Fig. 2. The factors involved in acidic pH maintenance and their role in normal epidermis, and the consequences of altered pH in patients with AD. (A) Exogenous.

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Fig. 2. The factors involved in acidic pH maintenance and their role in normal epidermis, and the consequences of altered pH in patients with AD. (A) Exogenous free fatty acids are derived from sweat glands or catalyzed from sebaceous gland-derived triglycerol moieties via microorganism-secreted lipases. Endogenous free fatty acids are derived from phospholipids by phospholipase A2 (PLA2), both of which are secreted by lamellar bodies (LBs) at the SC-stratum granulosum junction. Additionally, the Na+/H+ antiporter is involved in maintaining the skin acid mantle. Therefore, the skin acid mantle regulates SC integrity and cohesion, antimicrobial function, processing of LB polar lipids, structural organization of lamellar membrane, and β-glucocerebrosidase/sphingomyelinase function. (B) AD or other stressors alter the function of the skin acid mantle. The altered acid mantle increases serine protease activity and decreases the function of corneodesmosomes, resulting in decreased production of ceramides and LB secretion, altered SC cohesion and inflammation activation. Fig. 2. The factors involved in acidic pH maintenance and their role in normal epidermis, and the consequences of altered pH in patients with AD. (A) Exogenous free fatty acids are derived from sweat glands or catalyzed from sebaceous gland-derived triglycerol moieties via microorganism-secreted lipases. Endogenous free fatty acids are derived from phospholipids . . . Allergy Asthma Immunol Res. 2014 Jul;6(4):276-287. http://dx.doi.org/10.4168/aair.2014.6.4.276