In atopic dermatitis, Nonlesional
can be deceiving
Hematoxylin and eosin staining of normal skin, clinically unaffected/nonlesional atopic dermatitis (ANL), and lesional atopic dermatitis (AL). Immunohistochemical staining demonstrated increased expression of proliferation markers and decreased expression of terminal differentiation markers in ANL. Representative samples are based on genomic and histologic profiling of both ANL and AL (n=12, each) compared with normal skin (n=10). Scale bar=100µm.
Suárez-Fariñas M. Nonlesional atopic dermatitis skin is characterized by broad terminal differentiation defects and variable immune abnormalities. J Allergy Clin Immunol. 2011;127(4):954-964.
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Current findings show that nonlesional skin exhibits subclinical defects similar to lesional skin, including1,3,4:
In some patients, skin barrier dysfunction, resulting from either genetic defects and/or Th2 immunologic defects, ultimately5,6:
Nonlesional skin in patients with atopic dermatitis is not histologically normal and is indicative of the subclinical inflammation inherent to atopic dermatitis.3,4
Underlying inflammation is a source of lesions and itch, the primary signs and symptoms of atopic dermatitis.2-4 Atopic dermatitis is a chronic inflammatory skin disease that is characterized by intense pruritus and eczematous lesions.7 Key Type 2 cytokines, IL-4 and IL-13, are drivers involved with the underlying inflammatory process.2,8,9