Lipid Nutrition and the Epidermal Barrier: The Connection Between Immune-Mediated Inflammatory Diseases and Peroxisome Proliferator-Activated Receptors, a New Therapeutic Target in Psoriasis and Atopic Dermatitis

The authors describe peroxisome proliferator-activated receptor (PPAR) transcription factors as connectors between the enzymatic mechanisms of the epidermal barrier and the abnormal immune and inflammatory responses that characterize atopic dermatitis and psoriasis. Also described is a new connection between lipid metabolism and the epidermal barrier. A suggestion that emerges is that atopic dermatitis and psoriasis share at least 2 pathogenic mechanisms-namely, deficient expression of PPAR-α and impaired production of interleukin-10 and interferon-γ-in spite of differences in causes and manifestations. A standardized olive oil formulation with powerful bactericidal and fungicidal effects also has the ability to increase serum levels of these 2 cytokines and regulate serum levels of high-density lipoprotein cholesterol in patients at high risk for inflammatory and cardiovascular disease, suggesting that these may be among the mechanisms responsible for the benefits observed following oral and/or topical administration in patients with atopic dermatitis or psoriasis.

ResumenLos autores describen los factores peroxisome proliferator-activated receptors (PPAR) como conectores entre los mecanismos enzimáticos de la barrera epidérmica (BE) y las alteraciones inmuno/inflamatorias que caracterizan a dermatitis atópica (DA) y psoriasis. Igualmente, se describe una nueva conexión entre el metabolismo lipídico y la BE. El análisis de estos hechos permite sugerir que DA y psoriasis, aunque diferentes en su causalidad y clínica, exhiben al menos dos hechos patogénicos comunes, que se manifiestan por defectos en la expresión de PPAR-α y en la producción de IL-10 e IFN-γ. La capacidad de una formulación magistral de aceites de oliva (FMAO) para aumentar los niveles séricos de ambas citocinas, y regular el colesterol HDL sérico, en pacientes con alto riesgo inflamatorio/cardiovascular, junto a sus potentes efectos bactericidas y fungicidas, sugiere que estos sean algunos de los mecanismos responsables de los positivos efectos observados con la FMAO (oral y/o tópica) en pacientes con DA y psoriasis.