Centre of Evidence Based Dermatology, Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK.
Clin Exp Dermatol. 2022 Oct;47(10):1805-1811. doi: 10.1111/ced.15279. Epub 2022 Jul 12.
Little attention is paid to disease definition in dermatology and how such definitions come about, yet defining a disease is a fundamental step upon which all subsequent clinical management and prognostic judgements depend. Developing diagnostic criteria is also a critically important step for research purposes so that studies referring to groups of people can be compared in a meaningful way. This short review introduces the concepts of regressive and progressive nosology, and how definitions of a dermatological disease can evolve in a useful way as knowledge about that disease increases. It also highlights the dangers of panchrestons - names that try to explain all yet end up explaining very little. It also considers approaches to disease definition, such as whether a binary yes/no or continuous approach is more appropriate. Conceptual frameworks including essentialistic vs. nominalistic approaches using the biomedical or biopsychosocial perspectives are articulated. The review then illustrates hazards of underdiagnosis and overdiagnosis, and introduces the notion of 'disease mongering' - the selling of disease in order to promote the use of medicines. The review concludes with a reaffirmation of the importance of defining dermatological disease, and why any new diagnostic criteria must be shown to increase predictive ability before they are assimilated into clinical practice and research.
皮肤科对疾病定义的关注较少，也鲜少有人关注这些定义是如何产生的，但定义一种疾病是所有后续临床管理和预后判断的基础步骤。为了研究目的，制定诊断标准也是至关重要的一步，这样才能以有意义的方式比较涉及人群的研究。这篇简短的综述介绍了退行性和进行性分类学的概念，以及随着对某种疾病认识的增加，皮肤科疾病的定义如何以一种有用的方式演变。它还强调了泛概念（panchrestons）的危险——这些名称试图解释一切，但最终解释得很少。它还考虑了疾病定义的方法，例如是采用二进制的是/否方法还是连续方法更为合适。使用生物医学或身心观点的本质主义与唯名主义方法等概念框架都被阐明。然后，该综述说明了漏诊和过度诊断的危害，并引入了“疾病营销”的概念——为了促进药物的使用而推销疾病。最后，该综述重申了定义皮肤科疾病的重要性，以及任何新的诊断标准在被纳入临床实践和研究之前，必须证明其具有提高预测能力的作用。
