The skin is a sensory organ that comprises a large range of sensory receptors associated with non-neuronal components (
Figure 2), such as Meissner corpuscles, Pacini corpuscles, and Ruffini endings in the dermis or Merkel cell complexes in the epidermis
[69,70][20][21]. Besides, intra-epidermal nerve fibers (IENF), classified as C- and Aδ-fibers, unmyelinated, and thickly myelinated, respectively transduce stimuli via specific receptors, in particular Transient Receptor Potential (TRP) ion channels
[71][22]. Originally described as “touch corpuscles” by Friedrich Merkel in 1875, Merkel complexes are groups of specialized cells in the epidermis of glabrous skin that are innervated by sensory fibers, via synaptic junctions. Merkel cells are anchored within the epidermis by thin cytoplasmic protrusions projecting to keratinocytes and by desmosomes
[70][21]. The IENF are not the exclusive transducers of pain and itch. While TRP is expressed both by sensory neurons and keratinocytes, its specific and selective activation on keratinocytes is sufficient to induce pain
[71][22]. The entire epidermis may be thus considered as a sensory tissue
[72][23]. IENF can communicate with different cell populations in the different layers of the skin by releasing various types of neuropeptides. Almost all cutaneous cells express functional receptors for neuropeptides, through which they receive signals from the nervous system. In turn, skin cells produce neuropeptides and neurotrophins, which stimulate nerve fibers. This exchange creates a positive bidirectional feedback loop. There is increasing evidence that the cutaneous nervous system modulates physiological and pathophysiological effects including cell growth and differentiation, immunity, and inflammation as well as tissue repair. Skin innervation is part of the peripheral nervous system. This cutaneous nervous system is constantly receiving and responding to various types of stimuli which can be either physical (thermal, mechanical, electrical, light), chemical, or produced by allergens, haptens, microbiological agents, trauma, or inflammation. Cutaneous nerves can also respond to stimuli from the blood stream and react to emotions. Moreover, the central nervous system can modulate a large number of functions within the skin including vasomotricity, thermoregulation, piloerection, gland and cell secretion, tissue growth and differentiation, wound healing, immune response, and inflammation
[73,74][24][25]. This happens either directly, via efferent autonomic nerves and brain-derived mediators or indirectly, through the immune cells and adrenal glands relaying central signals.
The epidermis closely interacts with nerve endings and both epidermis and nerves produce substances for mutual sustenance. Several factors including pH gradient, skin barrier integrity, irritant exposure, and the microbiome can modulate these interactions. Complex interplay exists between the immune and sensory nervous systems through the activation of protease-activated receptors (PARs) by endogenous and microbiome-derived proteases and the release of cytokines, neuropeptides, and neurotrophins by both keratinocytes and neurons
[73,76][24][27]. Activation of PARs can be linked to downstream activation of transient receptor potential (TRP) of ion channels, e.g., ENaC that mediate neurogenic inflammation and pain and participates to the production and the secretion of lipids by the epidermis
[77][28]. Furthermore, PAR2 might contribute to epidermal barrier impairment by compromising TJs integrity and claudin-1 expression
[78][29].