“…Dysfunction of the stratum corneum seems to be associated with the increased permeability and penetration of environmental irritants and allergens in clinically normal AD skin (Cooper, 1994;Deleuran et al, 1998;Fitzharris and Riley, 1999;Gloor et al, 1981;Ogawa and Yoshiike, 1993;Rothe and Grant-Kels, 1996;Tan et al, 1996;Tanaka et al, 1994;Tupker et al, 1990), which predisposes it to inflammation (Broberg et al, 1992;Lammintausta et al, 1993). The impaired barrier function of the stratum corneum in AD has been found to result from the decreased production of ceramides (Imokawa et al, 1991(Imokawa et al, , 1994, which are generated from sphingomyelin by sphingomyelinase Higuchi et al, 2000;Murata et al, 1996;Wood et al, 1996). However, the activity of sphingomyelin deacylase, which hydrolyzes sphingomyelin at the acyl site to yield sphingosylphosphorylcholine, is abnormally high in clinically normal and lesional skin in AD , resulting in the ceramide deficiency (Imokawa et al, 1991).…”