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The epithelial immune microenvironment (EIME) in atopic dermatitis and psoriasis

Nature Immunology volume 19, pages 1286–1298 (2018)Cite this article

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Abstract

The skin provides both a physical barrier and an immunologic barrier to external threats. The protective machinery of the skin has evolved to provide situation-specific responses to eliminate pathogens and to provide protection against physical dangers. Dysregulation of this machinery can give rise to the initiation and propagation of inflammatory loops in the epithelial microenvironment that result in inflammatory skin diseases in susceptible people. A defective barrier and microbial dysbiosis drive an interleukin 4 (IL-4) loop that underlies atopic dermatitis, while in psoriasis, disordered keratinocyte signaling and predisposition to type 17 responses drive a pathogenic IL-17 loop. Here we discuss the pathogenesis of atopic dermatitis and psoriasis in terms of the epithelial immune microenvironment—the microbiota, keratinocytes and sensory nerves—and the resulting inflammatory loops.

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Fig. 1: Skin as a protective organ.
Fig. 2: Age distribution and sites of predilection in AD and psoriasis.
Fig. 3: Theoretical inflammatory loops at the EIME.
Fig. 4: The type 2 EIME versus the type 17 EIME.

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Authors and Affiliations

  1. Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan

    Teruki Dainichi, Akihiko Kitoh, Atsushi Otsuka, Saeko Nakajima, Takashi Nomura & Kenji Kabashima

  2. Department of Dermatology and Department of Immunology, Cutaneous Biology Research Core, University of Pittsburgh, Pittsburgh, PA, USA

    Daniel H. Kaplan

  3. Singapore Immunology Network (SIgN) and Institute of Medical Biology, Agency for Science, Technology and Research (A*STAR), Biopolis, Singapore, Singapore

    Kenji Kabashima

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  1. Teruki Dainichi
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Dainichi, T., Kitoh, A., Otsuka, A. et al. The epithelial immune microenvironment (EIME) in atopic dermatitis and psoriasis. Nat Immunol 19, 1286–1298 (2018). https://doi.org/10.1038/s41590-018-0256-2

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