What’s new in atopic eczema? An analysis of systematic reviews published in 2009–2010

Authors


  • A similar and more detailed review to the material published here appeared in the 2010 Annual Evidence Update on Atopic Eczema published by NHS Evidence – skin disorders in September 2010 (http://www.library.nhs.uk/skin/ViewResource.aspx?resID=386959&tabID=289&catID=8310), and explicit reference is given to that fuller version throughout. There are no copyright issues with using material from that source.

  • Conflict of interest: KS, DJCG and HCW work in the UK National Health Service (NHS). NHS Evidence – skin disorders is funded by the NHS. DJCG and HCW have no financial connections with any pharmaceutical company. KS has previously received funding by Almirall and Janssen for travel/accommodation to attend courses.

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

Summary

This review provides a summary of key findings from 18 systematic reviews on atopic eczema, published or indexed between January 2009 and 24 August 2010. There was no good evidence on the possible benefit of organic food consumption and eczema. Maternal intake of fish or fish oil may be associated with a reduced risk of eczema in offspring, although further studies are needed. There is some evidence that partially hydrolysed infant formulas rather than standard formulas may be associated with a reduced risk of eczema in infants, but there are shortcomings in the existing evidence. An inverse relationship has been found between gliomas/acute lymphoblastic leukaemia and allergic disease/eczema, but there appears to be no association between multiple sclerosis and eczema. Attention deficit hyperactivity disorder does appear to be associated with eczema, but there is no evidence of a causal link. The risk of eczema seems to be increased in urban compared with rural areas. Some new evidence has suggested superiority of 1% pimecrolimus over potent and mild corticosteroids at 6 months but not 12 months, and there is some evidence for superiority of 0.03% and 0.1% tacrolimus over 1% pimecrolimus. An updated Cochrane Review still found no evidence of a benefit from any form of antistaphylococcal treatment in managing clinically infected or uninfected eczema. The evidence base is poor for bath emollients, occlusive treatments (e.g. wet and dry wraps) and woven silk clothing in treating eczema. In general, the methods used in most systematic reviews of eczema need to be reported more clearly, especially with regard to a more vigorous quality assessment of included studies. Included studies are frequently heterogeneous, proxy reporting is common, and appropriate disease definitions are often lacking. Better adherence to existing guidance on trial reporting and prospective registration of clinical trials may help improve the quality of studies.

Ancillary