Homeopathy for eczema: a systematic review of controlled clinical trials

Authors


  • Funding sources
    None.

  • Conflicts of interest
    None declared.

Edzard Ernst.
E-mail: edzard.ernst@pms.ac.uk

Summary

Background  Homeopathy is often advocated for patients with eczema.

Objectives  This article systematically reviews the evidence from controlled clinical trials of any type of homeopathic treatment for any type of eczema.

Methods  Electronic searches were conducted in Medline, Embase and the Cochrane Library with no restrictions on time or language. In addition, the bibliographies of the retrieved articles and our departmental files were hand searched. All controlled trials of homeopathy in patients with eczema were considered. Their methodological quality was estimated using the Jadad score.

Results  One randomized and two nonrandomized clinical trials met the inclusion criteria. All were methodologically weak. None demonstrated the efficacy of homeopathy.

Conclusions  The evidence from controlled clinical trials therefore fails to show that homeopathy is an efficacious treatment for eczema.

Homeopathy is a treatment based on the ‘like cures like’ principle. Homeopaths usually employ highly diluted remedies in order to stimulate the self-healing properties of the body.1 Thus homeopathy is used for many, if not most, chronic conditions, including eczema.2–6

Despite the facts that homeopathy originates from the prescientific era of medicine7 and that its value for treating eczema (or any other condition) is doubtful5,8,9 and based on little else than experience or anecdotal data,10–16 it is still highly popular.4,17 This may be due to a range of reasons,18 not least the fact that positive findings from case reports and other uncontrolled data continue to be published which are often misinterpreted as sound evidence of efficacy.12,19–23 Such results could, of course, be due to a range of unrelated causes, including the natural history of the disease, regression towards the mean, placebo effect or other nonspecific effects.24

This systematic review is aimed at summarizing and critically evaluating the evidence from controlled clinical trials testing the efficacy of homeopathy as a treatment of eczema.

Materials and methods

Searches were carried out on 17 November 2011 and updated on 7 February 2012 in Medline, Embase and the Cochrane Library for controlled clinical trials of any type of homeopathy as a treatment of any type of eczema. In addition, our departmental files, other systematic reviews8,25,26 and bibliographies of the retrieved studies were hand searched for further relevant studies. The search terms were homeopathy and derivatives, isopathy, homotoxicology, eczema, dermatitis, atopy and derivatives.

All controlled clinical trials were considered, if they tested homeopathic remedies for eczema in human patients regardless of control intervention or randomization. Uncontrolled studies were excluded. The methodological quality of all included trials was estimated using the Jadad score.27

Key data from each trial were extracted according to prespecified criteria (Table 1). The outcome measures were not prespecified but were extracted as reported by the original investigators.

Table 1.   Controlled clinical trials of homeopathy for eczema
ReferencePatientsDesign (Jadad score)Experimental treatmentControl treatmentMain resultsConclusions (quote)
  1. aMainly corticosteroids and antihistamines. QoL, quality of life; RCT, randomized clinical trial; pc, placebo-controlled; db, double-blind.

Keil et al.28118 children with eczemaComparative cohort study (1)Treatment by homeopaths (not specified)Conventional treatment (not specified)aNo intergroup differences in symptom scores or QoL…both therapy groups improved similarly regarding perception of eczema symptoms and disease-related quality of life
Witt et al.29135 children with atopic eczemaComparative cohort study (1)Treatment by homeopaths (not specified)Conventional treatment (not specified)aNo intergroup differences in symptom scores or QoL…homeopathic treatment was not superior to conventional treatment for children with mild eczema
Siebenwirth et al.3024 patients with atopic eczemaRCT, pc, db, two parallel groups (3)Individualized homeopathic treatment for 32 weeksPlaceboA nonsignificant trend favoured placebo over homeopathy…individualized homeopathic remedies did not prove to be superior to placebo

Results

The searches generated 96 hits of which three articles28–30 met the above-mentioned inclusion criteria (Fig. 1). All of them had methodological limitations. Two studies from the same research group28,29 were similar in design. They were both not randomized and lacked sufficient detail about treatments administered and both were open to selection and other biases. Inferences about cause and effect were therefore not possible.

Figure 1.

 Flowchart of included studies.

The randomized, placebo-controlled trial by Siebenwirth et al.30 was potentially more conclusive. However, only 14 of 24 patients completed the study. The results of this study did not indicate that individualized homeopathic treatment is superior to placebo.

The totality of this evidence from three controlled trials therefore fails to show a treatment effect. The two nonrandomized trials28,29 seem to suggest therapeutic equivalence between homeopathy and conventional therapy. Yet this result could be due to bias. The randomized study30 shows a marginal superiority of placebo over homeopathy.

Discussion

Perhaps the most surprising result of this systematic review is the fact that only three controlled trials of homeopathy have been published. Vis-à-vis the fact that most homeopaths firmly believe that homeopathic remedies are effective for eczema,10,30 this finding seems disappointing. The second amazing point is that none of the available studies is rigorous: two were not randomized28,29 and might have generated false-positive results due to selection bias, and one30 is far too small to provide reliable, generalizable findings. The inescapable conclusion from these considerations therefore is that the use of homeopathy is not supported by the findings of sound evidence, a conclusion that concurs with previous assessments.26

This raises the question why so many patients perceive benefit from consulting a homeopath. The most plausible answer is that they benefit from the nonspecific effects of homeopathy.31 For instance, the therapeutic encounter with homeopaths is usually empathetic and lengthy. Such factors can lead to clinical improvements even if the prescribed medication is a pure placebo.32 Proponents of homeopathy might therefore tend to argue (with some justification) that homeopathy is useful regardless of how it works.1 Sceptics, on the other hand, would suggest that nonspecific effects are an almost inevitable adjunct to any well-administered treatment and would also benefit a patient who is treated with effective conventional therapies. Exclusively employing nonspecific therapeutic effects, as in homeopathy, is therefore less than optimal and not in the best interest of patients with eczema.33

Proponents of homeopathy might argue that the above evidence does not convincingly demonstrate the lack of effectiveness of homeopathic remedies: absence of evidence is not evidence of absence of an effect! Strictly speaking, this is probably true. Yet one ought to point out that, in the best interest of patients, it is usually prudent to consider any therapy that is not supported by solid evidence as unproven. Such treatments do not normally have a place in routine healthcare.

This systematic review has several obvious weaknesses. There is no guarantee that all available studies were located. Publication bias might have distorted the overall picture. The paucity and low quality of the included studies preclude certainty. In total, these weaknesses render this review less than conclusive.

In conclusion, the available trial data do not demonstrate homeopathic remedies to be efficacious as a treatment of eczema.

What’s already known about this topic?

  •  Homeopathy is frequently advocated and used for eczema but its efficacy is uncertain.

What does this study add?

  •  The totality of the evidence from controlled clinical trials fails to suggest that homeopathy is an efficacious treatment for eczema.

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