Lipids in Normal and Pathological Desquamation

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This chapter presents the evidence that stratum corneum lipids are critical effectors of corneocyte cohesion and desquamation. Lipids in the stratum corneum are in the right place to modulate desquamation; that is, they are localized to the intercellular domain. Because normal desquamation occurs through detachment of single, intact corneocytes, it is reasonable to examine constituents of the cell membrane and intermembrane domain for effectors of this process. Desmosomes are intercellular attachment plaques that appear to function as spot welds in epithelial cell cohesion. A progressive loss of desmosomal structures occurs during stratum corneum transit, such that these structures are fragmentary or absent in the outer layers of normal stratum corneum. Thus, it can be inferred that cohesion of at least these outermost corneocytes normally must be mediated by other factors. A number of hypocholesterolemic agents induce scaling as a prominent side effect. In most instances in which the underlying metabolic defect in genetic disorders of cornification has been defined, inborn errors of lipid metabolism are responsible. Both the drug-induced scaling disorders and the genetic ichthyoses associated with lipid metabolic defects have provided invaluable models for the examination of the role of specific lipids in stratum corneum cohesion/desquamation.

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