Skin barrier function and atopic eczema : review article

The skin provides a semipermeable barrier, an antimicrobial barrier and an immunological barrier. The current view on the pathogenesis of atopic dermatitis (AD) suggests the 'outside-inside-outside' model, which emphasises that barrier disruption due to environmental or genetic insults drives the disease process in AD, thereby stimulating the immune system which then further disrupts the skin barrier. This article summarises the different aspects of normal skin barrier function. It describes how they are affected in AD and the clinical implications for the management of AD.