ReviewTopical therapy of atopic dermatitis: Controversies from Hippocrates to topical immunomodulators
Section snippets
Humoralism and diathesis: the conceptual basis for non-topical therapy
AD is a great model to illustrate the conceptual representations linking skin disorders and internal medicine. In particular, the visible oozing of eczema and alternating phases of AD and wheezing gave credit to the role assigned to cutaneous symptoms by the Hippocratic school. For the physicians favoring such a conception, eczema has been considered as a “noli me tangere” (don't touch me) and the nontopical treatment of AD is more beneficial than the topical therapy. Those physicians who
“Saignée séreuse” and rapid death: puzzling paradoxes of the hazards of active treatment
Until recently, the beneficial importance of oozing was regarded as evidence of the role played by the skin in the clearance of the vicious humors. Oozing had to be preserved or restored, even to be worsened or replaced by alternative ways of elimination of toxic humors. In the case of exceedingly rapid drying of the oozing, many authors recommended its replacement with bloodlettings (Alibert,7 Cazenave,9 Devergie,29 and Gibert33), leeches (Rayer regarded leeches as the only method that could
The influence of the Vienna school on topical therapy of chronic eczemas
In the 19th century, German dermatology has epitomized the opposite side of the controversy. According to Hebra, “hypothesising that cutaneous diseases and particularly those with oozing phenomena had to be considered as salutary, physicians exhorted their patients to endure eczema.”48 Hebra promoted the therapeutic value of bathing and showering, emollients, tar, and sulfur. A few years later, his successor in Vienna, Kaposi, also a strong advocate of the autonomy of skin disorders, was
Bathing and showering: hygienic measures still controversial
The use of water and its value in topical treatment of children with AD have been frequently debated. Strongly influenced by medical doctrines, some authors considered water as a curative agent, while some others denied its therapeutic value, regarding it as an irritating factor. Early in the 19th century, Alibert, as a proponent of the humoralist concepts, recommended that the eczema be allowed to ooze and promoted baths and showers as the most powerful methods for the treatment of cutaneous
From topical corticosteroid phobia to TIM phobia: a survival of Hippocratic medicine?
In 1952, Sulzberger and Witten70 published a preliminary report: “very short, consisting on but 34 lines, one table, a bibliography citing one pertinent paper and the formula for a simple prescription.” They actually promoted the use of a new topical drug in dermatology,5 17 hydroxycortisone–21 acetate (named compound F) 2.5% in a mixture of lanolin-petrolatum in treating 19 patients, aged 2 to 56, 8 of them having AD. Improvement was judged after 1 week based on clinical criteria, namely
Conclusions
The paradox of the still active reminiscence of unconscious humoralism in the approach to treatment of AD, which considers the skin at best as the target of some internal immune diathesis, or merely as a safety valve that is dangerous to close, is the mounting consensus of the central role of skin itself in the pathophysiology of the disease.74 The link of AD and asthma to a genetically proven barrier defect in the stratum corneum,75 which was hypothesised earlier, reinforces the importance of
References (76)
- et al.
The first images of atopic dermatitis: an attempt at retrospective diagnosis in dermatology
J Am Acad Dermatol
(2005) - et al.
The effect of topically applied compound F in selected dermatoses
J Invest Dermatol
(1952) - et al.
The use of corticosteroids and corticosteroid phobia in atopic dermatitis
Clin Dermatol
(2003) - et al.
The use of topical calcineurin inhibitors in dermatology: safety concerns. Report of the American Academy of Dermatology Association Task Force
J Am Acad Dermatol
(2006) - Smith WD, editor and trans. Hippocrates (vol 7). Cambridge, MA: Harvard University Press; 1994. p....
Diathèse in dictionnaire des sciences médicales
(1814)- et al.
Year book of dermatology and syphilology
(1933) - et al.
Topical corticosteroid phobia in patients with atopic eczema
Br J Dermatol
(2000) - et al.
Histoire de la dermatite atopique
(2004) Précis théorique et pratique des maladies de la peau
(1818)
Traité théorique et pratique des maladies de la peau, T I
Abrégé pratique des maladies de la peau, 4ème ed
Pathogénie et métastases de l'eczéma particulièrement chez les enfants in Congrès international de dermatologie et de syphiligraphie tenu à Paris en 1889, comptes-rendus publiés par le Docteur Henri Feulard
Leçons sur les maladies de la peau
Première note et observations préliminaires pour servir d'introduction à l'étude des prurigos diathésiques (dermatites multiformes prurigineuses chroniques exacerbantes et paroxystiques du type du prurigo de Hebra)
Ann Dermatol Syphil
Thérapeutique générale
Traité élémentaire de dermatologie pratique
Précis de dermatologie
Lectures on ekzema and ekzematous affections
A practical treatise on diseases of the skin
Traitement de l'eczéma et du psoriasis
On diseases of the skin, a system of cutaneous medicine (6th ed)
Leçons sur les maladies dartreuses
Leçons sur les affections cutanées de nature arthritique et dartreuses
Leçons sur les maladies chroniques en général et sur les affections de la peau en particulier
Diet and hygiene in diseases of the skin
L'eczéma des nourrissons
La Clinique
Les eczémas du nourrisson, leur rapports avec les vices de l'alimentation et les troubles digestifs
Hydrochloric acid milk treatment of eczema in children
München Med Wchscfrt
Traité pratique des maladies de la peau
Traité théorique et pratique des maladies de la peau
Leçons théoriques et cliniques sur les affections génériques de la peau
Sur l'eczéma des nourrissons
Gaz Hôp
Traité pratique des maladies de la peau et de la syphilis
Accidents cérébraux consécutifs à la disparition d'un eczéma chronique
J Mal Cut
A practical treatise upon eczema (3 ed)
De l'emploi de la toile de caoutchouc vulcanisée dans les maladies dartreuses
Gaz Hop Paris
Cited by (20)
Historic Perspective
2022, Atopic Dermatitis: Inside Out or Outside InDermatologic Conditions of Eminent Historical Figures
2021, Actas Dermo-SifiliograficasThe historical basis of a misconception leading to undertreating atopic dermatitis (eczema):facts and controversies
2010, Clinics in DermatologyCitation Excerpt :For instance, the oozing that features skin disorders now called eczemas was thus considered as a beneficial phenomenon: not a primarily cutaneous disease, but rather the mode of healing of an internal disease. According to the Hippocratic doctrine, the least thing to do was to hamper a skin exudation.1 Unfortunately, this approach had a long life, and still in the 19th century, several authors, especially in France, contributed to passing on the Hippocratic torch.5-7
The spongiotic reaction pattern
2009, Weedon's Skin Pathology: Third EditionWhat caused the Athenian itch in Hippocrates' On Epidemics?
2007, Journal of the American Academy of DermatologyAre atopic egg-sensitive infants able to eat eggs? from Woringer to Mathelier-Fusade [4]
2007, Annales de Dermatologie et de Venereologie
Funding sources: None.
Conflicts of interest: None identified.