Review Article | Published:

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

Nature Immunologyvolume 19pages12861298 (2018) | Download Citation

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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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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The authors declare no competing interests.

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Correspondence to Teruki Dainichi or Kenji Kabashima.

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https://doi.org/10.1038/s41590-018-0256-2