Why we need a harmonized name for atopic dermatitis/atopic eczema/eczema!
Authors: T. Bieber
Journal: Allergy (2016)

From a historical point of view, over more than a century, the numerous names which have been proposed for atopic dermatitis/atopic eczema/eczema make this condition so unique. This phenomenon most probably just reflects a high degree of lack of consensus among the authors due to the unknown pathophysiological background of this condition (Table 1). In some countries, such as Germany, most physicians dealing with this disease have experienced this kind of discussion many times during their own training time and academic career so that a revival of this discussion may be considered as rather useless. On the other hand, most physicians probably underestimate the important impact at different levels of the different names which have been coined for the most common skin disease. In this issue of the journal, Kantor et al. 1 analyzed the available bibliographic databases with the aim to get some figures about the current situation as reflected in the literature. They came to the not-surprising conclusion that the term ‘atopic dermatitis’ is the most accepted one worldwide and that the time is ripe to establish an international agreement on the nomenclature. Although this discussion and debate may be considered as a never-ending story, there are a number of good reasons to support this proposal. The absence of consensus on the name has a number of important consequences which can be summarized as following: With regard to the above-mentioned consequences of the current situation, there is an urgent need to find one consensual umbrella term for the most common skin disease. Indeed, it carries an important socioeconomic burden 11 and is currently considered as the starting point of the so-called atopic march 12 and the related comorbidities. At a first glance, this quest may seem paradoxical in a time when we more and more realize that the complexity of the natural history 13 and the clinical phenotype of the disease probably reflect a certain degree of heterogeneity in the pathophysiological mechanisms underlying the disease. Indeed, this would rather imply to abandon a uniform terminology and to seek for a splitting approach. However, the progress of our understanding of the genetic background and the immunological pathways leading to the disease will ultimately provide us with a number of diagnostic, prognostic, and predictive biomarkers for the stratification of this complex phenotype in the era of precision medicine 14, 15. Thus, the biomarker-based stratification will lead to a new kind of molecular taxonomy for which we need an umbrella term such as ‘atopic dermatitis’ 16. Once this discussion has been closed and the international agreement has been reached, the next exercise will be to harmonize the diagnostic criteria for atopic dermatitis on a worldwide level, since besides using the same name, using the same diagnostic criteria will have similarly important implications with regard to the above-mentioned aspects of the disease. This work was supported by the Christine Kühne-Center for Allergy Research and Education (CK-CARE). The author declares that have no conflicts of interest.