The history of atopic dermatitis

Roughly 2500 years ago, the Ancient Greek physician Hippocrates was the first to describe the condition of the chronically itchy skin. He treated a patient with a very dry, thickened and scaly skin and a strong itch present all over the patient’s body. 1 The symptoms of the disease thus described correspond to the condition known today as atopic dermatitis or atopic eczema.

Synonymous with the word dermatitis is the expression eczema, which was first used in 543 by the Greek physician Aatius of Amida and means “to boil out.”2 The Italian physician Girolamo Mercuriali gave an early description of atopic dermatitis in 1572 in his De morbis cutaneis, which was the first handbook on dermatological illnesses at the time.3,48 Looking at the literature throughout history, we can spot the first actual descriptions of atopic dermatitis only in the 19th century and under very different names, such as eczema rubrum, constitutional prurigo, prurigo diatésique, prurigo Basnier and others.4,5,6

In 1903, the French dermatologist Luis-Anne-Jean Brocq was the first to separate the condition from other forms of eczema by naming it “neurodermatitis.” He postulated that the illness was linked to the nerves of the afflicted. This line of thought became accepted by other doctors and laypersons and the idea that neurodermatitis was a psychiatric illness flourished despite the well known fact that it appeared in people with asthma, hay fever and food allergies. Neurodermatitis became the official name for atopic dermatitis for a few decades after Brocq and is still used today mostly in Austria and Germany.4

Fred Wise and Marion Sulzberger renamed the condition atopic dermatitis in 1933. The term was based on the word atopy, coined in 1923 by allergologists Arthur Coca and Robert Cooke for the purpose of describing inherited hypersensitivity to certain types of environmental allergens.4 Atopy comes from the Greek word atophos meaning “second placed.” Likewise, dermatitis is also Greek in origin, with derma meaning “skin” and itis, “inflammation.”6

To this day, experts disagree on the proper name for atopic dermatitis. The literature gives us expressions such as atopic dermatitis, neurodermatitis, atopic eczema, non-atopic eczema, atopiform dermatitis, intrinsic dermatitis, endogenic dermatitis, extrinsic dermatitis, atopic dermatitis/eczema syndrome and so on.  It is thus clear that atopic dermatitis may not be the term that we will end up using in the long run. The name of the condition will continue to change together with the development of molecular biology, genetics and immunology and with the advances in the aetiology of the illness.