RESEARCH NEWS - December 2011

Our new quarterly research update by Independent Nurse Consultant, Rebecca Penzer.

Eczema Treatment - reviewing the evidence

These Research News pages are brought to you with the support of an educational grant from T&R Derma

FILTERED RESEARCH

GUIDELINES

Scottish Inter Collegiate Guidelines Network (2011). Management of atopic eczema in primary care: A national clinical guideline.  Edinburgh: SIGN

This document has been produced by SIGN (Scottish Intercollegiate Guideline Network) who are part of NHS Quality Improvement in Scotland.  The very detailed guideline gives recommendations for the management of atopic eczema in children and adults in primary care, based on current best practice evidence. It includes advice on topical treatments, complementary therapies and the roles of diet and environmental factors.

Key recommendations include: ‘patients with atopic eczema should have ongoing treatment with emollients’, ‘patients should be advised to continue with emollient therapy during treatment with topical corticosteroids’, ‘patients with atopic eczema should be advised to apply topical corticosteroids once daily’, ‘oral antibiotics are not recommended in the routine treatment of non-infected atopic eczema’ and ‘topical tacrolimus should be considered, in patients aged two years and older, for short term, intermittent treatment of moderate to severe atopic eczema that has not been controlled by topical corticosteroids or where there is a serious risk of important adverse effects from further topical corticosteroid use, particularly skin atrophy’.

For each recommendation made, guidance as to the level of evidence that is available is given.
Access to this article is free of charge at: http://www.sign.ac.uk/pdf/sign125.pdf

EVIDENCE

Rehal B & Armstrong AW (2011) Health outcome measures in atopic dermatitis: a systematic review of trends in disease severity and quality-of-life instruments 1985-2010. PLoS 6(4):e17520

This study identified 791 randomised controlled trials that examined the treatment of atopic eczema.

Within these studies, 20 disease-severity instruments and 14 quality-of-life measures were identified. The article concluded that there is an increase in the usage of these tools in atopic eczema clinical trials.

Access to this article is free of charge at:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3076368/?tool=pubmed

Svensson A, Chambers C, Canemo A & Mitchell SA (2011) A systematic review of tacrolimus ointment compared with corticosteroids in the treatment of atopic dermatitis. Current Medical Research Opinion 27(7):1395–1406

This review compared the results of 17 trials in which tacrolimus ointment was compared with various strengths of topical steroid.

The overall conclusions stated that tacrolimus was of similar efficacy to topical corticosteroids. 

Access to the full article is not free, but the abstract can be seen at:
http://www.ncbi.nlm.nih.gov/pubmed/21563877

UNFILTERED RESEARCH

TOPICAL TREATMENT

Danby SG, Alenezi T, Sultan A, Chittock J, Kennedy K & Cork MJ (2011) The effect of aqueous cream BP on the skin barrier in volunteers with a previous history of atopic dermatitis. British Journal of Dermatology 165(2):329–34

Thirteen volunteers who had previously had atopic dermatitis (AD) but were currently clear applied aqueous cream twice daily for 4 weeks to the inside of their forearm. A number of tests were carried out to investigate how this affected their skin. 

The result showed that application of aqueous cream led to an increase in trans-epidermal water loss (i.e. more moisture was lost from the skin) and a decrease in the integrity of the top layer of skin (stratum corneum).

The authors concluded that ‘Aqueous cream BP used as a leave-on emollient caused severe damage to the skin barrier in volunteers with a previous history of AD. Aqueous cream BP should not be used as a leave-on emollient in patients with atopic dermatitis.’

Access to the full article is not free, but the abstract can be seen at: http://www.ncbi.nlm.nih.gov/pubmed/21564067

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