Zeitschrift für klinische und experimentelle Dermatologieforschung
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Eczema: A Proposed Reclassification Based on the Signature Pathology Finding of Occluded Sweat Ducts

Herbert B Allen, Catherine A Warner and Suresh G Joshi

Occluded sweat ducts are the hallmark of miliaria. The occlusions were thought to be due to biofilm or “slime” producing Staphylococcus epidermidis. Sulzberger first saw occluded ducts in eczema and 60 years later, these were rediscovered and shown to be due to many different species of staphylococci, including S. aureus, epidermidis, tenuis and many others. These occlusions also trigger the activation of the innate immune system, and this, while trying to attack and destroy the staphylococcal organisms, begins the cascade of events leading to the signs and symptoms of the many various forms of eczema. We propose a classification of these diseases as atopic eczema, seborrheic eczema, and others to unify these lesions with occluded ducts. Further, we propose a treatment protocol that addresses both the genetic and environmental “hits” in this classical “double-hit” disease.