Disfunção da Barreira Epidérmica na Dermatite Atópica
Resumo
A disrupção da barreira cutânea é um dos achados característicos da dermatite atópica (DA), que inclui alterações no envelope cornificado, lamela lipídica, tight-junctions e microbioma cutâneo. Estas alterações estão também presentes na pele não lesada de doentes com DA, o que sugere que os defeitos da barreira epidérmica possam ser a etapa inicial no desenvolvimento da DA e, eventualmente, de outras doenças atópicas (marcha atópica). A evidência atual indica que a fisiopatologia da DA envolve uma interação entre esta barreira cutânea disfuncional e uma resposta imunitária inata e adaptativa predominantemente do tipo 2, que contribuem para a disrupção da barreira epidérmica através da ação de citocinas do tipo 2. Neste contexto, as anomalias da barreira permitem uma maior penetração dos alergénios ambientais e alimentares, que aumentam a suscetibilidade à sua sensibilização. Durante o processo de sensibilização, a linfopoietina do estroma tímico (TSLP) polariza as células dendríticas da pele para uma resposta T-helper 2, desempenhando também um papel chave na sensibilização da alergia alimentar, asma e rinite alérgicas. Nesta revisão, os autores descrevem o conhecimento atual da fisiopatologia da barreira epidérmica, a sua alteração na DA e influência no desenvolvimento de comorbilidades atópicas e o papel da terapêutica de reparação da barreira na prevenção da progressão da marcha atópica.
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