title: Flexural eczema versus atopic dermatitis.
abstract: Flexural eczema and atopic dermatitis are frequently synonymized. As respiratory atopy is rarely tested for and found in these patients, systematically equating a flexural distribution of dermatitis with atopic dermatitis may too frequently result in misclassified diagnoses and potentially missed opportunity for intervention toward improving patients' symptoms and quality of life. We present a critical review of the available evidence for the atopic dermatitis diagnosis and discuss the similarities between atopic dermatitis and allergic contact dermatitis. Because neither flexural predilection nor atopy is specific for atopic dermatitis, we conclude that the term atopic dermatitis is a misnomer and propose an etymologic reclassification of atopic dermatitis to "atopy-related" dermatitis. Allergic contact dermatitis can induce an atopic dermatitis-like phenotype, and thus, flexural dermatitis cannot be assumed as atopic without further testing. Patch testing should at least be considered in cases of chronic or recurrent eczema regardless of the working diagnosis.
authors.affiliation: From *Loma Linda University; †University of California, San Diego, School of Medicine; ‡CWRU School of Medicine, University Hospitals Case Medical Center, Cleveland, OH; §National Allergy Research Centre, Department of Dermato-Allergology, Copenhagen University Hospital, Gentofte, Denmark; ∥SUNY, Stony Brook; and ¶Allergy and Training Program, Winthrop-University Hospital, Mineola, NY; #Department of Experimental Dermatology and Cosmetology, Jagiellonian University, Krakow, Poland.
authors.forename: Sharon E
authors.initials: SE
authors.lastname: Jacob
authors.forename: Alina
authors.initials: A
authors.lastname: Goldenberg
authors.forename: Susan
authors.initials: S
authors.lastname: Nedorost
authors.forename: Jacob P
authors.initials: JP
authors.lastname: Thyssen
authors.forename: Luz
authors.initials: L
authors.lastname: Fonacier
authors.forename: Radoslaw
authors.initials: R
authors.lastname: Spiewak
mesh_terms: D000842:Ankle; D017449:Dermatitis, Allergic Contact / Q000276:immunology*; D003876:Dermatitis, Atopic / Q000145:classification / Q000276:immunology*; D004485:Eczema / Q000145:classification / Q000276:immunology*; D004550:Elbow; D006801:Humans; D007717:Knee; D009333:Neck