Worsening Dermatitis: The Link Between Barrier Disruption and Skin Inflammation

Overview of Skin Barrier Disruption

The skin barrier is essential for skin health; it protects against environmental stressors and helps to maintain skin balance. In conditions like atopic dermatitis (AD or eczema), this barrier becomes compromised (Schmuth et al., 2024; Luger et al., 2021; Proksch et al., 2006). 

Mechanisms of Barrier Disruption

Dermatitis-related barrier disruption involves both physical and biochemical changes. The stratum corneum and tight junctions (the physical layer of the skin barrier) serve as critical defense layers, and their dysfunction contributes to the progression of AD (Nguyen et al., 2020; Luger et al., 2021). Environmental triggers, including irritants and allergens, further aggravate this disruption (Proksch et al., 2006), by penetrating further into the skin.

Long-Term Effects on the Skin Barrier

This barrier disruption and inflammation can become persistent and cyclical, and can lead to chronic skin conditions like eczema. Persistent inflammation not only weakens the barrier (Egawa & Kabashima, 2016), but leads to heightened sensitivity and immune responses (Proksch et al., 2006). These responses can significantly deteriorate the skin barrier by affecting the tight junctions, which are crucial for maintaining the barrier. In turn, this compromised skin barrier can lead to further inflammation, thereby creating a vicious cycle of barrier dysfunction and inflammation (Bäsler & Brandner, 2016; Yokouchi et al., 2015). The longer this cycle continues, the worse the condition of the skin becomes, and the harder it becomes to restore the barrier.

Therapeutic Approaches

Managing dermatitis effectively requires strategies that restore the skin barrier. Topical treatments, including emollients and lipid-based creams, help reinforce the barrier and reduce inflammation (Proksch et al., 2006; Proksch & Brasch, 2020). As Proksch & Brasch (2020) state, "[t]reatment strategies should aim to restore the skin barrier to cure and prevent the relapse of the disease."

Conclusion

Barrier disruption in dermatitis, particularly in AD, arises from a complex interplay of genetic, environmental, and immune-related factors. Over time, this damage can lead to chronic inflammation. While corticosteroids help reduce inflammation, they do not fully restore the skin barrier (Proksch & Brasch, 2020). Therefore, therapeutic strategies that prioritize barrier repair and maintenance are essential for long-term management and preventing disease progression (Proksch & Brasch, 2020).

References

Bäsler, K., & Brandner, J. (2016). Tight junctions in skin inflammation. Pflügers Archiv - European Journal of Physiology, 469, 3 - 14. https://doi.org/10.1007/s00424-016-1903-9

Nguyen, H., Trujillo-Paez, J., Umehara, Y., Yue, H., Peng, G., Kiatsurayanon, C., Chieosilapatham, P., Song, P., Okumura, K., Ogawa, H., Ikeda, S., & Niyonsaba, F. (2020). Role of Antimicrobial Peptides in Skin Barrier Repair in Individuals with Atopic Dermatitis. International Journal of Molecular Sciences, 21. https://doi.org/10.3390/ijms21207607

Schmuth, M., Eckmann, S., Moosbrugger-Martinz, V., Ortner-Tobider, D., Blunder, S., Trafoier, T., Gruber, R., & Elias, P. (2024). Skin Barrier in Atopic Dermatitis.. The Journal of investigative dermatology, 144 5, 989-1000.e1. https://doi.org/10.1016/j.jid.2024.03.006

Luger, T., Amagai, M., Dréno, B., Dagnelie, M., Liao, W., Kabashima, K., Schikowski, T., Proksch, E., Elias, P., Simon, M., Simpson, E., Grinich, E., & Schmuth, M. (2021). Atopic dermatitis: Role of the skin barrier, environment, microbiome, and therapeutic agents.. Journal of dermatological science. https://doi.org/10.1016/j.jdermsci.2021.04.007

Proksch, E., Fölster-Holst, R., & Jensen, J. (2006). Skin barrier function, epidermal proliferation and differentiation in eczema.. Journal of dermatological science, 43 3, 159-69. https://doi.org/10.1016/J.JDERMSCI.2006.06.003

Egawa, G., & Kabashima, K. (2016). Multifactorial skin barrier deficiency and atopic dermatitis: Essential topics to prevent the atopic march.. The Journal of allergy and clinical immunology, 138 2, 350-358.e1. https://doi.org/10.1016/j.jaci.2016.06.002

Proksch, E., & Brasch, J. (2020). Role of the Permeability Barrier in Contact Dermatitis. Contact Dermatitis. https://doi.org/10.1007/978-3-642-03827-3_6

Yokouchi, M., Kubo, A., Kawasaki, H., Yoshida, K., Ishii, K., Furuse, M., & Amagai, M. (2015). Epidermal tight junction barrier function is altered by skin inflammation, but not by filaggrin-deficient stratum corneum.. Journal of dermatological science, 77 1, 28-36. https://doi.org/10.1016/j.jdermsci.2014.11.007