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What’s new in atopic eczema? An analysis of the clinical significance of systematic reviews on atopic eczema published in 2006 and 2007

Authors


  • A similar and more detailed review to this appeared in the 2007 Annual Evidence Update on Atopic Eczema from the National Library for Health Skin Disorders Specialist Library in September 2007 (http://www.library.nhs.uk/skin/Page.aspx?pagename=ECZEMANEW) and explicit reference is given to that fuller version throughout. There are no copyright issues with using material from that source.

  • Conflict of interest: Both authors work in the UK National Health Service (NHS), which funds the National Library for Health. Neither author has any financial connections with any pharmaceutical company.

Professor Hywel Williams, Professor of Dermato-Epidemiology, Centre of Evidence-Based Dermatology, Queen’s Medical Centre, University of Nottingham NG7 2UH, UK.
E-mail: hywel.williams@nottingham.ac.uk

Summary

This review summarizes clinically important findings from 19 systematic reviews published between January 2006 and August 2007 on the topic of atopic eczema (AE). The evidence suggests that avoidance of allergenic foods during pregnancy or the use of hydrolyzed or soy formula milks does not prevent eczema. Delayed introduction of solids may decrease eczema risk. Asthma typically develops in around a third of children with eczema, and wheezing in early infancy is a predictor of risk. Established topical corticosteroids such as betamethasone should be used just once daily. Topical tacrolimus and pimecrolimus can be used for people who become dependent on topical corticosteroids, especially on sensitive sites such as the face. Wet wraps are useful in secondary care for inducing remission in a child, but they are not a treatment for mild eczema and they should not be used long term. Oral ciclosporin can be used for inducing a remission in severe eczema, and azathioprine can be considered for maintenance treatment. Narrowband ultraviolet (UV)B phototherapy can be used for chronic AE, and UVA1 may be useful for acute eczema. There is little convincing evidence of a clinical benefit with evening primrose oil for eczema, but there is some good new evidence that educational support to eczema families is beneficial. Future trials need to be larger, and include active comparators, patient-reported outcomes and longer-term aspects of disease control. They should be better reported, and registered on a public clinical trials register.

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