Intractable Atopic Eczema Suggests Major Affective Disorder: Poor Parenting is Secondary

To the Editor.—  Koblenzer and Koblenzer,¹ in a recent issue of the Archives, report on an interesting anecdotal association between chronic intractable atopic eczema in children and dysfunctional parent-child relationships. They conclude that the former is probably caused by the latter, ie, that the atopic eczema is psychogenic. Those of us who work in the rapidly developing field of psychoneuroimmunology can offer a more modern and scientific interpretation.A familial history of atopic eczema suggests a familial risk of major affective disorder. There is extensive literature describing associations between major affective disorder and atopy. It includes many studies demonstrating an association between major affective disorder and various clinical syndromes, such as fibrositis (fibromyalgia),² that present with evidence for hyperimmunity, including cutaneous inflammation.³ Major affective disorder, in turn, would be an obvious reason for the inability of parents to maintain a healthy parent-child relationship. Indeed, the modern adult