Several other lines of evidence support the outside-in view of atopic dermatitis as resulting from a primary defect in the skin barrier. For example, disease severity correlates with transepidermal water loss levels and reduced skin hydration in atopic dermatitis - even in uninvolved skin - evidence that the defective regulation of water loss is not merely a consequence of inflammation.

Patients with Atopic Dermatitis have Impaired Barrier Function
Transepidermal water loss (A) increase not only in lesional, but also in non-lesional skin of patients with atopic dermatitis compared to the skin of normal controls, and hydration (B) is reduced.1
1. Aberg KM, et al. J Invest Dermatol 2008;128;917-925. 2. Jensen JM, et al. J Invest Dermatol 2004;122:1423-1431. 3. Chamlin SL, et al. J Am Acad Dermatol 2002;47:198-208