Talk:Atopic dermatitis

message: I read this page out of interest after a patient decided they were an expert on Eczema after reading this Wikipedia article. I found a lot of factual errors in the article no doubt contributing to the widespread misconceptions about the causes of eczema.
* Food & allergy is considered to play a minor role in eczema. If it was as simple as a dairy (or other food) allergy and excluding it from the diet, eczema would disappear overnight and I would be out of a job.
* Allergy testing is not routinely recommended in clinical practice for a number of reasons. These include the fact that allergy plays a minor role, allergy tests (eg RAST and skin prick testing) are unreliable with low sensitivity and specificity. If a patient is allergic to a food they should be able tell you so from their experiences without the need for useless testing.
* There is (almost) a complete lack of discussion about the role of bacterial colonisation with Staphylococcus aureus.
* Climate
* I could go on and on.
Perhaps the editors for this page should have a thorough read of: http://dermnetnz.org/dermatitis/atopic-causes.html (and associated pages) which presents a more accurate view of the causes of eczema. It is written and edited by expert dermatologists.  —Preceding unsigned comment added by 121.98.223.127 (talk) 11:42, 20 January 2011 (UTC)
replies: text: Given that this Wikipedia article currently lacks any credible source as to the cause of atopic dermatitis, following this guy's advice is without a doubt the best idea. How this was not done 2 years ago is beyond me. Triougd (talk) 19:12, 14 May 2013 (UTC)
thread_title:  Rewrite of Causes Section Required 

message: Removing the nonsense about psyche and emotions barring a scholarly cite beyond Sontag, who was talking about popular culture reacting to disease, and not disease reacting to popular culture.
I don't know what you removed, but stress, including by extension emotionally induced stress, plays a major role in aggravating, and even causing (according to some) atopic dermatitis. Ken K. Smith (a.k.a. Thin Smek) (talk) 16:33, 19 December 2018 (UTC)
thread_title: Removing

message: "neurodermatitis" should definitely be subsumed by "atopic dermatitis". AFAIK the latter (or equivalently, "atopic eczema") is now the preferred term.
:You are absolutely right! The leading German Handbook of dermatology Fritsch P, Dermatologie und Venerologie, Springer, Berlin; 2nd edition (September 2003), ISBN: 3540003320 names the disease "Atopische Dermatitis" (German), in English this is "atopic dermatitis", and names one synonym "Neurodermitis" (German), in English this is "Neurodermatitis". -- Kind Regards, -- Paunaro 20:07, 26 September 2006 (UTC)
thread_title:  Please merge with "neurodermatitis" 

message: 1. regarding the merge with atopy: not a good idea, IMO, since atopic eczema is not the same thing as atopy, and the main eczema entry needs to be able to point to entries on each type.
2. regarding the merge with neurodermatitis: I argue against. There is some confusion on this issue, since in central Europe atopic eczema seems to be referred to -- some of the time -- as disseminated neurodermatitis. In the English speaking countries (and others?), however, neurodermatitis (or localized neurodermatitis) refers to lichen simplex chronicus and prurigo nodularis, eczemas either self-inflicted or of unknown etiology, but quite distinct from atopic dermatitis.
I think the entry on neurodermatitis should be returned to the original lichen simplex chronicus that has been overwritten with atopic stuff.
V.B. 05:06, 9 October 2006 (UTC)
replies: text: oh yeah, and do not merge with neurodermatitis either, as per VB atopic dermatitis and neurodermatitis are distinct (at least in the UK) --Coroebus 20:19, 15 November 2006 (UTC)
replies: text: Totally agree. Atopy is an immunologic state; atopic dermatitis is a form of eczema. Do not merge.
*Do not merge with atopy. Atopy is the systemic over-production of IgE whereas atopic dermatitis is specifically a disease of the skin. Other diseases that have a component of atopy/allergy (asthma/rhinitis/hayfever etc.) should also be dealt with separately. Atopic diseases manifest at specific anatomical sites, atopy is instead systemic and arguably not a disease in its own right.Yendor 18:39, 21 December 2006 (UTC)
thread_title:  do not merge 

message: If you look up this entry on German Wiki, you will find that the neurodermitis term is the old one that is being superceded. However, it seems in common usage still. 170.215.67.24 05:26, 9 October 2006 (UTC)
thread_title:  atopisches ekzem 

message: I created a disambiguation page in reference to neurodermatitis, directing folks to either lichen/prurigo, or to atopic eczema. 170.215.67.24 22:53, 14 October 2006 (UTC)
thread_title:  disambiguation 

message: "Although many people are intimidated by the term 'steroids,' their proper use can result in atopic dermatitis being brought under control."
This statement is not NPOV, and tends towards the irresponsible.  Yes, strong steroids will superficially "cure" most skin problems.  But there are also serious risks of systemic side-effects.  It is important to use these drugs with care, and only use the minimum necessary, for a minimum time, to get the needed results.
* Citation needed ;). Yes there is a theoretical risk of systemic side-effects to topical steroids, however I would not call it a serious risk as it is exceedingly rare (Rook's Textbook of Dermatology, 8th Edition, 2010. Chapter 73, Section 4).
* Also steroids do not cure most skin problems. There are over 3000 skin conditions. It is inconceivable that topical steroids would even have an effect on more than 50% let alone "cure" them. For the conditions that do respond to topical steroids, most are simply managed or controlled rather than cured with topical steroids.
* For the above reasons I suspect that it is you that is not being neutral and risks irresponsibility.
* Also the focus should not be about trying to be neutral but rather being evidenced based.
* Most dermatologists will probably agree that a major problem in clinical practice is that patients have an irrational fear of topical steroids and fail to use enough of them. This is perpetuated by idiots running around virtually telling people they will die from their topical steroids. This leads to poor control and earlier introduction of systemic immunosuppressants such as methotrexate, azathioprine and ciclosporin. I'm sure you can figure out which has a more serious risk of systemic side-effects. (PS. no I don't have a citation for this as it should be self explanatory).  —Preceding unsigned comment added by 121.98.223.127 (talk) 12:09, 20 January 2011 (UTC)
thread_title:  not NPOV 

message: NEJM review http://content.nejm.org/cgi/content/short/358/14/1483 JFW | T@lk 14:43, 6 April 2008 (UTC)
thread_title:  Review 

message: The umbrella term for inflammatory skin reactions is dermatitis, subdivisions are for example contact dermatitis and eczema. Eczema is further subdivided into atopic eczema and non-atopic eczema (depending on IgE levels)
Historically eczema, neurodermitis (neurodermatitis in Engl.) and atopic eczema were used as synonyms. Therefore the article on neurodermatitis should be deleted. A few lines in the atopic eczema article should suffice.
Johansson SG. Revised, global nomenclature for allergy. Unambiguous terms create clarity and prevent misunderstandings. Lakartidningen.2006;103:379-83. (in Swedish)
Haddendaddendoedenda (talk) 20:25, 15 February 2009 (UTC)
thread_title:  Revised, global nomenclature for allergy

message: There is a journal article linked from the Wiki page on Dental amalgam controversy which concerns "The Beneficial Effect of Amalgam Replacement on Health in Patients with Autoimmunity".  Article here.  Atopic eczema is discussed as one of the disorders that can be affected (albeit, it is the one with the "lowest rate" of improvement).  Asat (talk) 20:57, 16 November 2009 (UTC)
thread_title:  Amalgam fillings 

message: We have this paper but it is not a review  Doc James (talk · contribs · email) 05:17, 9 August 2011 (UTC)
thread_title: Steroid addition

message: Bad reference:
16: "^ a b c . pp. 52–56. doi:10.2340/00015555-0565." ? The doi link goes to a DOI Not Found page.
Not-referenced:
The first paragraph of Prevention -> Diet is not cited: "Originally controversial, the association of food allergy with atopic dermatitis has now been clearly demonstrated. Many common food allergens can trigger an allergic reaction: such as milk, nuts, cheese, tomatoes, wheat, yeast, soy, and corn. Many of these allergens are common ingredients in grocery store products (especially corn syrup, which is a sugar substitute). Specialty health food stores often carry products that do not contain common allergens."
I would like to see citations for each of those food items listed relative to atopic dermatitis. Thanks anyone working on this.  — Preceding unsigned comment added by 75.97.112.151 (talk) 14:10, 26 August 2011 (UTC)
thread_title:  Prevention -> Diet --- not referenced / bad reference 

message: "To combat the severe dryness associated with atopic dermatitis, a high-quality, dermatologist-approved moisturizer should be used daily."
I'm not sure what the source for this sentence is. I used to use high-quality, dermatologist-approved moisturizer. After a while I decided it was pretty expensive and tried a form of petroleum jelly (similar ingredients) from sort-of the Dutch equivalent of the dollar store (actually just a store with cheap goods, not everything the same price). Anyway, this stuff is about 10 times as cheap and comparable to the "high-quality, dermatologist-approved moisturizer", at least for me. So I'd like to know the source for this sentence.W3ird N3rd (talk) 04:11, 2 May 2012 (UTC)
replies: text: I agree its lacking a source. Would suggest that it gets edited to "To combat the severe dryness associated with atopic dermatitis,  moisturizer should be used daily." Unifoe (talk) 01:19, 28 October 2012 (UTC)
thread_title:  High-quality, dermatologist-approved moisturizer. 

message: Dairy/milk does contain more than just lectins. I think it is a mistake to reduce dairy/milk to lectins, there are other substances in milk (e.g. proteins like lactose, casein, albumin, immunogloblin) that can cause problems. There should be IMHO a dairy section. Tony Mach (talk) 05:08, 13 May 2013 (UTC)
replies: text: The dairy section is going to need some better sources if it's going to stay up. It currently states that "atopic dermatitis is caused by an allergic reaction to the consumption of cow milk products ("dairy") and eggs." The source on the other hand only claims that "These findings suggest that children with more severe eczema are less likely than those with mild eczema to outgrow their milk or egg allergy." Which is completely different. Triougd (talk) 20:44, 13 May 2013 (UTC)
thread_title:  Dairy 

message: Currently the lack of vitamins is not described as a possible reason for atopic dermatitis, although there is indication that it plays a role:
*Vitamin Ehttp://onlinelibrary.wiley.com/doi/10.1046/j.1365-4362.2002.01423.x/abstract
*Vitamin DSamochocki Z, Bogaczewicz J, Jeziorkowska R, Sysa-Jędrzejowska A, Glińska O, Karczmarewicz E, McCauliffe DP, Woźniacka A., http://www.ncbi.nlm.nih.gov/pubmed/23643343 , Vitamin D effects in atopic dermatitisBorzutzky A, Camargo CA Jr., http://www.ncbi.nlm.nih.gov/pubmed/23971753 , Role of vitamin D in the pathogenesis and treatment of atopic dermatitisDaniel A Searing, Donald YM Leung, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2914320/ , Vitamin D in Atopic Dermatitis, Asthma and Allergic DiseasesBacharier LB., http://www.ncbi.nlm.nih.gov/pubmed/24001801 , Vitamin D status at birth: An important and potentially modifiable determinant of atopic disease in childhood?D.G. Peroni, G.L. Piacentini, E. Cametti, I. Chinellato, A.L. Boner, http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2133.2010.10147.x/full , Correlation between serum 25-hydroxyvitamin D levels and severity of atopic dermatitis in children  — Preceding unsigned comment added by 92.192.92.7 (talk) 08:19, 1 December 2013 (UTC)
replies: text: For vitamin D there are plenty of books reffering to it: https://www.google.com/search?q=vitamin+d+atopic+dermatitis&btnG=Search+Books&tbm=bks&tbo=1 --92.192.92.7 (talk) 10:13, 1 December 2013 (UTC)
replies: text: Per WP:MEDRS we use more or less only secondary sources. This secondary source states there is no clear association between vitamin D and atopic dermatitis. Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:46, 1 December 2013 (UTC)
thread_title:  Lack of Vitamins 

message: I looked into this page because I had a sudden attack of this condition several days ago. My arm looked exactly like this picture. The rash appeared in half a minute (!) However, I am 35 and never had food allergies. This attack was seemingly caused by an antibiotic which was prescribed to me (I never took it before). My mother gave me hydrocortysone which worked immediately. But my arm was badly scarred after it, and by now there are still slight traces of scars.
The article speaks of the condition as of chronic, but my case was apparently acute. And it says nothing of reaction to antibiotics.
93.80.113.253 (talk) 14:52, 7 February 2015 (UTC)
replies: text: Probably because you did not have this. Doc James (talk · contribs · email) 15:40, 7 February 2015 (UTC)
thread_title: At a Loss

message: "Things that commonly make it worse include wool clothing, soaps" - does this refer to Soap or Detergent? Most things labelled 'soap' in a supermarket are not traditional soap but contain detergents such as Sodium laureth sulfate, which is indeed a known irritant (as mentioned on its page). --Melarish (talk) 17:37, 8 November 2015 (UTC)
thread_title:  Soap 

message: doi:10.1016/S0140-6736(15)00149-X JFW | T@lk 13:12, 11 March 2016 (UTC)
thread_title:  Lancet seminar 

message: The following content are from evidence based management practice, unfortunately everything isn't referenced. Those who understand wikipedia rules do help to salvage the following. Thank you.
=== Life style ===
The advantage of the emollients is that it creates an artificial skin barrier to the impaired stratum corneum and retains hydration of the epidermis; when the water component evaporates, it cools the skin, this tends to decrease the blood supply to the skin and to lessen the release of inflammatory mediators, thus relieves the itch. The main function of emollients is possible prevention of aggravating factors of eczema.
=== Probiotics ===
especially microbes that have been associated with the following: Th1 type immunity, generation of TGF-, which suppresses Th2 responses, and induction of oral tolerance and IgA production, an essential component of mucosal immune defence.
In a study of mothers who have had at least one first-degree relative (or partner) with atopic disease (eczema, rhinitis, or asthma), the mother was given lactobacillus GG prenatally and their infants were given it postnatally for 6 months. At the age of 2 years in those receiving lactobacillus GG, the incidence of atopic eczema was 23% vs. 46% in controls, a highly significant result. It has recently been shown that this benefit is maintained at 4 years followup.Kalliomaki M, Salminen S, Arvilommi H, et al. Probiotics in primary prevention of atopic disease: a random placebo controlled trial. Lancet 2001; 357:1076–9Kalliomaki M, Salminen S, Poussa T, et al. Probiotics and prevention of atopic disease: 4-year follow-up of a randomised placebo controlled trial. Lancet 2003; 361:1869–71
===Medication===
Corticosteroids have a strong anti-inflammatory action and this is the reason why they are so effective in eczema. The cellular effects are due to the binding of the glucocorticosteroids (GCS) to the cytosolic GCS receptor in nucleated cells. Since most cells have these receptors, the effects of the GCS are multiple. Once the steroids have bound to the receptor, there is conformational change in the GCS receptor complex; which moves to the nucleus. The GCS complex now binds to segments of DNA cell glucocorticoid-responsive elements. As a result, certain parts of the genome are affected, leading to increased or decreased transcription, with resulting increased or decreased cytokine production. GCS will also bind to NF-kB, which has been shown to be a regulator for many cytokines and cell adhesion molecules. Binding of GCS to NF-kB will switch off cytokine production, particularly of those cytokines concerned with T-cell-mediated inflammation. The loss of existing collagen and inhibition of new collagen formation and making the skin thinner is the main side-effect of topical steroids.
ciclosporin (risk factors includes nephrotoxic & carcinogenic), methotrexate, interferon gamma-1b, mycophenolate mofetil (risk factors include bone marrow suppression and the risks of malignancy)
Topical or systemic triazole antifungal preparations are also used appropriate for combating Pityrosporum orbiculare.
::Please read WP:MEDRS. References are needed. Also the detail mechanism of action of CS belongs on that article. Best Doc James (talk · contribs · email) 21:32, 12 August 2016 (UTC)
thread_title:  Additions 

message: Corticosteroids have a strong anti-inflammatory action and this is the reason why they are so effective in eczema. The cellular effects are due to the binding of the glucocorticosteroids (GCS) to the cytosolic GCS receptor in nucleated cells. Since most cells have these receptors, the effects of the GCS are multiple. Once the steroids have bound to the receptor, there is conformational change in the GCS receptor complex; which moves to the nucleus. The GCS complex now binds to segments of DNA cell glucocorticoid-responsive elements. As a result, certain parts of the genome are affected, leading to increased or decreased transcription, with resulting increased or decreased cytokine production. GCS will also bind to NF-kB, which has been shown to be a regulator for many cytokines and cell adhesion molecules. Binding of GCS to NF-kB will switch off cytokine production, particularly of those cytokines concerned with T-cell-mediated inflammation. The loss of existing collagen and inhibition of new collagen formation and making the skin thinner is the main side-effect of topical steroids.
ciclosporin (risk factors includes nephrotoxic & carcinogenic), methotrexate, interferon gamma-1b, mycophenolate mofetil (risk factors include bone marrow suppression and the risks of malignancy)
Topical or systemic triazole antifungal preparations are also used appropriate for combating Pityrosporum orbiculare.
::Please read WP:MEDRS. References are needed. Also the detail mechanism of action of CS belongs on that article. Best Doc James (talk · contribs · email) 21:32, 12 August 2016 (UTC)
thread_title: Medication

message: I noticed much better pictures on google images search for this Topic (actually, for Atopic Eczema itself). Photos showing dime- to quarter-sized red disks with several small whitish or yellowish bumps in the middle. Someone I know has a small outbreak, hence my interest. How does a main, single photo usually get swapped out on wikipedia? Ok to link to or display in an article 2 or more photos in wikimedia? Thank you all for your time. Vid2vid (talk) 07:37, 24 November 2018 (UTC)
thread_title:  Photograph for this topic very sub-par, not very indicative - could we change it?? 

message: Will atopic dermatitis stay on your forever? 2405:ACC0:1102:B33A:3D00:B98E:7B49:554B (talk) 10:33, 3 March 2023 (UTC)
thread_title:  Atopic dermatitis