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. Skin barrier often gets disrupted by chronic exposition to water plus detergents or solvents. Thereafter, irritants may penetrate into the skin and may induce injury to keratinocyte cell membrane in the living epidermal layers leading to cytokine release and inflammation. Also, penetrated allergens may come into contact with Langerhans and T cells and may induce complex immunological reactions and inflammation which lead to allergic contact dermatitis. Treatment strategies should aim to restore the skin barrier to cure and prevent 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. Barrier creams are establishing an artificial barrier and may prevent occupational contact dermatitis. Gloves are a much stronger barrier to protect from the environmental hazards but may lead to irritation because of sweating and hyperhydration.