Introduction

Dermatologists are clever classifiers. We master a repertoire of approximately 2000 different diagnoses, which can be classified and structured. Classification of diseases is very important. By classifying biological phenomena, we structure our understanding of the underlying biological complexity, and thereby make it possible for us not only to ask meaningful positivist scientific questions, but also offer help to our patients.

Two threats exist in all classification systems, splitting and lumping, and both are equally serious. Splitting occurs when the same disease entity is split into numerous diagnoses depending on, for example, location, a good example being pityriasis amientacea and scalp psoriasis. This overwhelms the reader with diagnoses that are not essentially different, but that have been classified as different because of an essentially random aspect of the disease, e.g., location or clinical appearance. This does not allow a meaningful use of existing knowledge by direct transfer, and therefore erodes the understanding of the underlying pathogenic process as well as accumulation of clinically relevant knowledge.

The other extreme is lumping, where all diseases are lumped together pell-mell in large categories, where little consideration is given to significant etiological, pathogenic, and clinical differences between disease entities. It may be speculated that several of the more common dermatological diseases fall into this trap, as clinical experience suggests significant inter-individual differences in regard to treatment response or prognosis.

Nosology should be based on defined parameters, e.g., anatomy (gross and microscopic), etiology, pathogenesis or therapy. It should provide clinically meaningful distinctions between disease entities in order not only to promote the understanding of the disease and accumulation of knowledge, but also to help practical management.

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