Guidelines of care for atopic dermatitis

Hanifin, Jon M.; Cooper, Kevin D.; Ho, Vincent; Kang, Sewon; Krafchik, Bernice R.; Margolis, David J.; Schachner, Lawrence A.; Sidbury, Robert; Whitmore, S. Elizabeth; Sieck, Carol K.; Voorhees, Abby S. Van

doi:10.1016/j.jaad.2003.08.003

Cited by 318 publications

(163 citation statements)

References 197 publications

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“…188 The SIGN, 42 NICE 41 and American Academy of Dermatology (AAD) 94 guidelines have all covered emollients. A review of reducing pruritus for eczema 93 covers emollients, topical doxepin and sodium chromoglycate and a Cochrane review 189 covers evening primrose oil and borage oil for eczema treatment.…”

Section: Existing Systematic Reviewsmentioning

confidence: 99%

“…245 A systematic review in 2007, with a search end date in September 2005, assessed the safety of topical therapies for atopic dermatitis and this included topical antibiotics and antiseptic treatments. 80 All three of the current eczema guidelines from the AAD, 94 …”

Section: Existing Systematic Reviewsmentioning

confidence: 99%

“…Five reviews 79,[272][273][274][275] specifically examine probiotic supplementation, a Cochrane review 276 and subsequent non-Cochrane updated review 277 specifically evaluate dietary exclusions, another Cochrane review 278 specifically explores dietary supplementation and other reviews 35,41,42,93,94,[279][280][281][282][283] cover more than one dietary intervention. A Cochrane review of evening primrose oil and borage oil supplementation has also recently been published.…”

Section: Existing Systematic Reviewsmentioning

confidence: 99%

“…Since 2000, 15 systematic reviews [79][80][81][82][83][84][85][86][87][88][89][90][91][92][93] and three guidelines 41, 42,94 have been published on the use of topical corticosteroids and/or topical calcineurin inhibitors. Two reviews have assessed occlusive therapy.…”

Section: Introductionmentioning

confidence: 99%

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Scoping systematic review of treatments for eczema

Nankervis

Kim

Delamere

et al. 2016

Programme Grants Appl Res

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BackgroundEczema is a very common chronic inflammatory skin condition.ObjectivesTo update the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) systematic review of treatments for atopic eczema, published in 2000, and to inform health-care professionals, commissioners and patients about key treatment developments and research gaps.Data sourcesElectronic databases including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Skin Group Specialised Register, Latin American and Caribbean Health Sciences Literature (LILACS), Allied and Complementary Medicine Database (AMED) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from the end of 2000 to 31 August 2013. Retrieved articles were used to identify further randomised controlled trials (RCTs).Review methodsStudies were filtered according to inclusion criteria and agreed by consensus in cases of uncertainty. Abstracts were excluded and non-English-language papers were screened by international colleagues and data were extracted. Only RCTs of treatments for eczema were included, as other forms of evidence are associated with higher risks of bias. Inclusion criteria for studies included availability of data relevant to the therapeutic management of eczema; mention of randomisation; comparison of two or more treatments; and prospective data collection. Participants of all ages were included. Eczema diagnosis was determined by a clinician or according to published diagnostic criteria. The risk of bias was assessed using the Cochrane Collaboration risk-of-bias tool. We used a standardised approach to summarising the data and the assessment of risk of bias and we made a clear distinction between what the studies found and our own interpretation of study findings.ResultsOf 7198 references screened, 287 new trials were identified spanning 92 treatments. Trial reporting was generally poor (randomisation method: 2% high, 36% low, 62% unclear risk of bias; allocation concealment: 3% high, 15% low, 82% unclear risk of bias; blinding of the intervention: 15% high, 28% low, 57% unclear risk of bias). Only 22 (8%) trials were considered to be at low risk of bias for all three criteria. There was reasonable evidence of benefit for the topical medications tacrolimus, pimecrolimus and various corticosteroids (with tacrolimus superior to pimecrolimus and corticosteroids) for both treatment and flare prevention; oral ciclosporin; oral azathioprine; narrow band ultraviolet B (UVB) light; Atopiclair™ and education. There was reasonable evidence to suggest no clinically useful benefit for twice-daily compared with once-daily topical corticosteroids; corticosteroids containing antibiotics for non-infected eczema; probiotics; evening primrose and borage oil; ion-exchange water softeners; protease inhibitor SRD441 (Serentis Ltd); furfuryl palmitate in emollient; cipamfylline cream; andMycobacterium vaccaevaccine. Additional research evidence is needed for emollients, bath additives, antibacterials, specialist clothing and complementary and alternative therapies. There was no RCT evidence for topical corticosteroid dilution, impregnated bandages, soap avoidance, bathing frequency or allergy testing.LimitationsThe large scope of the review coupled with the heterogeneity of outcomes precluded formal meta-analyses. Our conclusions are still limited by a profusion of small, poorly reported studies.ConclusionsAlthough the evidence base of RCTs has increased considerably since the last NIHR HTA systematic review, the field is still severely hampered by poor design and reporting problems including failure to register trials and declare primary outcomes, small sample size, short follow-up duration and poor reporting of risk of bias. Key areas for further research identified by the review include the optimum use of emollients, bathing frequency, wash products, allergy testing and antiseptic treatments. Perhaps the greatest benefit identified is the use of twice weekly anti-inflammatory treatment to maintain disease remission. More studies need to be conducted in a primary care setting where most people with eczema are seen in the UK. Future studies need to use the same core set of outcomes that capture patient symptoms, clinical signs, quality of life and the chronic nature of the disease.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Existing Systematic Reviewsmentioning

confidence: 99%

Section: Existing Systematic Reviewsmentioning

confidence: 99%

Section: Existing Systematic Reviewsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Scoping systematic review of treatments for eczema

Nankervis

Kim

Delamere

et al. 2016

Programme Grants Appl Res

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“…In the treatment of atopic dermatitis, along with anti-inflammatory agents such as corticosteroids and calcineurin inhibitors, regular applications of moisturizer have been recommended. 17,18) Considering that chitosan is a non-toxic, biodegradable and biocompatible polymer, our findings suggest that the addition of chitosan to commonly used topical treatments may be a therapeutic option for treating itch and dry skin conditions in dermatological disorders, including atopic dermatitis.…”

Section: Discussionmentioning

confidence: 91%

Inhibitory Effect of Chitosan-Containing Lotion on Scratching Response of Hairless Mice with Atopic Dermatitis-Like Dry Skin

Fujii

Shimizu

Nakamura

et al. 2011

Biological & Pharmaceutical Bulletin

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Persistence of Mild to Moderate Atopic Dermatitis

et al. 2014

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Importance Atopic dermatitis (AD) is a common illness of childhood Objective The goal of this study was to evaluate the natural history of AD and determine the persistence of symptoms over time. Design A cross-sectional and cohort study. Setting A nation-wide long-term registry of children with AD. Participants Children enrolled in the Pediatric Eczema Elective Registry (PEER). Main outcome Self-reported outcome of whether or not a child’s skin was AD symptom-free for 6 months at 6 month intervals. Results 7,157 subjects were enrolled in the PEER study for a total of 22, 550 person-years. At least 2 years of follow-up was observed for 4,248 and at least 5 years of follow-up was observed for 2,416 children. Multiple demographic and exposure variables were associated with more persistent AD. At every age (i.e. 2 to 26 years), more than 80% of PEER subjects had symptoms of AD and/or were using medication to treat their AD. It was not until age 20 years that 50% of subjects had at least one lifetime six-month symptom and treatment free period. Conclusions and Relevance Based on this large longitudinal cohort study, symptoms associated with AD appear to persist well into the second decade of a child’s life and likely longer. AD is likely a life-long illness.

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Guidelines of care for atopic dermatitis

Cited by 318 publications

References 197 publications

Scoping systematic review of treatments for eczema

Scoping systematic review of treatments for eczema

Inhibitory Effect of Chitosan-Containing Lotion on Scratching Response of Hairless Mice with Atopic Dermatitis-Like Dry Skin

Persistence of Mild to Moderate Atopic Dermatitis

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