The historical basis of a misconception leading to undertreating atopic dermatitis (eczema):facts and controversies

Farhi, David; Taïeb, Alain; Tilles, Gérard; Wallach, Daniel

doi:10.1016/j.clindermatol.2009.03.009

« Previous Next »Clinics in Dermatology
Volume 28, Issue 1 , Pages 45-51, January 2010

The historical basis of a misconception leading to undertreating atopic dermatitis (eczema):facts and controversies

David Farhi, MD
- Service de Dermatologie, Pavillon Tarnier, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université René Descartes - Paris V, 27 rue du faubourg Saint Jacques, 75014 Paris, France
- Corresponding author. Department of Dermatology and Venereology, Pavillon Tarnier, CHU Cochin, 89 rue d'Assas, 75006 Paris, France; Tel.: +33 1 58 41 18 34; fax: +33 1 58 41 17 65.
Alain Taïeb, MD
- Service de Dermatologie et Dermatologie Pédiatrique, Centre de Référence pour les Maladies Rares de la Peau, CHU Saint André, 1 rue Jean Burguet, 33000 Bordeaux, France
Gérard Tilles, MD
- Musée de l'hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
Daniel Wallach, MD
- Service de Dermatologie, Pavillon Tarnier, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université René Descartes - Paris V, 27 rue du faubourg Saint Jacques, 75014 Paris, France

Abstract

The quest for clarifying the pathophysiology of atopic dermatitis (eczema) has lasted for 25 centuries. Yearning to discern the primum movens of atopic dermatitis, physicians aimed to identify the curative therapy. Recent scientific efforts has brought to the light an ever-growing amount of interplaying pathophysiologic factors, including the epidermal barrier, the digestive flora, food, early infections and antigenic stimulations, and innate and adaptive immune response; however, overfocusing on some of these factors, along with misconceptions about the benefit/risk balance of topical therapies, has sometimes led topical therapies being disregarded. Reviewing the history of pathophysiologic concepts, we aim to return topical therapies to the center of the clinical management of atopic dermatitis.