Filaggrin mutations associated with skin and allergic diseases.
Irvine AD, McLean WHI, Leung DYM. Filaggrin mutations associated with skin and allergic diseases. N Engl J Med 2011;365(14):1315-27.
Study type: Review (NEJM) · Added to this library August 23, 2026
What the researchers did
The definitive review of filaggrin's role in eczema and the "atopic march."
What they found
The broken barrier comes first; allergens and microbes enter through it; the immune system's allergic skew follows.
Why it matters
Barrier before inflammation is the causal order — which is why nourishing and rebuilding (not just suppressing) is treatment of the root, 治本.
Relates to the patterns: Blood Deficiency / Wind-Dryness · Fetal Toxin
This summary is educational and does not replace care from your child's pediatrician. Evidence tiers matter: a finding in cells or animals is a reason a treatment could work, not proof that it does.
More in AD biology
Progressive activation of TH2/TH22 cytokines and selective epidermal proteins characterizes acute and chronic atopic dermatitis.
Gittler JK, Shemer A, Suárez-Fariñas M, et al. Progressive activation of TH2/TH22 cytokines and selective epidermal proteins characterizes acute and chronic atopic dermatitis. J Allergy Clin Immunol 2012;130(6):1344-54.
Study type: Human skin-biopsy transcriptomics
What: Sequenced acute vs chronic eczema lesions to see how the disease changes over time.
Found: Acute lesions are Th2/Th22-driven; chronic lesions add Th1 activation and epidermal thickening — the disease shifts state as it ages.
Why it matters: This measured trajectory is the classical pattern sequence — the weeping acute (Damp-Heat) lesion maturing into the dry, thickened chronic (Blood-Deficiency/Wind-Dryness) one. Two vocabularies, one timeline.
Early-onset pediatric atopic dermatitis is TH2 but also TH17 polarized in skin.
Esaki H, Brunner PM, Renert-Yuval Y, et al. Early-onset pediatric atopic dermatitis is TH2 but also TH17 polarized in skin. J Allergy Clin Immunol 2016;138(6):1639-1651.
Study type: Human skin-biopsy study (infants/children vs adults)
What: How baby eczema differs immunologically from adult eczema.
Found: Pediatric eczema shows Th2 plus Th17 activation with barrier/lipid defects dominant — a different disease profile from chronic adult eczema.
Why it matters: Pediatric TCM has always treated infant eczema as its own pattern class (Spleen-centred, supply-side); the transcriptome agrees that babies are not small adults.
The Asian atopic dermatitis phenotype combines features of atopic dermatitis and psoriasis with increased TH17 polarization.
Noda S, Suárez-Fariñas M, Ungar B, et al. The Asian atopic dermatitis phenotype combines features of atopic dermatitis and psoriasis with increased TH17 polarization. J Allergy Clin Immunol 2015;136(5):1254-64.
Study type: Human comparative biopsy study
What: Compared eczema biology across Asian and European-American patients.
Found: Asian eczema is more IL-17-driven and "psoriasiform" — thicker, scalier, sharper-bordered — despite similar Th2 levels.
Why it matters: Eczema differs by population as well as by person. It also explains why an IL-17-suppressing ointment (indigo) earns its keep on the sharply bordered plaque.
Intrinsic atopic dermatitis shows similar TH2 and higher TH17 immune activation compared with extrinsic atopic dermatitis.
Suárez-Fariñas M, Dhingra N, Gittler J, et al. Intrinsic atopic dermatitis shows similar TH2 and higher TH17 immune activation compared with extrinsic atopic dermatitis. J Allergy Clin Immunol 2013;132(2):361-70.
Study type: Human biopsy study
What: The ~20% of eczema patients with normal IgE ("intrinsic" eczema), profiled.
Found: Same Th2 activation but higher Th17/Th22 — a distinct endotype hiding under one diagnosis.
Why it matters: More evidence that "eczema" is several diseases — which is precisely what pattern differentiation has always claimed.