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August 2001

Does the Tail Wag the Dog?Role of the Barrier in the Pathogenesis of Inflammatory Dermatoses and Therapeutic Implications

Arch Dermatol. 2001;137(8):1079-1081. doi:10-1001/pubs.Arch Dermatol.-ISSN-0003-987x-137-8-ded10001

WE HAVE BEEN in the era of immunology in skin disease. Since the classic experiment of Schellander and Marks1 describing epidermal hyperplasia following dermal implantations of carrageenan, the epidermal changes that accompany inflammatory dermatoses have been considered downstream participants in disease pathogenesis (inside-outside concept). Accordingly, the current paradigm calls for either nonspecific treatment of inflammation or therapy aimed at specific T-cell components.2 Since the epidermal changes are considered mere downstream participants, therapies aimed at normalizing epidermal function are considered secondary and inconsequential. Despite the acknowledged importance of xerosis and epidermal injury in these diseases, recent consensus reports barely mention the use of emollients in the therapy of atopic dermatitis and psoriasis.3-5