Talk:Atopic dermatitis

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Cause[sic] and Cure[sic][edit]

Atopic Eczema DOES have a definite cause (lectin) but also has many mitigating factors which are often misidentified as "causes". Millions of people don't take the precautions bellow yet don't have Eczema - suggesting that eczema is not caused by not following them:

  • Keep your skin well hydrated. If the skin is dry apply cortisone creams or petrolatum emollient. The use of oil baths can also be beneficial.
  • Try to avoid the use of soaps. The soaps irritated and dry the skin. When you´re washing, use only water.
  • Limit the use of soap to the axillaries, genital area, and feet. Soup substitutes can be used-without detergent. If you must wash your hands frequently you clarify thoroughly after washing them and then apply a small amount of hydrocortisone cream.
  • Avoid excessive heat. Most dermatitis patients show that heat and sweat worsen their eczema. You should use fresh clothes and be in air conditioning.
  • Avoid direct contact with wool and heavy clothing.
  • Avoid anything that you think will aggravate eczema, if you notice any kind of perfume, cream, makeup because itching or irritation will not use them.
  • Try to get used to using a routine treatment, applying hydrocortisone creams can be done safely for long time. You should try to apply powerful steroid creams only occasionally.
  • The use of antihistamines with sedative effect and tranquilizer is often useful in the treatment of atopic dermatitis, psychotherapy however not generally useful. Medications that reduce the itching can make it easier for patients to normal life.

Atopic Eczema also has a definite cure. It is one that involves a temporary lifestyle (dietary) change. Just because the cure isn't a cream, a drink or a few pills doesn't mean that it cannot be THE CURE. Logic would define that the cure to a non congenital disease would involve a reversal, removal or some sort of antagonistic action against the Cause.
Laoseb97 (talk) 15:02, 12 May 2013 (UTC)

Lectins are currently listed as the cause for atopic dermatitis and not eating them is listed as the cure, both without any source. I'm guessing you're the one who edited that in. Since you must have found this out somewhere, adding your sources shouldn't be too hard. Triougd (talk) 20:24, 13 May 2013 (UTC)

@ Triougd: "Adding your sources shouldn't be too hard." IMHO it is. This is mainly because I didn't get the information from only one source- making it hard give a better citation. The majoriy of the things that I have edited in, have come from the sources that I have already given and the hyperlinks to other wikipedia pages. My edits to this article are basically the results of weeding through the web and are the bigger picture from all the sources.
Here are some half-misleading (Flawed) external sources I came across along the way that contribute as deductive evidence (with notable qoutes).

  • "4. Eczema can be reversed by changing the diet you are eating." - http://eczema-natural-healing.com/eczema-diet.html
  • "I ask her whether my eczema is curable and she told me “NO”, it’s in my genes. She diagnosed my eczema as skin asthma!!!! I just simply refused to accept that and went on to research on an alternative natural cure. Like you, I believe that my system is full of toxin and I am finding ways and cheaper means (as I am only an employee) to clean my system." - http://eczemacure.info/2008/02/14/michele-ang-cures-herself-of-eczema-which-manifested-on-her-arm-and-leg-2/
  • "...lectins damage the walls of your intestines, helping to create “leaky gut”, so that other large particles can cross the intestinal barrier, enter your blood stream and begin other immune cascades. This is basically how food sensitivities start." -

http://www.paleoplan.com/2011/03-30/why-no-grains-and-legumes/

  • "But no over-the-counter lotion or change to our home took the eczema away." -

http://simplehomemade.net/how-a-simple-diet-change-cured-infant-eczema/

@ Everyone: Please help add better citations for this article Laoseb97 (talk) 17:46, 14 May 2013 (UTC)

Well, most of those sources seem to be anecdotal evidence from practitioners of alternative medicine, and that does not count as reliable sources according to Wikipedia's standards. You are most likely going to have to find a peer-reviewed research article investigating a link between lectins and atopic dermatitis, or at the very least just a mention of the possibility of such a link in medical literature.
I also just read the article suggested by this person (2 years ago! how can no one have read this before?), which among other things claims the following:
"Parents often suspect food allergies in children with atopic dermatitis because they notice the eczema getting worse when new foods are introduced. Whilst it is very common for the eczema to become more difficult to manage when new foods are being introduced it is only very rarely due to a true allergy. As eczema tends to reflect other stresses the body is facing, any new challenge, such as the digestive system getting used to a new food, may cause a temporary increase in eczema symptoms. Just as the gut takes some time to tolerate certain new foods, so does the skin."
So it is very probable that your lectin hypothesis is just a wild goose chase. Triougd (talk) 19:07, 14 May 2013 (UTC)

@ Triougd: Thanks for replying and for your links you recommended to me.
I have a few clarifications and queries to make;

  1. I have now read the article and I have to say, that it's basically the same spiel on the NHS website, which I have read thoroughly. If you look back to the main article (atopic ...), you'll see that I have acknowledged these many "causes" (quote from the article you suggested) as Mitigating factors and, also, briefly explained how they each contribute to the disease.
  2. Actually, I am not saying that the cause is a food allergy, It is NOT IMO. Instead I claim that It it is merely the result of over consumption ("A diet high in Lectins" - my quote) of a potentialy harmful food (all food is in excess). see e.g.Goiter and the seemingly harmless, Broccoli!. That is why say that the cure is temporary exclusive diet change - implying that a patient will be able to resume a more varied/ healthier eating habit/diet.
  3. What do you mean by "peer reviewed"
  4. So it is very probable that your lectin hypothesis is just a wild goose chase - Do you personally think that my hypothesis makes/ lacks ANY sense ? Or are you just trying to make sure this article is well cited. I'd like to know. Just curious as to your motive. I find your statement slightly offensive but i'll laugh it off.

Laoseb97 (talk) 19:17, 15 May 2013 (UTC)

1. Well, the linked article outright states that the cause for atopic dermatitis is currently unknown. It does however explicitly state what makes it better and what makes it worse, according to what medical science has found out. And as long as the cause stays unknown that is just as good as what we're going to get.
2. I know you aren't claiming it's caused by a food allergy, but the argument in that quote still holds. People think it is caused by a food allergy because when they eat certain kinds of food they get worse. You think it is caused by lectins because when they eat certain kinds of food they get worse. That qoute explains both of these situations.
3. Peer review is an important part of any scientific field. See here for what counts as a reliable source according to Wikipedia.
4. Well, I came to this article expecting to find correct (and well-sourced) information on atopic dermatitis. I did not find that. What I instead found was a bunch of unsourced claims and even worse, a bunch of wrongly sourced claims. I consider the last part to be especially damning since I don't like to be lied to when I read an article. The state of this article is so bad that it actually managed to do what thousands of other wikipedia-articles has never been able to do before; making me register an account.
The reason I speculated that the lectin hypothesis is a wild goose chase comes from the fact that I haven't been able to track down any credible source on it at all. I care about finding out exactly which hypothesis is the correct one, not whether or not that one is. Triougd (talk) 20:26, 15 May 2013 (UTC)

Thank you for the links again - I have read them.
I understand the importance of sources in medical articles and I am sorry that my edits were substandard (in terms of what you said). I think you said something about "alternative medicine" - I like the name (joke). Seriously though, In view of all that we have discussed , I am now contemplating making a new page called "Lectin hypothesis" as an alternative medicine stub-thing - I will take what i said on this article, on there and leave it as a hypothesis until somebody finds a black and white, peer reviewed, reliable source that supports it. Then I will collapse the page into "Atopic Dermatitis" . Meanwhile you could then revert (I don't know how to revert) the page, to your favorite archived version. Would you be in favor of that? Also any advice/ cautions would be appreciated.
I haven't been able to track down any credible source on it at all. I care about finding out exactly which hypothesis is the correct one, not whether or not that one is - Thanks for trying anyway.Laoseb97 (talk) 18:59, 16 May 2013 (UTC)

I should make it clear that I'm not blaming your edits for the state of this article. We already know from this talk page that the article has most likely been in a terrible state for at least the last 2 years (and probably longer than that), and I doubt your edits could have made it much worse. I also fully support your edit that deleted the dairy section (which unfortunately was reverted), since it is wrongly sourced as well.
I'm not sure how to "roll back" to an older version either, only how to revert one specific edit at a time. Therefore I suggest just deleting everything we can't find a source for (mainly the lectin and dairy sections, but also some of the other unsourced claims), and replace it with "The cause of atopic dermatitis is currently unknown" using the previously linked article as a source.
As to putting the lectin hypothesis in its own article, you should probably see if you can find a good source explaining what problems they cause in general and then mention eczema as a possible example. I'm guessing it has a high chance of being deleted otherwise. It may also be helpful to read the Wikipedia policy written here if you haven't already done so. Triougd (talk) 22:11, 16 May 2013 (UTC)

Oh, ok.
Ok.
In the light of your advice, I not going to make the new page (I know It is far more advanced than current sources suggest ( It counts as OR). I am better off not writing it on Wikipedia. Ill try and find some where else to post it- I might serve Better as Original research. Thanks.Laoseb97 (talk) 18:38, 17 May 2013 (UTC)

Rewrite of Causes Section Required[edit]

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)

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)

Removing[edit]

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.

Atopic dermatitis is a subtype of eczema[edit]

also, it is NOT the same as a candida infection... if there is a relationship, then the previous author needs to provide a scholarly citation See: http://www.niams.nih.gov/hi/topics/dermatitis/

Please merge with "neurodermatitis"[edit]

"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 [1] 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)

References[edit]

  1. ^ Fritsch P, Dermatologie und Venerologie, Springer, Berlin; 2nd edition (September 2003), ISBN: 3540003320

do not merge[edit]

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)V.B.

do not merge with atopy, they are distinct. --Coroebus 19:21, 30 October 2006 (UTC)

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)
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)
  • I do not think that Atopy should be merged with Atopic Dermatitis for the reasons above. Atopic Dermatitis is a specific form of Atopy, while Atopy is a more general condition including other specific forms, such as allergic conjunctivitis, allergic rhinitis and asthma.

Dont merge with atopy because as already mentioned atopy is a immune state rather than a disease in its self. Also the current trend in research is to actually group it with other inflammatory diseases such as crohns disease and leprosy, this is because of research into the role of barrier function in these diseases. Moreover as already mentioned atopy is defined as over production of IgE, well in 20-30% of cases of AD there is no IgE overproduction.

atopisches ekzem[edit]

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)V.B.

disambiguation[edit]

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)V.B.

not NPOV[edit]

"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)

"Alternative medicines may (illegally) contain very strong steroids"
Sure, they may. But most alternative medicines for eczema probably have no steroids. For example, GLA (gamma-linolenic acid) a fatty acid found in evening primrose oil, black currant oil and borage, is not a steriod. -69.87.204.151 23:48, 2 March 2007 (UTC)

  • No right-minded doctor would, I hope, not advocate anything other than using steroids "with care, and only use the minimum necessary, for a minimum time, to get the needed results", but there again is this not an appropriate approach to take with almost all medicines ? Stating that "their proper use can result in atopic dermatitis being brought under control" does not seem unbalanced - it has qualification of "proper use" and only states "control", not of any permanent cure.
  • As for alternatives... yes "most ... probably have no steroids", but there again it is probable that most don't work (for if they did and had robust evidence of this then they would be incorporated into conventional medical practice).
    • As the article cites, there have been well reported studies looking into the precise constituents of obtained supposed "pure" TCM (Traditional Chinese Medicine) preparations for eczema, that found potent steroids had been added - of course proposed regulation of herbal supply and manufacture would eliminate such events. Also (real) TCM has not been without its own reported serious systemic effects (see Perharic L, Shaw D, Leon C, De Smet P, Murray V (1995). "Possible association of liver damage with the use of Chinese herbal medicine for skin disease". Vet Hum Toxicol 37 (6): 562–6. PMID 8588298. )
    • As for GLA, why if it is so effective were the UK licenses for prescription items revoked? Answer - because became apparent initial claims for efficacy not subsequently confirmed on review & later studies. See the editorial: "Evening primrose oil for atopic dermatitis -- Time to say goodnight". BMJ 327: 1358–1359. 13 December 2003. doi:10.1136/bmj.327.7428.1358.  . Also same reasons for withdrawal in cyclical pre-menstrual breast discomfort in women. [1])
      • Kitz R, Rose M, Schönborn H, Zielen S, Böhles H (2006). "Impact of early dietary gamma-linolenic acid supplementation on atopic eczema in infancy". Pediatr Allergy Immunol 17 (2): 112–7. PMID 16618360.  concludes that "Dietary GLA-supplementation could not prevent AD"
    • re Borage oil, it is ineffective:
  • So, stating the conventional, evidence based treatments in favour of the ineffective alternatives is very much within NPOV guidelines. David Ruben Talk 03:15, 3 March 2007 (UTC)

Review[edit]

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

Revised, global nomenclature for allergy[edit]

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)

Amalgam fillings[edit]

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)

Steroid addition[edit]

We have this paper but it is not a review Rapaport, MJ; Lebwohl, M (2003 May-Jun). "Corticosteroid addiction and withdrawal in the atopic: the red burning skin syndrome.". Clinics in dermatology 21 (3): 201–14. PMID 12781438.  Check date values in: |date= (help) Doc James (talk · contribs · email) 05:17, 9 August 2011 (UTC) What do you mean, "it's not a review?" — Preceding unsigned comment added by 98.102.223.174 (talk) 21:30, 8 January 2013 (UTC)

Prevention -> Diet --- not referenced / bad reference[edit]

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)

High-quality, dermatologist-approved moisturizer.[edit]

"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)

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)

Dairy[edit]

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)

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)

Lack of Vitamins[edit]

Currently the lack of vitamins is not described as a possible reason for atopic dermatitis, although there is indication that it plays a role:

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)
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.[2] Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:46, 1 December 2013 (UTC)

At a Loss[edit]

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)

Probably because you did not have this. Doc James (talk · contribs · email) 15:40, 7 February 2015 (UTC)