August 2025 digest

The Enduring Challenge of Atopic Dermatitis Nomenclature: From Hyde to Our Time

Hyde’s academic career spanned appointments at Northwestern University and the University of Chicago, where he became a central figure in establishing dermatology as a modern medical specialty. His textbook, A Practical Treatise on Diseases of the Skin (1883), ran through eight editions and helped define the field for decades. Hyde’s name is again invoked today because he described prurigo nodularis, a disease often considered a cousin of Atopic Dermatitis (AD)—which itself was known until the mid-20th century as prurigo Besnier, and earlier as prurigo Hebra. Historical considerations around 1900 show clearly that what we now call AD was then viewed as part of a clinical spectrum bridging eczema and prurigo, with underlying tendencies to extend either through eczematization (Besnier) orlichenification (Brocq) 

More than a century later, Hyde’s reflections on nomenclature remain strikingly relevant. Just as “eczema” proved too imprecise for his generation—before “atopic dermatitis” was proposed in 1933 by Sulzberger and Wise—today’s clinicians and researchers continue to grapple with terminology. AD is now divided into subtypes to serve research needs and drug-targeting strategies. Yet for patients, and for many physicians, “eczema” remains the preferred name. This disconnect complicates understanding, expectations, and even the framing of treatment goals.

Hyde warned that outdated or ambiguous terms risked perpetuating confusion rather than progress. His words foreshadowed the current debates: Is “atopic dermatitis” too broad a label for the heterogeneity of the disease, or is it the right umbrella term to define patient populations with robust clinical criteria? Should “eczema” be retained for its clinical utility, even if it lacks precision? These questions echo his 1904 editorial, underscoring that language in dermatology is not merely semantics—it shapes research, therapy, and ultimately patient care.

As we advance into an era of biologics, molecular endotyping, and personalized medicine, Hyde’s call for rigor in nomenclature should guide us. Just as he sought to retire “eczema” as a catch-all, today we must strive for terminology that reflects biology, informs treatment, and communicates clearly across science, medicine, and society. Our Society endorses the term atopic dermatitis, which has a robust clinical and scientific foundation. The passing of “eczema” may never be complete, but Hyde’s legacy reminds us that progress in dermatology begins with the precision of its words.

To read more about the history of atopic dermatitis, see Histoire de la dermatite atopique by Daniel WALLACH, Alain TAÏEB, and Gérard TILLES (Masson, 2004).

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