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FILTERED RESEARCH - EVIDENCE
Shams K, Grindlay DJ & Williams HC (2011) What’s new in atopic eczema? An analysis of systematic reviews published in 2009–2010. Clinical and Experimental Dermatology 36(6):573–7
This review provides a summary of key findings from 18 recent reviews on atopic eczema. The list of generalised findings includes: the risk of eczema seems to be increased in urban compared with rural areas; there was no good evidence on the possible benefit of organic food consumption and eczema; and maternal intake of fish or fish oil may be associated with a reduced risk of eczema in offspring, although further studies are needed and an updated Cochrane Review found no evidence of benefit from any form of anti-staphylococcal treatment in managing clinically infected or uninfected eczema.
Access to the full article is not free but the abstract can be seen here.
UNFILTERED RESEARCH - TOPICAL TREATMENT
Aschoff R, Schmitt J, Knuschke P, Koch E, Brautigam M & Meurer M (2011) Evaluation of the atrophogenic potential of hydrocortisone 1% cream and pimecrolimus 1% cream in uninvolved forehead skin of patients with atopic dermatitis using optical coherence tomography. Experimental Dermatology 20(10):832–6
This study aimed to investigate whether the use of mild topical steroid had any effect on skin thickness when compared to pimecrolimus (Elidel), which is another treatment for eczema often recommended for use on the face.
Twenty people with a history of mild to moderate atopic eczema were recruited. Each person had hydrocortisone 1% cream applied twice daily to one side of their forehead and pimecrolimus 1% cream on the other side for 4 weeks.
During this time and up to 4 weeks after the end of treatment, various assessments of skin quality were made. The results suggested that at the end of the treatment period the skin had thinned significantly in the hydrocortisone group and insignificantly in the pimecrolimus group. 4 weeks post treatment, skin thickness had returned to normal in both groups. The investigators suggest that pimecrolimus may be safer and more appropriate to use in treating atopic dermatitis in sensitive areas such as the face.
Access to the full article is not free but the abstract can be seen here.
Emer JJ, Frankel A, Sohn A & Lebwohl M (2011) A bilateral comparison study of pimecrolimus cream 1% and a topical medical device cream in the treatment of patients with atopic dermatitis. Journal of Drugs in Dermatology 10(7):735–43
This study recruited 20 people with eczema and asked them to apply pimecrolimus cream twice daily to a patch of eczema on one side of their body and an emollient three times a day to an equivalent lesion on the other side of their body.
This process was continued for 4 weeks with various assessments being performed. At the end of the study period 75% were rated clear or almost clear by the Physician Global Assessment for both the pimecrolimus and emollient treated area.
Significant improvements were noted in all measures for both types of treatment and the authors concluded that the emollient cream used was as safe and effective as the pimecrolimus cream at improving the atopic eczema.
Access to the full article is not free but the abstract can be seen here.
Gandy JJ, Snyman JR & van Rensburg CE (2011) Randomized, parallel-group, double-blind, controlled study to evaluate the efficacy and safety of carbohydrate-derived fulvic acid in topical treatment of eczema. Clinical, Cosmetic and Investigational Dermatology 4:145–8
Fulvic acid is thought to have anti-inflammatory and antibacterial properties. In this study it was mixed in an emollient base with a pH of 4.8 and the resulting product compared with the efficacy of an emollient alone also with a pH of 4.8. 36 people with atopic eczema were randomised to either receive the fulvic acid product or the emollient alone. The products were applied twice daily for a 4-week period.
The Physician Global Assessment showed significantly greater improvement in the fulvic acid group than the emollient group. Specifically, erythema and severity were significantly more improved.
The patient assessment using a visual analogue score showed improvements in both groups with no significant difference between them. The researchers conclude that further investigation of fulvic acid needs to be carried out as a possible treatment for eczema.
Access to this article is free of charge and can be found here.
Heinlin J, Schiffner-Rohe J, Schiffner R, Einsele-Kramer B, Landthaler M, Klein A, Zeman F, Stolz W & Karrer S (2011) A first prospective randomized controlled trial on the efficacy and safety of synchronous balneophototherapy vs. narrow band UVB monotherapy for atopic dermatitis. Journal of the European Academy of Dermatology and Venereology 25(7):765–73
This is a German study in which a comparison is made between normal narrow-band UVB treatment and a process known as balneophototherapy.
In balneophototherapy, the conditions found at the Dead Sea are recreated by introducing 10% sea salt baths alongside light therapy. In this study 180 patients were allocated to the control group (just UVB) or the experimental group (balneophototherapy).
Treatment times varied depending on response, and the end-point was 35 sessions or early clearance. SCORAD scores were measured at the beginning and end of treatment. For this size of experimental group a 15% superiority of one treatment over another was considered significant.
At the beginning of the study baseline SCORAD scores were comparable. By the end of the study the experimental group in which balneophototherapy was used showed a significantly greater improvement in their SCORAD scores with a mean difference of 15.4%.
Access to the full article is not free but the abstract can be seen here.
Ortonne JP, Nikkels AF, Reich K, Ponce Olivera RM, Lee JH, Kerrouche N, Sidou F & Faergemann J (2011) Efficacious and safe management of moderate to severe scalp seborrhoeic dermatitis using clobetasol propionate shampoo 0.05% combined with ketaconazole shampoo 2 %: a randomized, controlled study. British Journal of Dermatology 165(1):171–6
This study aims to compare two possible treatments for seborrhoeic dermatitis to see which is most effective. The study had three unique phases each lasting 4 weeks: the first phase was active treatment, then a maintenance phase and finally a follow-up phase. The 326 subjects were randomised to one of four groups, each group receiving a different combination of treatment:
•Group 1: ketoconazole shampoo alone twice weekly.
•Group 2: clobetasol propionate shampoo alone twice weekly.
•Group 3: clobetasol propionate shampoo twice weekly alternating with ketoconazole shampoo twice weekly.
•Group 4: clobetasol propionate shampoo four times a week, alternating with ketoconazole shampoo twice weekly.
In the maintenance phase all subjects used ketoconazole shampoo once weekly and had no treatment in the follow-up phase. The results suggest that all three regimens with clobetasol propionate in them were more efficacious than ketoconazole alone. The regimen that offered the most sustained benefit in the maintenance phase was clobetasol propionate twice weekly alternating with ketoconazole twice weekly. Therefore this is the treatment regimen recommended by the authors for the treatment of moderate to severe scalp seborrhoeic dermatitis.
Access to the full article is not free but the abstract can be seen at here.
Simpson E & Dutronc Y (2011) A new body moisturizer increases skin hydration and improves atopic dermatitis symptoms among children and adults. Journal of Drugs in Dermatology 10(7):744–9
This report is on a brand of moisturiser (Cetaphil Restoraderm). It has been included because research into the effects of emollients is scarce in the literature.
The report shows results from four studies and suggests that application of this emollient improves skin hydration when compared with a control and that the effect lasted for at least 24 hours. When skin barrier function was disrupted it could be brought back to normal significantly more quickly than with the control.
When used for 4 weeks in patients with a history of atopic eczema, there was a significant decrease in itching and stinging along with an increase in quality of life. When used as an adjunctive treatment with a topical steroid in patients with mild to moderate atopic eczema over 4 weeks, there was a more rapid decrease in disease severity than in the control
group.
Access to the full article is not free but the abstract can be seen here.
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