An allergist's view of atopic dermatitis

Based on the disagreements about the role of atopy in the condition known as atopic dermatitis, it is not surprising that there have been divergent views concerning the appropriate treatment of the disease. A large population of physicians, including most dermatologists and some allergists, believe that the fundamental approach to a successful outcome of the dermatitis is to control the itching and to improve the chronic dryness of the skin. Following a completely different approach are physicians, including many allergists, who are convinced that atopic dermatitis usually involves an imbalance of, or an abnormality in, the immunologic system. For this group, one of the main features of treatment is to remove or avoid offending allergens. Because of the demonstrated pathogenic role of food allergy in the majority of patients with eczema, any child with chronic moderate or severe disease that requires daily medications should be considered for allergic evaluation of this disorder. Further studies still need to be performed concerning the role of environmental and food allergens and the early- and late-phase reactions in atopic dermatitis.