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. 2022 Jan 15;9(1):112. doi: 10.3390/children9010112

Figure 1.

Figure 1

A model of contact irritant diaper dermatitis. The first step involves the penetration of irritants through the skin which stimulates keratinocytes (KC) to release proinflammatory mediators interleukin 1 alpha (IL-1α) and tumor necrosis factor alpha (TNF-α). The entry of irritants and microorganisms is facilitated by damage of stratum corneum (SC) integrity by fecal enzyme degradation, overhydration and disruption of the lipid bilayer structure. The initial release of IL-1α and TNF-α promotes further production of cytokines and chemokines IL-1β, granulocyte macrophage-colony stimulating factor (GM-CSF), IL-6, IL-8, vascular endothelial growth factor (VEGF), migration of Langerhans cells (LC) to the dermis, production of collagenases (col.) and prostaglandin E (PGE) by fibroblasts (FB), vasodilatation of the blood vessels, upregulation of adhesion molecules on endothelial cells and the transmigration of inflammatory cells (TL—T lymphocyte, EOS—eosinophil, NEU—neutrophil, MAC—macrophage) to the epidermis. The net effect is inflammation and erythema of the skin. Probiotics present a protective shield against irritants, maintain a lower pH, secrete beneficial metabolites and block pathogen invasion.