Science advances in the understanding of atopic dermatitis and opens ways for more effective and personalized treatments, focusing on skin barrier, microbiome and skin immunology
(DA) is a chronic skin inflammatory disease that affects millions of people around the world, responsible for intense, dryness and injuries that significantly impact quality of life. It is often associated with rhinitis and asthma, composing the so -called atopic triad. Still challenging for the recent research advances are unraveling the mysteries of DA and opening doors for more effective and specific treatments.
New understandings about skin barrier, microbiome and inflammatory pathways
Understanding of the evolved significantly, and is no longer seen as a dry skin condition and is understood as the result of the interaction between genetics, environment and immune system. Atopic skin has a dysfunctional skin barrier, which loses its protective function against external aggressors.
This leads to excessive water loss, facilitating dryness and entry of allergens and irritants, triggering inflammatory responses. Current research has identified disabled proteins and lipids in this barrier, which allows the development of therapies aimed at its restoration.
Another key point is the skin microbiome, that is, the community of microorganisms that inhabits our skin. In the DA, there is an imbalance with proliferation of unwanted bacteria, such as the Staphylococcus aureuswhich aggravate inflammation.
An exacerbated immune response is also observed: the body reacts disproportionately to harmless stimuli. Specific inflammatory roads, such as those mediated by interleucines (IL) 4 and 13, play a central role in itching and inflammation. This understanding has driven the development of specific and more effective therapies.
Biological therapies and personalized treatment gain space
With advances in the understanding of the disease, new approaches emerged for patients who do not respond well to classic treatment, based on hydration, corticosteroids, topic calcineurine inhibitors, oral immunosuppressants and phototherapy. The main revolution has been the use of immunobiologicals, such as Dupilumab-a recombinant IgG4 human monoclonal antibody that blocks the IL-4 and IL-13 signaling roads. These cytokines are directly involved in atopic inflammation, and the specific block of these roads has shown important benefits.
In addition, small oral molecules inhibitors of the Janus Quinase (JAK), such as abrocitinib, baricitinib and upadacitinib, have been effective in selectively blocking the inflammatory signs involved in the DA. The tendency is for research to continue to direct therapies that act on specific targets and specific cell phones, allowing increasingly accurate interventions.
Prevention, technology and precision medicine
Prevention and individualized care gain strength in the approach of DA, focusing on keeping the disease controlled and avoiding recurrences. Hydration remains the basis of treatment, with preference for neutral moisturizers specific to atopic skin. New formulations with adequate pH, ceramides and filagrin are increasingly accessible and effective in restoration of the skin barrier.
Early identification of the disease and the onset of appropriate measures help reduce the severity of seizures. Emerging technologies, such as bioactive creams, intelligent dressings and agents that stimulate the natural production of skin components, expand the therapeutic possibilities.
Personalized medicine is the future. Genetic and immunological analyzes may indicate biomarkers capable of predicting the response to treatments, allowing each patient to receive the most effective intervention with fewer side effects. Atopic dermatitis is a prevalent condition of multidisciplinary interest. The in -depth understanding of its mechanisms and the advancement of new therapies open concrete perspectives of more control and quality of life. The journey has evolved – but the future reserves even more hope.
*By Dr. Gabriel Peres – CRM-SP 150185 | RQE 71440
Dermatologist and micrographic surgeon of Mohs, holder of the Brazilian Society of Dermatology.
