Neuroinmunodermatología: Una Nueva Frontera entre la Piel, el Sistema Nerviosoy el Sistema Inmune
Resumen
Introducción : La neuroinmunodermatología representa un campo emergente que explora la interacción bidireccional entre el sistema nervioso, el sistema inmunitario y la piel. Este eje neuroinmunocutáneo (NIC) constituye una red funcional que integra mecanismos neuroendocrinos, inmunomoduladores y sensoriales. Su desregulación contribuye al desarrollo y perpetuación de enfermedades inflamatorias y autoinmunes de la piel, caracterizadas por inflamación crónica, prurito y alteraciones emocionales. Objetivo: Describir los mecanismos fisiopatológicos, las implicaciones clínicas y las estrategias terapéuticas emergentes derivadas del estudio del eje neuroinmunocutáneo, así como sus proyecciones hacia la medicina de precisión y la integración neuropsicoinmunológica. Metodología: Se realizó una revisión narrativa sistematizada de la literatura publicada entre 2010 y 2025 en PubMed, Scopus, Web of Science y Embase. Se seleccionaron estudios clínicos, experimentales y revisiones sistemáticas que abordaran interacciones neuroinmunológicas en la piel, incluyendo mediadores moleculares (neuropeptidos, citoquinas, hormonas), enfermedades representativas (dermatitis atópica, psoriasis, vitiligo, prurito neuropático) y terapéuticas innovadoras (biológicos, neuromodulación, intervenciones psicológicas y tecnologías digitales). La calidad metodológica se evaluó mediante las guías PRISMA 2020 y SANRA. Resultados: La evidencia demuestra que la activación cruzada entre fibras nerviosas sensoriales, mastocitos, queratinocitos y células dendríticas genera una cascada inflamatoria mediada por sustancia P, CGRP, IL-31, TSLP y CRH. Este circuito neuroinmunológico explica la coexistencia de síntomas cutáneos, prurito y estrés. Los avances recientes incluyen terapias dirigidas anti-IL-31RA, anti-CGRP y anti-IL-4Rα, así como estrategias de neuromodulación (estimulación vagal, TENS, mindfulness) y desarrollos biotecnológicos (organoides de piel innervada e inteligencia artificial aplicada a dermatología). Conclusión: La neuroinmunodermatología redefine la piel como un órgano neuroendocrino e inmunológicamente activo. Este paradigma integrador abre una nueva era en la medicina personalizada, en la que los circuitos neuroinmunes se convierten en dianas diagnósticas y terapéuticas para mejorar la calidad de vida y modular la homeostasis mente-piel-sistema inmune.
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Yang J, et al. Artificial intelligence for dermatologic precision medicine. Nat Med. 2023;29(2):230–43.
Mittelstadt BD. Ethics of biomedical AI: balancing innovation and privacy. Nat Med. 2024;30(2):174–80.
Kabashima K, et al. The future of neuroimmunodermatology: integrative approaches in translational research. J Invest Dermatol. 2024;144(7):1225–39.
Pavlov VA, Tracey KJ. The vagus nerve and the inflammatory reflex. Nat Rev Endocrinol. 2012;8(12):743–54.
Bonaz B, Sinniger V, Pellissier S. Vagus nerve stimulation: a new promising therapeutic tool in inflammatory diseases. J Physiol. 2016;594(20):5781–90.
Slominski AT, et al. Cutaneous neuroendocrine systems and skin homeostasis. Trends Endocrinol Metab. 2021;32(5):337–50.
Arck PC, Slominski A, Theoharides TC, Peters EM, Paus R. Neuroimmunology of stress: skin takes center stage. Physiol Rev. 2006;86(4):1309–79.
Chiu IM, von Hehn CA, Woolf CJ. Neurogenic inflammation and the peripheral nervous system in host defense and immunopathology. Nat Neurosci. 2012;15(8):1063–73.
Dainichi T, Hanakawa S, Kabashima K. The molecular basis of neuroimmune interactions in the skin. Trends Immunol. 2018;39(11):1007–19.
Theoharides TC, Alysandratos KD, Angelidou A, et al. Mast cells and inflammation. Biochim Biophys Acta. 2012;1822(1):21–33.
Tóth BI, Oláh A, Szöllősi AG, Bíró T. TRP channels in the skin. Br J Pharmacol. 2014;171(10):2568–81.
Ikoma A, Steinhoff M, Ständer S, Yosipovitch G, Schmelz M. The neurobiology of itch. Nat Rev Neurosci. 2006;7(7):535–47.
Cevikbas F, Lerner EA. Physiological and pathological functions of itch signaling molecules. Semin Immunopathol. 2019;41(3):293–310.
Peters EMJ, Liezmann C, Spatz K, et al. Neuroimmunology of the skin: basic concepts and clinical implications. Exp Dermatol. 2020;29(3):241–53.
Pavlov VA, Tracey KJ. Neural regulation of immunity: molecular mechanisms and clinical translation. Nat Neurosci. 2017;20(2):156–66.
Assas BM, Pennock JI, Miyan JA. Calcitonin gene-related peptide is a key neuroimmune modulator in health and disease. Front Endocrinol (Lausanne). 2014;5:23.
Misery L, et al. Neuropathic pruritus: diagnostic and therapeutic aspects. Dermatol Clin. 2018;36(2):213–8.
Riol-Blanco L, Ordovas-Montanes J, Perro M, et al. Nociceptive sensory neurons drive interleukin-23-mediated psoriasiform skin inflammation. Nature. 2014;510(7503):157–61.
Napadow V, et al. Brain mechanisms of chronic itch and pain: implications for clinical practice. J Allergy Clin Immunol. 2022;149(6):1894–906.
Fortune DG, et al. Mindfulness-based interventions in dermatology: effects on inflammation and quality of life. Br J Dermatol. 2020;182(5):1140–8.
Steinhoff M, Bíró T. Neuroimmunology of the skin. Handb Clin Neurol. 2020;167:365–81.
Tominaga M, Takamori K. Peripheral itch sensitization and chronic itch in atopic dermatitis. Allergol Int. 2022;71(3):282–91.
Lee J, Böscke R, Björklund ÅK, et al. Generation of innervated human skin organoids from pluripotent stem cells. Nature. 2020;584(7822):399–405.
Kim J, et al. Smart skin interfaces for real-time neurocutaneous monitoring. Nat Biomed Eng. 2024;8(1):31–45.
Yang J, et al. Artificial intelligence for dermatologic precision medicine. Nat Med. 2023;29(2):230–43.
Mittelstadt BD. Ethics of biomedical AI: balancing innovation and privacy. Nat Med. 2024;30(2):174–80.
Kabashima K, et al. The future of neuroimmunodermatology: integrative approaches in translational research. J Invest Dermatol. 2024;144(7):1225–39
Derechos de autor 2025 María Camila Serrano Redondo , Maylin María Duarte López , María Camila Hernández Cañas , Ibeily Juliana Arévalo Torrado, Ricardo José Picón Quintero , Leidy Paola Torres Chaparro , Heidi Estefanía Vásquez Guerrero , Andrea Marcela Daza Arrieta , Victoria Isabel Daza Salcedo , Brian Emilio Giraldo Sangregorio , María Alejandra Vivas Prada
Esta obra está bajo licencia internacional Creative Commons Reconocimiento 4.0.
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