Evidence base: Atopic eczema

Keep up to date with the latest evidence for the management of atopic eczema

Flexural involvement in the childhood phase of AE (Author image)
Flexural involvement in the childhood phase of AE (Author image)

Clinical trials

Gene-environment interaction and effect on epidermal barrier and development of AE is explored in detail.

  • Schmitt J, von Kobyletzki L, Svensson A et al. Efficacy and tolerability of proactive treatment with topical corticosteroids and calcineurin inhibitors for atopic eczema: systematic review and meta-analysis of randomized controlled trials. Br J Dermatol 2011; 164: 415-28.

The role of 'proactive' treatment with low-dose anti-inflammatories to reduce/prevent flares is explored in this systematic review of randomised controlled proactive treatments.

Limitations of currently available treatments for AE, advantages and disadvantages of new therapeutic modalities and potential new cellular targets are discussed.

  • Greer FR, Sicherer SH, Wesley Burks A. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics 2008; 121(1): 183-91.

This report reviews the evidence relating to the role of diet in AE. There is evidence that exclusive breastfeeding in the first four months of life in infants at high risk of developing atopy may decrease the risk of developing atopic dermatitis in the first two years.

Guidelines

  • NICE. Atopic eczema in children: management of atopic eczema in children from birth up to the age of 12 years. CG57. London, NICE, 2007.

Refer to table 1 on assessment of disease and table 2 on stepped approach to management.

An extensive guideline, covering all the salient points relating to the management of AE.

Key text

  • Williams H. Evidence based dermatology (second edition). Oxford, Blackwell Publishing, 2008.

The chapter on atopic dermatitis is well written and concise. Case scenarios and questions are used as triggers to discuss the evidence-based management of eczema.

Online

The 'What's New' section provides annual evidence update information.

This is a good resource for clinical guidelines.

  

Contributed by Dr Rufaro Gamanya, clinical lecturer, department of dermatology and wound healing, Cardiff University School of Medicine.



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