The association between house dust mites (HDMs) and atopic dermatitis (AD) has long been a contested issue in both dermatology and allergy/immunology. As AD continues to burden millions of individuals and even whole societies, the commercial availability of a HDM allergen mix for epicutaneous testing has revived efforts to identify a definitive link between HDMs and AD. Conclusive evidence of a role for HDMs in the pathogenesis of AD would justify patch testing with mite allergens and would further the use of allergen-specific immunotherapy in the management of such patients; an absence of involvement would refocus our investigative efforts on other conspirators. We present a thorough review of the dissenting scientific evidence and expert opinions on this controversial topic. The association of HDMs with AD has remained elusive, and additional investigation is necessary to resolve this vexing riddle.
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