Suggestions regarding a more appropriate understanding of atopic dermatitis.

Department of Dermatology, Columbia University, New York, New York, USA. AlDerm31@earthlink.net

PURPOSE OF REVIEW: The importance of consistency and accuracy of medical terminology must be recognized by all health care providers and researchers. Yet, recent publications by recognized authorities regarding atopic dermatitis seem to defy that basic tenet. I (an allergist/dermatologist) have (objectively) reviewed and (subjectively) interpreted the currently (peer reviewed) published designations etymologically, and some of their concepts scientifically. RECENT FINDINGS: Interdisciplinary, regional and international meetings have been discussing, assessing, and deliberating the newest data and observations, consistently realizing little consensus. The concluding trivial agreement denotes their individual bias. Given the same information, allergists, dermatologists, and generalists do not conceptualize, and yet dogmatically manage patients with atopic dermatitis. SUMMARY: Etymologically, and scientifically, atopic dermatitis can only be distinctively designated as the dermatologic syndrome, which heralds the atopic diathesis. Concomitantly, atopic dermatitis without atopy would be an oxymoron. Definitions based on anachronistic criteria demand updating. IgE, like eosinophilia, must be appreciated as epiphenomena of the transient Th1/Th2 cell reversal, which clearly differentiates 'atopic eczema' from all the 'other' eczemas. Failure to recognize the isomorphic feature of the eczema of atopic dermatitis denies patients with an essential therapeutic modality, namely 'Do not scratch, nor rub'. Education regarding the 'triggers' of itch would yield greater success (from recurrences), than prescribing immunomodulation.

PMID: 16131916 [PubMed - indexed for MEDLINE]