KNOWLEDGE about nonallergic aspects of so-called atopic eczemas gleaned by workers in different fields has become very extensive. Unfortunately, the demands of specialization have placed the contributions from several fields into mutual isolation. If there is to be further progress, not only must there be a wider cross-field dissemination of these contributions, but there must, in addition, be an integration of them. Without such an integration it is doubtful whether workers from one field will be able to use properly the findings of workers from another, and the possibility of error from distorted perspectives would also remain unchecked.In this paper an attempt will be made to provide this type of integration. A kind of natural history of infantile eczema will be presented along with hypotheses to explain each important step, and with citations from the literature of relevant fields bearing on both the natural history and the hypotheses. Much of the paper will be concerned with matters of the physiology and pathology of the skin.Most of the material discussed should be as relevant to eczema (atopic derma¬ titis, neurodermatitis, etc.) in older children and adults as it is to the infantile variety. Attempts will be made to indicate instances in which this is not the case.
THE HISTOPATHOLOGYControversy exists regarding the theory of the pathogenesis of eczema in matters involving even the visible pathology. Two schools of thought exist, with eminent adherents on each side, and it might be deemed highly presumptuous for me, who am not a histopathologist, to enter into this controversy. However, it is my opinion that the weight of evidence favors one theory, and that this theory, the newer of the two, will gain adherents as it becomes more widely known.Both schools acknowledge the intraepidermal vesicle as the fundamental lesion of infantile eczema ; the controversy concerns the manner in which it is formed.According to one school, vesiculation is due to changes occurring first in the dermis. According to the other school, it is due to primary changes in the epidermis. A detailed presentation of the first view (dermal changes primary) is given by MacLeod and Muende.
