ABSTRACT
From the first reliable descriptions of acne in the early 19th century, dermatologists recognized it as a disease of the pilosebaceous follicle. Until the middle of the 20th century, they hypothesized that seborrhoea, follicular keratosis and microorganisms could be individually responsible for the acne lesions. Inflammation was only regarded as the final and inescapable step of the acne process. Although the importance of these factors has been reevaluated, recent works still regarded them as mandatory. In the 1970s, the onset of isotretinoin dramatically improved acne management. It also provided great opportunities for a better understanding of the pathogenic factors of acne. This study analyzes their genesis and development from the seminal contributions until recent advances.
Subject(s)
Acne Vulgaris/history , Dermatitis, Seborrheic/history , Gram-Positive Bacterial Infections/history , Inflammation/history , Propionibacterium acnes , Sebum , Skin Diseases, Bacterial/history , Acne Vulgaris/drug therapy , Acne Vulgaris/etiology , Acne Vulgaris/pathology , Animals , Anti-Bacterial Agents/therapeutic use , Dermatitis, Seborrheic/complications , Dermatologic Agents/therapeutic use , Diet/history , Gram-Positive Bacterial Infections/microbiology , History, 16th Century , History, 17th Century , History, 18th Century , History, 19th Century , History, 20th Century , History, 21st Century , Hormones/history , Humans , Inflammation/complications , Isotretinoin/therapeutic use , Skin Diseases, Bacterial/complications , Skin Diseases, Bacterial/microbiology , Vitamin A/therapeutic useSubject(s)
Dermatology/history , Museums , France , History, 19th Century , History, 20th Century , Hospitals , HumansABSTRACT
The quest for clarifying the pathophysiology of atopic dermatitis (eczema) has lasted for 25 centuries. Yearning to discern the primum movens of atopic dermatitis, physicians aimed to identify the curative therapy. Recent scientific efforts has brought to the light an ever-growing amount of interplaying pathophysiologic factors, including the epidermal barrier, the digestive flora, food, early infections and antigenic stimulations, and innate and adaptive immune response; however, overfocusing on some of these factors, along with misconceptions about the benefit/risk balance of topical therapies, has sometimes led topical therapies being disregarded. Reviewing the history of pathophysiologic concepts, we aim to return topical therapies to the center of the clinical management of atopic dermatitis.
Subject(s)
Dermatitis, Atopic/therapy , Eczema/therapy , Evidence-Based Medicine , Health Knowledge, Attitudes, Practice , Adrenal Cortex Hormones/therapeutic use , Anti-Infective Agents/therapeutic use , Clinical Trials as Topic , Complementary Therapies/methods , Dermatitis, Atopic/classification , Dermatitis, Atopic/prevention & control , Dermatologic Agents/administration & dosage , Desensitization, Immunologic/methods , Diet Therapy/methods , Drugs, Chinese Herbal/therapeutic use , Eczema/classification , Eczema/prevention & control , Humans , Immunosuppressive Agents/therapeutic use , Research DesignSubject(s)
Mycology/history , Mycoses/history , France , History, 19th Century , Humans , Hungary , Jews/history , ParisSubject(s)
Tinea Capitis/history , Tinea Capitis/radiotherapy , Child , History, 20th Century , HumansABSTRACT
Although atopic dermatitis can be treated efficiently, there is still much controversy about the risk/benefit ratio of both topical corticosteroids and topical immunomodulators. Conflicting data may be found about the usefulness of bathing, diet regulation, and other therapeutic interventions. These controversies result in part from the persistence of Hippocratic doctrines in modern medical thinking. Humoralist and diathetic doctrines, as they pertain to eczema, are reviewed. The paradoxical worsening of oozing and the deadly hazards of hospitalization before the era of antibiotics are brought to mind. We hope that this historical review will improve the understanding of current controversies and help dermatologists to manage patients with atopic dermatitis and other chronic skin diseases.
Subject(s)
Dermatitis, Atopic/history , Dermatitis, Atopic/therapy , History, 19th Century , History, 20th Century , History, Ancient , HumoralismSubject(s)
Agar/history , Mycological Typing Techniques/history , Mycology/history , France , History, 19th Century , Humans , TrichophytonSubject(s)
Adrenal Cortex Hormones/history , Anti-Inflammatory Agents/history , Dermatologic Agents/history , Dermatology/history , Ointments/history , Administration, Topical , Adrenal Cortex Hormones/administration & dosage , Anti-Inflammatory Agents/administration & dosage , Cortisone/administration & dosage , Cortisone/history , France , History, 20th Century , Humans , Hydrocortisone/administration & dosage , Hydrocortisone/history , Skin Diseases/drug therapy , United StatesABSTRACT
BACKGROUND: Atopic dermatitis was defined in 1933. Earlier descriptions have yet not been thoroughly studied. OBJECTIVE: Our purpose was to identify the first images of atopic dermatitis among historical illustrations of skin diseases. METHODS: We posted 20 selected images on an Internet site and asked experts in pediatric dermatology to decide whether or not they represented atopic dermatitis. RESULTS: By means of the Delphi technique, a consensus could be reached for 19 of the 20 images. The experts' accuracy was good. LIMITATIONS: Thirty-one experts participated. No validated criteria were used for the selection of the images. CONCLUSION: The first representations of atopic dermatitis are engravings of skin diseases described under the names of strophulus confertus (Willan, 1796), lichen agrius (Willan, 1796), porrigo larvalis (Bateman, 1816), and eczema rubrum (Rayer, 1835). Teledermatology techniques can be reliably applied to retrospective diagnosis.