Ziyi Wang, Dajin Shang, Chuanying Zhao, Tiancong Song, Congcong He
The understanding of atopic dermatitis (AD) pathogenesis is evolving beyond the barrier-immune dichotomy, with neuropsychological factors gaining prominence as a central component. This review systematically decodes the multi-level crosslink within the "brain-skin axis" in AD, encompassing recent advances in peripheral sensory neuron sensitization, central neural remodeling, and neuro-immune interactions. We elaborate on the roles of neuropeptides, cytokines, the autonomic nervous system, and the hypothalamic-pituitary-adrenal axis in the itch-scratch cycle, inflammation amplification, and mood disorders. Furthermore, we examine the influence of novel therapeutic strategies, including biologics, Janus kinase inhibitors, psychological approaches, and microbiome modulation, on these neuropsychological components. Finally, we outline future research directions, such as elucidating the molecular mechanisms of neuro-immune crosstalk, identifying relevant biomarkers, and establishing interdisciplinary diagnostic and treatment models. A deeper understanding of the role of neuropsychological factors in AD not only drives innovation in treatment strategies but also offers new perspectives for breaking the vicious cycle of "pruritus-inflammation-psychological distress."