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Review
. 2025 Jan 5;103(1):65-72.
doi: 10.62438/tunismed.v103i1.5220.

The primary mechanisms underlying atopic dermatitis

Sara Missaoui  1 , Asmaa Gaadi  1 , Khaoula Oussama  1 , Zahra Adam  1 , Ahmed Aziz Bousfiha  1 , Fouzia Hali  2
Affiliations
Review

The primary mechanisms underlying atopic dermatitis

Sara Missaoui et al. Tunis Med. .

Abstract

Introduction: Atopic dermatitis (AD) is a complex skin disease frequently linked with other atopic symptoms such allergic rhinitis and asthma. The disease's history consists of persistent relapses with extreme pruritus, which lowers quality of life. AD has become a global health concern as its incidence has increased over the last few decades. It ranks as the third most common dermatologic disorder.

Aim: There are several open questions about the mechanisms underlying atopic dermatitis (AD), This review aims to emphasize the recent advances in scientific research regarding the pathophysiologic mechanism of AD and the clinical application of these factors.

Methods: A PubMed search was performed using the keywords "Atopic Dermatitis (AD)", "epidemiology", "clinical presentation", "diagnosis", "pathophysiology", "genetic defect", "impaired skin barrier", "immune dysregulation". The search strategy included meta-analyses, clinical trial, observational studies, and reviews.

Results: Atopic dermatitis affects over 2 million children worldwide, with a lifetime incidence of up to 20%. New data suggest that its incidence is still growing, particularly in low-income nations. AD is diagnosed clinically using the patient's medical history, particular clinical symptoms, and the elimination of other non-inflammatory skin conditions. The pathogenesis of AD is extremely complicated and involves several etiologies, including genetics, the microbiome, abnormalities in the skin barrier, along with dysfunctional innate and adaptive immune systems.

Conclusion: Recent research has improved our understanding of disease pathophysiology in atopic dermatitis. Current and future clinical trials are expected to continue clarifying this complex and heterogeneous skin disease, and to develop medications that promise more effective therapy, particularly for individuals with limited response to conventional treatments.

Keywords: Atopic Dermatitis (AD); clinical presentation; diagnosis; genetic; pathophysiology; treatment.

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Figures

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Figure 1. Approximate Distribution of Age at Onset for Symptoms of Atopic Dermatitis
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Table 1. Clinical manifestations of AD(20–22).
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Table 2. Diagnostic criteria for AD(21,22).
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Figure 2. Pathogenesis of atopic dermatitis. FLG; filaggrin, Th2 cell; T helper type 2 cell, Th22 cell; T helper type 22 cell, IL; interleukin, TSLP; thymic stromal lymphopoietin, IgE; immunoglobulin-E, H4R; histamine-4 receptor, ILC2; group 2 innate lymphoid cells.
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Table 3. Main groups of genes linked to the development of atopic dermatitis AD(40–45,45–55).
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Table 4. Example of some current therapeutic pipeline for atopic dermatitis.
See this image and copyright information in PMC

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