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Atopic Eczema Between Rationality and Irrationality

Thomas Ruzicka, MD
Arch Dermatol. 1998;134(11):1462-1469. doi:10.1001/archderm.134.11.1462.
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Atopic eczema is one of the most common chronic inflammatory skin diseases. Its treatment is a matter of intensive controversy between rational academic medicine and irrational alternative complementary medicine more than any other skin disease. Rational therapy is based on a sound pathophysiological foundation. The complex pathophysiology of the disease includes interactions between genetic predisposition and exogenous provocation factors, and treatment necessitates an integrated holistic approach. Despite excellent therapeutic results with the methods of conventional medicine, which uses mostly drugs of natural origin such as glucocorticosteroids, patients with atopic eczema and their parents frequently seek complementary treatments that use unproven and unvalidated diagnostic and therapeutic procedures. Treatments based on simplistic theories and irrational ideologies cause unnecessary long-term suffering to patients and are harmful because they withhold effective treatment modalities.

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Figure 1.

Atopic disorders. Concept of an extrinsic (exogenous allergic) and intrinsic (endogenous) atopic eczema.

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Figure 2.

Model of integrated therapy for atopic eczema.

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Figure 3.

Severe atopic eczema. Left, Massive inflammation and pruritus treated with diet, compresses with urine, and other alternative approaches. Right, After 3 days of treatment with a glucocorticoid with low atrophogenic potential, complete remission was achieved. No adverse effects occurred during this short-term treatment. Long-term strategy comprises stabilization with UV therapy and allergological and psychosomatic evaluation to identify possible provocation factors.

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