The Steroid-Sparing Effect of an Emollient Therapy in Infants with Atopic Dermatitis: A Randomized Controlled Study

Grimalt, Ramón; Mengeaud, V.; Cambazard, F.

doi:10.1159/000096915

Cited by 210 publications

(190 citation statements)

References 59 publications

(50 reference statements)

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“…Most of the 15 new trials 123,126,[190][191][192][193][194][195][196][197][198][199][200][201][202] looking at emollients reported after 2000 compared twice-daily treatment with an emollient (often applied concurrently with topical corticosteroid treatment) with treatment with topical corticosteroids alone, other emollients or, in one case, no treatment. Most trials had a treatment length of around 4-6 weeks and none of the trials gave treatment for > 2 months.…”

Section: Studiesmentioning

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: Studiesmentioning

confidence: 99%

“…Most trials had a treatment length of around 4-6 weeks and none of the trials gave treatment for > 2 months. Nearly all of the trials included participants with mild to moderate eczema, with only three trials 123,126,191 including participants with severe eczema.…”

Section: Studiesmentioning

confidence: 99%

Scoping systematic review of treatments for eczema

Nankervis

Kim

Delamere

et al. 2016

Programme Grants Appl Res

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“…clinically-uninvolved skin sites, as well as skin cleared of inflammation for ≤5 years, continue to display barrier abnormalities 2 ; 3) emollient therapy comprises effective ancillary therapy for AD 9 . Finally, 4) as will be discussed further below, specific lipid replacement therapy, which targets the prominent lipid abnormalities that account for the barrier abnormality 6,9 , not only corrects the barrier abnormality, but also ameliorates inflammation in AD.…”

Section: Introductionmentioning

confidence: 99%

“…Finally, 4) as will be discussed further below, specific lipid replacement therapy, which targets the prominent lipid abnormalities that account for the barrier abnormality 6,9 , not only corrects the barrier abnormality, but also ameliorates inflammation in AD.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Implications of a Barrier-based Pathogenesis of Atopic Dermatitis

Elias

2010

Ann Dermatol

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In this review, I first provide relevant background information about normal epidermal barrier structure and function. I then update recent information about how inherited defects in either filaggrin and/or in the serine protease inhibitor, lymphoepithelial Kazal-type inhibitor 1, converge to stimulate the development of atopic dermatitis (AD). Next I explain the multiple mechanisms whereby a primary barrier abnormality in AD can lead to inflammation. Furthermore, I explore how certain acquired stressors, such as a reduced external humidity, high pH soaps/surfactants, psychological stress, as well as secondary Staphylococcus aureus infections initiate or further aggravate AD. Finally, and most importantly, I compare various therapeutic paradigms for AD, highlighting the risks and benefits of glucocorticoids and immunomodulators vs. corrective, lipid replacement therapy. (Ann Dermatol 22(3) 245∼254, 2010)

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“…Os autores concluí-ram que a redução na colonização pelo S. aureus é conseqüência da melhora na superfície cutânea pela ação antiinflamatória da droga e, possivelmente, pelas propriedades emolientes do veículo. 17 O veículo pomada tem ação emoliente intrínse-ca e, embora alguns pacientes prefiram a textura em creme, a maioria dos dermatologistas recomenda pomada para pacientes com DA, pois auxilia na hidratação por redução da TEWL, principalmente nas lesões crônicas. Adicionalmente, os excipientes dos cremes podem irritar a pele sensível do paciente ató-pico.…”

Section: Discussionunclassified

Avaliação da eficácia e segurança do tacrolimo pomada 0,03% no tratamento da dermatite atópica em pacientes pediátricos

Duarte¹,

Sittart

Pires

et al. 2008

An. Bras. Dermatol.

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Resumo: FUNDAMENTOS -Tacrolimo pomada é eficaz no tratamento da dermatite atópica. OBJETIVOS -Avaliar a eficácia e segurança do tacrolimo pomada 0,03% (Protopic ® ) no tratamento de pacientes pediátricos com dermatite atópica. MÉTODOS -Estudo multicêntrico, aberto e não comparativo. Incluídos 174 pacientes (dois a 10 anos) com dermatite atópica. Utilizou-se tacrolimo duas vezes ao dia, por seis semanas. O critério primário de eficácia foi a melhora clínica > a 90% avaliada pelo médico (Escala de Avaliação Global da Resposta Clínica). Outros critérios de eficácia foram a redução no índice de área e gravidade do eczema (EASI), a redução do percentual de superfície corporal afetada (%BSA) e a avaliação do prurido pelo paciente (escala analógica visual). Segurança foi avaliada pela ocorrência de eventos adversos relatados pelos pais e pacientes ou pelos investigadores. RESULTADOS -Trinta e três por cento dos pacientes apresentaram melhora clínica >90%. Quando avaliado o escore EASI, houve redução de 45,5% (primeira semana) e 61,8% (sexta semana) quando comparado com o basal (p<0,001). Em relação a %BSA, houve redução de 30,4% e 55,5%, na primeira e na sexta semana. Houve redução do prurido em relação ao basal (p<0,001).Os eventos adversos mais comuns foram -queimação e prurido localizados. CONCLUSÃO -Tacrolimo pomada 0,03% é terapia segura e efetiva no tratamento da dermatite atópica leve a grave em pacientes pediátricos. INTRODUÇÃOA dermatite atópica (DA) é doença inflamatória cutânea crônica, com períodos de remissão e exacerbação. O prurido representa sintoma cardinal dessa condição. Acomete predominantemente a faixa etária pediá-trica, com 60% dos casos iniciando no primeiro ano de vida e 85% nos primeiros cinco anos. 1,2 A prevalência da DA tem aumentado nos últimos anos, e atualmente é estimado o acometimento de até 20% da população mundial. 1 Solé et al. demonstraram que a prevalência de eczema atópico e sintomas relacionados é variável no Brasil, com índices mais elevados nas regiões Norte e Nordeste, embora as variantes graves da doença sejam mais freqüentes na Região Sul. A prevalência do eczema flexural no Brasil varia de 5,3% a 13% em crianças e é menor em adolescentes (3,4-7,9%). 3 A doença tem etiologia complexa com ativação de mecanismos imunológicos e inflamatórios. O fenó-tipo clínico característico é resultado de suscetibilidade genética, fatores individuais, defeitos na barreira cutânea e resposta imunológica local e sistêmica. 4 A disfunção na ativação das células T com produção de citocinas representa papel central na patogênese da doença. 5 A DA pode afetar significativamente a qualidade de vida das crianças por comprometer as interações sociais e familiares, rebaixar a auto-estima, elevar o absenteísmo escolar e causar distúrbios do sono. 6 O controle da doença requer abordagem ampla, com medidas ambientais, comportamentais e farmacológicas. A abordagem ao paciente inclui identificação e restrição de alérgenos específicos, educação dos pais e pacientes, hidratação cutânea e manutenção da funç...

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The Steroid-Sparing Effect of an Emollient Therapy in Infants with Atopic Dermatitis: A Randomized Controlled Study

Cited by 210 publications

References 59 publications

Scoping systematic review of treatments for eczema

Scoping systematic review of treatments for eczema

Therapeutic Implications of a Barrier-based Pathogenesis of Atopic Dermatitis

Avaliação da eficácia e segurança do tacrolimo pomada 0,03% no tratamento da dermatite atópica em pacientes pediátricos

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