Topical therapy of atopic dermatitis: Controversies from Hippocrates to topical immunomodulators

Historical Perspectives on Atopic Dermatitis: Eczema Through the Ages

“…The Hippocratic theory of humoral imbalance, the belief that skin lesions and itchiness were cutaneous rectifications of humoral disequilibrium deeper inside the body, influenced many physicians of the premodern era. The prevailing thought was that skin disease was an essential excretory process that, if disturbed, would place patients in harm's way . Daniel Turner wrote, “itching Humor…which if you go about to heal…you may 'tis certain quickly cure them of their itch, but you will as certainly put them into hazard of their lives, because you thereby pollute their blood and nervous fluid by driving back these excrements into the vessels” .…”

“…The Hippocratic theory of humoral imbalance, the belief that skin lesions and itchiness were cutaneous rectifications of humoral disequilibrium deeper inside the body, influenced many physicians of the premodern era. The prevailing thought was that skin disease was an essential excretory process that, if disturbed, would place patients in harm's way (13,14). Daniel Turner wrote, "itching Humor.…”

Molecular genetics of the epidermal differentiation complex: perspectives for dermatology and medicine or the ‘purloined letter syndrome’

“…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. This doctrine, which limits therapeutic intervention to a minimalist approach, is still unconsciously prevalent in dermatological treatment since major concerns have been raised against the use of topical corticosteroids and, more recently, against topical calcineurin inhibitors, such as tacrolimus and pimecrolimus [6]. However, in the last few decades, several authors have pointed out that atopy in AD might be a secondary process, rather than the cause of the disease [7][8][9].…”

Are baths desirable in atopic dermatitis?

“…In addition to corticosteroid or topical immunomodulatory therapy, management of the underlying pruritus relies on symptomatic measures including the local application of emollients or moisturizers . However, a key component of successful AD management is appropriate skin care, including advice for bathing …”

“…2,3 However, a key component of successful AD management is appropriate skin care, including advice for bathing. 4,5 Importantly, there is ongoing debate in the literature regarding the usefulness of bathing in the management of AD, 5 and AD guidelines have not provided compelling recommendations regarding optimal bathing. Some authors consider water as a curative agent, [6][7][8][9] although others consider bathing to be instead an additional skin irritant.…”