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The many informations and commentaries in this book, starting from the clinical morphology via pathophysiology, diagnostics, therapy, and prevention, make clear that atopic dermatitis is a very complex illness which cannot be treated well in a quick physician-patient contact and by writing a prescription for a cream or an injection.

In spite of clear-cut psychosomatic interactions with deteriorations of skin lesions in specific stress situations, it has to be stated that atopic dermatitis is no “psychiatric” disease, but a skin disease which can be modulated by psychological influences—negatively and positively! The development of atopic eczema is never the product of “guilt”—neither of the patient nor of the mother or father—rather it is a complex interplay of genetic predisposition and environmentally induced factors.

Although patients may be very severely affected, it is possible in most cases to improve the disease in a way that a normal and enjoyable life is possible. To achieve this, the efforts not only of the patient but also of his environment, in family and occupation, and a continuous activity and observation of various aspects are necessary. These include strategies for daily skin care and avoidance of noxious influences. Psychological influences neither should be overestimated, however, also not be neglected. It may happen that a short eczema flare can start in a period of extreme happiness.

It should be stressed that patients with atopic dermatitis—similar to those with atopic airway disease—are not helpless victims of their destiny. Even if the genetic predisposition cannot be changed at this time, and the patients will have the tendency to hypersensitivity of the skin organ and possible development of eczema, I do not like the term “incurable” for this illness. The excruciating eczematous skin lesions can be very well treated—and this can be done in any case of flare. Furthermore there is hope for future more targeted therapies with prologics and small molecular on the way through clinical trials!

The basis of a good prognosis for a relatively normal life is a confidential cooperation between the patient and a physician with special experience in this disease and who can give the patient, even in difficult times, the joy of life and the capability to work with adequate therapeutic strategies.

I tell my patients:

“You will be your own skin doctor; you will know what cream to apply at which time to which area of your body and in which concentration and what you should take systemically in order to be symptom-free. For possible catastrophes, I feel responsible and you can come back to me, we will deal with those!”