ABSTRACT
Mutations in genes coding for certain proteases and transglutaminases, essential for keratinocyte differentiation and cornified envelope formation, may also lead to skin barrier dysfunction. Some ceramide-dominant mixtures have been shown by transepidermal water loss measurements to repair skin barrier function and improve signs and symptoms of eczema in atopic dermatitis. The genetic makeup of atopic dermatitis thus appears to include a complex mixture of prevalent filaggrin gene mutations plus a large number of low-frequency mutations in genes that influence epidermal differentiation, such as those encoding the cornified envelope proteins loricrin and involucrin. Pharmacotherapeutic agents for atopic dermatitis, such as corticosteroids and calcineurin inhibitors, may be compounded in complex formulations containing urea, salicylic acid, or retinoids intended to enhance delivery. Several creams have been introduced in the USA and other markets as medical devices for the treatment of signs and symptoms of atopic dermatitis.
