Cellular Aspects of Cutaneous Inflammation: Clinical and in vitro studies of allergie contact dermatitis and allergie drug eruptions

This thesis is about the application of immunological insights and techniques to improve diagnosis, treatment and follow-up of inflammatory skin diseases, like allergic contact dermatitis (ACD) and allergic drug eruptions (ADE). The cells and mediators involved in cutaneous inflammation, allergic skin reactions in particular, will be discussed below. In chapter 1.2 and 1.3, clinical, epidemiological and immunological aspects of ACD and ADE, respectively, will be discussed. Finally, the various immunological techniques used in this thesis will be summarized in chap· ter 1.4. Healthy, uninflamed skin, with the horny layer as the first barrier, protects the body from loss of cells, fluids and electrolytes and from penetration of harmful substances like chemicals and infectious agents. In inflammatory skin conditions, such as psoriasis, contact allergy and wound healing, this barrier is disrupted or indi· rectly disturbed by an inflammatory infiltrate in the epidermis. Usually, inflammati on is an effective response. It is the basic reaction of living tissue to several types of injuries leading to its complete or incomplete healing. The classical signs of inflammation, irrespective of the tissue(s) involved, are rubor, calor, dolor, tumor and functio laesa, Le. redness, heat, pain, swelling and disturbed function, respectively. However, inflammatory skin disease may become 50 severe and widespread that it intervenes with physiological functions of the skin, like protection against external agents, prevention of water and heat loss, and, in a broader sense, psychosocial functions of the affected individu al. In inflammatory skin diseases, allergic skin reactions included, various resident, recruited and/or recirculating ce lis and their mediators participate. Together they constitute the Skin Immune System (SIS) [1, 2J. The SIS includes cells of the epidermis, the dermis, the blood vessels, the Iymphatics, and their mediators. The cutaneous nervous system interacts with several of these components of the SIS. The various constituents mentioned will now be looked at more closely in the following sections.

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