cell membrane in the living epidermal layers leading to cytokine release and inflammation. Also, allergens may come into contact with Langerhans and T cells and induce immunological reactions and inflammation which lead to allergic contact dermatitis. Treatment strategies should aim to restore the skin barrier to cure and prevent the relapse of the disease. Corticosteroids reduce immunological reactions and inflammation, but do not lead to a complete barrier repair. For long-term treatment of eczema, drugs which improve the skin barrier like pimecrolimus or, in particular, emollients should be preferred. © 2011 Springer-Verlag Berlin Heidelberg.