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Immunology of atopic dermatitis: novel insights into mechanisms and immunomodulatory therapies.

Atopic dermatitis (AD) is a chronic, pruritic, inflammatory skin condition that is associated with immune dysregulation and epidermal barrier dysfunction. The imbalance of the Th2 and Th1 pathways and their associated cytokines in AD presents as one facet of the pathogenic mechanisms. Changes in the T-cell populations and the associated cytokines during the acute and chronic phases of AD can cause variations in disease presentations and treatment responses. Continued discoveries in the immunopathogenesis of AD provide optimism for the development of efficacious therapeutic agents. Novel immunomodulatory therapies include apremilast, dupilumab, IL-37, omalizumab, rituximab, mepolizumab, infliximab, allergen-specific immunotherapy, Mycobacterium vaccae, and leflunomide. These agents serve as examples of how modulation in immunopathogenesis of AD can lead to therapeutic discoveries.