종설 : 아토피피부염에서 보습제 사용

Atopic dermatitis(AD), one of the most common chronic inflammatory skin disease, is characterized by dry and itchy skin. Environmental influence on the disease process is complex, and the role of the stratum corneum(SC) as a biosensor, regulating the metabolic response to a variety of exogenous insults, appears to be essential. The water content of the SC is decreased in patients with AD. Dysfunction in the permeability barrier of the stratum corneum, as measured by the transepidermal water loss (TEWL), is considered to be one of the most important etiologic factors in AD, as an impaired barrier function allows the penetration of irritants and allergens which trigger the development of dermatitis. These impaired functions of atopic skin are probably related to abnormalities in lipid components of the SC. Clinically, some moisturizers improve the skin barrier function of atopic dry skin. Moisturizers are the obvious treatment for dry skin, and if used properly are useful treatment adjuncts in inflammatory dermatoses including AD. Not only the active ingredients, but also the excipients in moisturizers, which are incorporated mainly to improve stability and viscosity, affect the structure and function of the skin. Moisturizers usually contain humectants to enhance the water-binding capacity of the SC. Moisturizers have multifunctional effects. Desired properties include reduction of clinical signs of dryness, like scaling and roughness, and decrease in perceived feelings of tightness and itching. Moisturizers are considered very safe, especially when compared to some drugs eg, topical corticosteroids. However, adverse skin reactions from topical moisturizer preparations are not uncommon. The most common adverse reactions are sensory or subjective sensations immediately after application of a topical product. Systemic side effects of moisturizers are extremely rare. Ingredients reported to be capable of inducing systemic toxicity are salicylic acid and propylene glycol. The SC should be protected against deleterious substances and strengthened by the use of moisturizers in patients with atopic dermatitis. Ingredients such as emulsifiers, pH, chelating agents, antioxidants, and preservatives may need to be addressed in future studies on patients with atopic dermatitis.