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