Pathogenesis of atopic dermatitis (AD).

Skin barrier dysfunction and Th2/Th22-deviated immune reactions are the fundamental abnormality in
AD. Genetic mutations in filaggrin (FLG) cause barrier disruption and dehydration, which make the
external allergens permeable. The barrier-disrupted epidermis abundantly releases thymic stromal
lymphopoietin (TSLP), which triggers the Th2/Th22 immune response. The Th2/Th22 deviation is
further accelerated during disease progression, for example, from acute to chronic or childhood to adult
AD. In addition, Th1 but not Th17 cells tend to participate in the chronic phase of AD. Th2 cytokines
(IL-4 and IL-13) stimulate B cells to produce IgE antibodies to allergens. Some IgEs react to self-
antigens. IgE autoreactivity also contributes to disease activity. In addition, IL-4, IL-13 and IL-22 are
strong suppressors of FLG expression. Pruritus is evoked by TSLP and Th2-derived IL-31

Sel Th2 akan memproduksi IL-4, IL- 5, dan IL-3, yang meningkatkan regulasi IgE, sedangkan sel Th1
terutama akan memproduksi IFN-γ dan IL-12 yang akan menekan produksi IgE serta meningkatkan
regulasi antibodi IgG
 1. How probiotics could help in the treatment and prevention of AD?

They modify the overall composition of the intestinal microbiota or modulate immune responses in
the host. Suppress the TH2 response, leading to improvements in the balance between TH1and TH2.
meningkatkan produksi IFN-γ dan menurunkan kadar IgE serta menurunkan sekresi TNF alpha (TNF-
α), IL-5, dan IL-10.
2. Probiotic dose recommendation to treat AD
3. What are the differences between probiotic, prebiotic, and symbiotic?

4. Food that contain prebiotic?

Banana,berries, apples onion, garlic, oatmeal, honey, asparagus, tomatos, whole grains, chia
seed, potatoes, cassava

5. Role of vit D in DA

VD appears to be essential for normal epidermal dif ferentiation and skin barrier permeability,
increase in expression of skin barrier genes including filaggrin.
VD decreases B cell proliferation, plasma cell differentiation and immunoglobulin production
The immature and tolerogenic VD-treated DCs produce cytokines with suppressor activity
including IL-10 and TGF-β and effectively induce Tregs

6. Vit D reduce bacterial skin infection

Vit D increase expression of cathelicidin and beta defensin 2 an antimicrobial peptide.

This journal mention, supplementary w/ 1000 IU/day of vD for 3 weeks reduce bacterial skin
infection.