Eczema and dermatitis

Johannes Ring, Ulf Darsow, Thilo Jacob, Heidrun Behrendt

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background: Eczema and/or dermatitis are noncontagious inflammatory skin diseases. The most common forms of dermatitis are contact dermatitis, which can be either allergic or irritative-toxic in origin, and atopic eczema (atopic dermatitis). There is a controversy as to what role allergic reactions (namely IgE-mediated reactions) play in atopic eczema (AE). Methods/Data base: In a review of the literature as well as a summary of our own studies in epidemiology and clinical research, the current state of the art is reflected. Results: AE is a highly prevalent disease; there is a strong genetic predisposition with a maternal preponderance. Among environmental factors, exposure to allergens and pollutants as well as socioeconomic status have been found to be significant risk factors for the development of AE. Using the atopy patch test (APT) it has been proven that IgE-inducing aeroallergens can elicit eczematous skin lesions, however, not all cases of AE are associated with IgE sensitization. On the basis of the new and commonly accepted definition of "atopy" as a familiar tendency to develop IgE antibodies to environmental allergens (connected with typical symptoms of asthma, rhinoconjunctivitis, and eczematous skin lesions) it was necessary to find a new nomenclature for AE, since the "intrinsic" variant can no longer be called "atopic." The major differences between allergic contact dermatitis (ACD) and AE are the genetic predisposition and connection to respiratory diseases as well as the early onset in life for AE. Th2 reactions and IgE antibodies against protein allergens play a role in the initiation of AE, while in ACD, low molecular weight haptens and Th1 reactions trigger the skin lesions. Conclusions: On the basis of pathophysiological findings and the definition of atopy, the new terminology regarding allergic skin diseases is discussed, where the term "dermatitis" replaces what was previously called either "eczema" or "dermatitis". There is no change regarding contact dermatitis and other forms of dermatitis (nummular dermatitis, seborrheic dermatitis). However, the term "atopic eczema" is replaced by "eczema", while "atopic" is reserved for the IgE-associated ("extrinsic") form of eczema. The non-IgE-associated ("intrinsic") variants will be called nonatopic eczema. It remains to be seen whether this terminology will be accepted in the medical world. The underlying differences, however, are not a mere terminological problem but have very practical implications regarding prevention and therapy.

Original languageEnglish
Pages (from-to)19-25
Number of pages7
JournalAllergy and Clinical Immunology International
Volume17
Issue number1
DOIs
StatePublished - Jan 2005

Keywords

  • Atopy
  • Contact dermatitis
  • Dermatitis
  • Eczema
  • Terminology

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