Jacob Sharon E, Goldenberg Alina, Nedorost Susan, Thyssen Jacob P, Fonacier Luz, Spiewak Radoslaw
From *Loma Linda University; †University of California, San Diego, School of Medicine; ‡CWRU School of Medicine, University Hospitals Case Medical Center, Cleveland, OH; §National Allergy Research Centre, Department of Dermato-Allergology, Copenhagen University Hospital, Gentofte, Denmark; ∥SUNY, Stony Brook; and ¶Allergy and Training Program, Winthrop-University Hospital, Mineola, NY; #Department of Experimental Dermatology and Cosmetology, Jagiellonian University, Krakow, Poland.
Dermatitis. 2015 May-Jun;26(3):109-15. doi: 10.1097/DER.0000000000000102.
Flexural eczema and atopic dermatitis are frequently synonymized. As respiratory atopy is rarely tested for and found in these patients, systematically equating a flexural distribution of dermatitis with atopic dermatitis may too frequently result in misclassified diagnoses and potentially missed opportunity for intervention toward improving patients' symptoms and quality of life. We present a critical review of the available evidence for the atopic dermatitis diagnosis and discuss the similarities between atopic dermatitis and allergic contact dermatitis. Because neither flexural predilection nor atopy is specific for atopic dermatitis, we conclude that the term atopic dermatitis is a misnomer and propose an etymologic reclassification of atopic dermatitis to "atopy-related" dermatitis. Allergic contact dermatitis can induce an atopic dermatitis-like phenotype, and thus, flexural dermatitis cannot be assumed as atopic without further testing. Patch testing should at least be considered in cases of chronic or recurrent eczema regardless of the working diagnosis.
屈侧湿疹和特应性皮炎常被视为同义词。由于这些患者很少接受呼吸道特应性检测且检测结果呈阳性，因此将屈侧分布的皮炎系统性地等同于特应性皮炎，可能会频繁导致诊断错误，并可能错失改善患者症状和生活质量的干预机会。我们对特应性皮炎诊断的现有证据进行了批判性综述，并讨论了特应性皮炎与过敏性接触性皮炎之间的相似之处。由于屈侧偏好和特应性都不是特应性皮炎的特异性表现，我们得出结论，“特应性皮炎”这一术语用词不当，并提议将特应性皮炎进行词源学重新分类为“与特应性相关的”皮炎。过敏性接触性皮炎可诱发特应性皮炎样表型，因此，未经进一步检测，不能将屈侧皮炎假定为特应性皮炎。无论初步诊断如何，对于慢性或复发性湿疹病例，至少应考虑进行斑贴试验。
