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Atopic Eczema Between Rationality and Irrationality

Atopic Eczema Between Rationality and Irrationality 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.Atopic eczema is one of the most common chronic inflammatory skin diseases, and its incidence is increasing—doubling in each of the past few decades. In Great Britain and Scandinavian countries, point prevalence was determined to be between 9.7% and 23%.There are several risk factors associated with atopic eczema. Socioeconomic factors are of importance. The disease is more frequent in urban areas compared with rural areas, and in cities, a higher prevalence is observed among higher socioeconomic classes. Atopic eczema presents features of a "civilization disease," with the highest prevalence in highly industrialized countries. Indoor climates in highly insulated buildings support the growth of dust mites and molds, and high concentrations of noxae are common. There are also the decrease in infections and improved living conditions in highly industrialized countries. Other possible contributory factors include changes in nutrition and a decrease in infant breast-feeding. Furthermore, the prognosis ofinfantile atopic eczema is worse than previously assumed, with a persistence rate of 40% to 60% after puberty.Another important risk factor is respiratory allergy; 40% to 60% of all persons with atopic eczema have respiratory allergies.The following review presents pathophysiological concepts of atopic eczema that are based on the interaction between genetic predisposition and environmental influences, and that provide a scientific foundation for a concept-oriented, rational treatment of the disease. Rational treatment of disease is based on a pathophysiological concept and/or is of proven scientific efficacy.Treatment of atopic eczema is a matter of intensive controversy between rational academic medicine and irrational, alternative complementary medicine more than any other skin disease. Some proponents of complementary medicine and their followers deliberately disregard the fact that excellent results can be obtained today with the methods of academic medicine, using an integrated, holistic therapeutic approach. Moreover, drugs and therapeutic modalities in academic medicine are almost without exception of natural origin (Table 1). Thus, conventional medicine implements principles of natural medicine without the need of an ideological or pseudophilosophical justification. The only purely "chemical" synthetic drugs used in the treatment of atopic eczema are the antihistamines; however, they are one of the best-tolerated classes of drugs in dermatology and medicine.Table 1. Natural Remedies and Therapeutic Modalities Used in Allopathic DermatologySee table graphicPatients with atopic eczema, and their parents, often seek complementary treatments from obscure healers and physicians, many of whom use unproven and unvalidated diagnostic and therapeutic procedures. Unfortunately, this withholds from patients (frequently children) the excellent treatment options available in conventional medicine and results in unnecessary long-term suffering. While some alternative healers often follow simplistic and irrational treatment concepts, I present an integrated therapeutic concept implementing holistic principles as it is used with some variations in most leading departments of dermatology in the Western world. The excellent treatment results routinely obtained with this rational approach make these alternative therapies appear redundant and harmful because they withhold effective treatment modalities.PATHO http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Dermatology American Medical Association

Atopic Eczema Between Rationality and Irrationality

JAMA Dermatology , Volume 134 (11) – Nov 1, 1998

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Publisher
American Medical Association
Copyright
Copyright 1998 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.
ISSN
2168-6068
eISSN
2168-6084
DOI
10.1001/archderm.134.11.1462
Publisher site
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Abstract

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.Atopic eczema is one of the most common chronic inflammatory skin diseases, and its incidence is increasing—doubling in each of the past few decades. In Great Britain and Scandinavian countries, point prevalence was determined to be between 9.7% and 23%.There are several risk factors associated with atopic eczema. Socioeconomic factors are of importance. The disease is more frequent in urban areas compared with rural areas, and in cities, a higher prevalence is observed among higher socioeconomic classes. Atopic eczema presents features of a "civilization disease," with the highest prevalence in highly industrialized countries. Indoor climates in highly insulated buildings support the growth of dust mites and molds, and high concentrations of noxae are common. There are also the decrease in infections and improved living conditions in highly industrialized countries. Other possible contributory factors include changes in nutrition and a decrease in infant breast-feeding. Furthermore, the prognosis ofinfantile atopic eczema is worse than previously assumed, with a persistence rate of 40% to 60% after puberty.Another important risk factor is respiratory allergy; 40% to 60% of all persons with atopic eczema have respiratory allergies.The following review presents pathophysiological concepts of atopic eczema that are based on the interaction between genetic predisposition and environmental influences, and that provide a scientific foundation for a concept-oriented, rational treatment of the disease. Rational treatment of disease is based on a pathophysiological concept and/or is of proven scientific efficacy.Treatment of atopic eczema is a matter of intensive controversy between rational academic medicine and irrational, alternative complementary medicine more than any other skin disease. Some proponents of complementary medicine and their followers deliberately disregard the fact that excellent results can be obtained today with the methods of academic medicine, using an integrated, holistic therapeutic approach. Moreover, drugs and therapeutic modalities in academic medicine are almost without exception of natural origin (Table 1). Thus, conventional medicine implements principles of natural medicine without the need of an ideological or pseudophilosophical justification. The only purely "chemical" synthetic drugs used in the treatment of atopic eczema are the antihistamines; however, they are one of the best-tolerated classes of drugs in dermatology and medicine.Table 1. Natural Remedies and Therapeutic Modalities Used in Allopathic DermatologySee table graphicPatients with atopic eczema, and their parents, often seek complementary treatments from obscure healers and physicians, many of whom use unproven and unvalidated diagnostic and therapeutic procedures. Unfortunately, this withholds from patients (frequently children) the excellent treatment options available in conventional medicine and results in unnecessary long-term suffering. While some alternative healers often follow simplistic and irrational treatment concepts, I present an integrated therapeutic concept implementing holistic principles as it is used with some variations in most leading departments of dermatology in the Western world. The excellent treatment results routinely obtained with this rational approach make these alternative therapies appear redundant and harmful because they withhold effective treatment modalities.PATHO

Journal

JAMA DermatologyAmerican Medical Association

Published: Nov 1, 1998

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