Atopic dermatitis, atopic eczema, or eczema? A systematic review, meta-analysis, and recommendation for uniform use of 'atopic dermatitis'

Abstract

Background: The lack of standardized nomenclature for atopic dermatitis (AD) creates unnecessary confusion for patients, healthcare providers, and researchers. It also negatively impacts accurate communication of research in the scientific literature. We sought to determine the most commonly used terms for AD.

Methods: A systematic review of the MEDLINE, EMBASE, and LILACS (1945-2016) for the terms AD, atopic eczema (AE), and multiple other eczematous disorders.

Results: In MEDLINE, 33 060 were identified, of which 21 299 (64.4%) publications used the term 'AD', 15 510 (46.9%) 'eczema', and only 2471 (7.5%) AE. Most of these publications used the term AD (82.0%) or eczema (70.8%) without additional nomenclature; only 1.2% used AE alone. Few publications used the terminology 'childhood eczema', 'flexural eczema', 'infantile eczema', 'atopic neurodermatitis', or 'Besnier's prurigo'. AD was rarely used until the late 1970s, after which it became the most commonly used of the three terms and continuously increased until 2015. Atopic eczema decreased between 2008 and 2015. Atopic dermatitis was the most commonly used term in studies across almost all publication types, languages, and journals.

Conclusion: Atopic dermatitis is the most commonly used term and appears to be increasing in popularity. Given that eczema is a nonspecific term that describes the morphological appearance of several forms of dermatitis, we strongly suggest the use of a more specific term, AD, in publications, healthcare clinician training, and patient education. Support from researchers, reviewers, and editors is key to success.

Keywords: atopic dermatitis; atopic eczema; eczema; nomenclature; terminology.

Figure 1

Venn diagram of number of publications using the terms ‘atopic dermatitis’ (red), ‘atopic eczema’ (green), and/or ‘eczema’ (blue).

Figure 2

Total number of publications using different terms for atopic dermatitis and other eczematous disorders.

Figure 3

Publication trends for atopic dermatitis (AD), atopic eczema (AE), and eczema in the scientific literature (1945–2015) from MEDLINE. The absolute number (panel A) and percentage (panel B) of publications using one or more of the terms AD (blue), eczema (red), and/or AE (gray) are presented. In addition, the absolute number (panel C) and percentage (panel D) of publications using only a single term of AD (blue), eczema (red), and/or AE (gray) are presented.

Figure 4

Predictors of use of atopic dermatitis (AD), atopic eczema (AE), and eczema in the scientific literature. The absolute number of publications using the terms AD (blue), eczema (red), and AE (gray) was stratified by the nature of the research subjects (panel A), publication language (panel B), and publication type (panel C).

Figure 5

The proportion of publications using the terms atopic dermatitis (AD), atopic eczema (AE), or eczema does not vary by the impact factor of the publishing journal. The absolute number of publications using the terms AD (blue), eczema (red), or AE (gray) was stratified by the journals with top 10 impact factors for dermatology (top left panel), allergy/immunology (top right panel), pediatrics (bottom left panel), and medicine (bottom right journal).