Unclassified endogenous eczema

Patients with intractable eczema are often referred for patch testing to exclude contact dermatitis. If this is excluded, then a diagnosis of endogenous eczema is made. At our clinic, we find a sizeable proportion of these patients do not fit any of the known patterns of endogenous eczema. These patients are given the diagnosis of unclassified endogenous eczema and make up 8% of the patients seen at our Occupational and Contact Dermatitis Clinic. There is little information available on this group of patients, with no mention of this problem in the recent dermatological literature. Since March 1996, we have further investigated these patients, to develop some understanding of this category. 12 of 34 patients reviewed over this period had an elevated IgE level above 100 IU/ ml. Thus, despite no past history or family history of eczema, asthma or hayfever, at least 1/3 of these patients are probably suffering from atypical, late onset atopic dermatitis. Patients were later contacted by telephone (average 2 years) to assess the natural history of this condition. In 20 of the 31 patients contacted, their eczema had either improved or resolved. We think that this important category of eczema needs to be recognized and further investigated.