When I still was a medical student, I undertook a practical training program in Internal Medicine at Allgemeines Krankenhaus der Stadt Wien, the legendary AKH, in Vienna. One of the admitted patients suddenly developed pruritic clear vesicles along the sides of his fingers, and Prof. K. wanted to know a diagnostic hypothesis from me. Trying to demonstrate some confidence, I quickly answered: “It’s a kind of eczema.” But he gave me back this reply: “You’re right and you're wrong. You’re right because the patient is likely to take from you the correct orientation about his illness and to receive a successful treatment. And you’re wrong because this disease is expected to be called dyshidrotic dermatitis. The word ‘eczema’ should be banished from medical vocabulary. Von Hebra and Kaposi, two of the greatest ever dermatologists, worked here at AKH, and both used to say that the most suitable definition of eczema is that which looks like eczema!”

I thought about it afterwards. What hell is the problem in using a word that stood the test of time?

I got a response few years later, when I was resident in Pathology. Dr. A. Bernard Ackerman came to Vitória, the city where I was living in those days, in order to conduct a very intensive five-day course of Dermatopathology. It wasn’t difficult for him persuading me to avoid the word ‘eczema’. Dr. Ackerman told that it is merely a descriptive diagnosis shared by a variety of cutaneous conditions with widely diverse etiologies, some of which are completely unrelated. Furthermore, he said, even the supposed microscopic hallmark of ‘eczema’, the spongiosis, is unreliable, since this feature is usually minimal, if so, in chronic lesions with superimposed lichenification that the original spongiotic process is no more prone to be identified. Dr. Ackerman rounded the issue off by arguing that some skin diseases, like psoriasis, dermatophytosis, pigmented purpuric dermatosis, and mycosis fungoides, may present variable spongiosis, although nobody hasn’t demonstrated any effort of include them into the group of the eczematous dermatitis.

Henceforward I started to spurn the word ‘eczema’ in my reports, professional talks and classes.

This radical attitude brought me some problems. My reports became less understandable that patients started to demand a consultation just to ask me questions like this: “I googled ‘seborrheic dermatitis’ and I found that it’s a kind of eczema. Is this a truthful information?” Once, a non-dermatologist clinician phoned me to ask about ‘nummular dermatitis’ and then she criticized my explanation: “You were expected to made clear in your report that it is nothing but a kind of eczema!” And medical students disapproved my academic polemicism: “Dear professor, all these renowned books use the word ‘eczema’ without any firmly rejection. You mean that all of them are mistaken? What is your problem in using a word that stood the test of time?”

Oh, yeah, I did recognize the last question! It’s the same that I made myself years before in Vienna, when I still was a medical student. I had a strong sense of déjà-vu, but in a reverse way, that invited me to a reflection.

Nowadays my reports are fairly different on the use of the word ‘eczema’. “It must be evident to the patient and to the non-dermatologist clinician!”, I think as I begin to draw it up. And my reputation grew within medical students.

Oh, yeah, I learned to stop worrying and no longer spurn the word ‘eczema’!

Nevertheless, a familiar feeling of inaccuracy remains in me every time I write or say the word ‘eczema’. Perhaps this residual contempt shall pass one day.