Skin Barrier Dysfunction and the Atopic March

Abstract

The atopic diseases: atopic dermatitis, asthma and allergic rhinoconjunctivitis are frequent diseases in the population occurring sequentially in the young (the atopic march). The discovery of filaggrin gene (FLG) mutations and impairments in the skin barrier as predisposing factors for atopic dermatitis and subsequent asthma and atopic sensitization in the context of eczema has improved our understanding of the atopic march. The atopic diseases can now be viewed upon as causally related conditions—rather than sequentially occurring manifestations of the same underlying atopic disease state—with atopic dermatitis and FLG mutations being a prerequisite for the development of the other atopic diseases, particularly asthma. This review discusses the role of the skin barrier function, particularly the role of FLG mutations, in the atopic march.