What’s new in atopic eczema? An analysis of systematic reviews published in 2018. Part 1: prevention and topical therapies

Abstract

Summary This review is part of a series of annual updates that summarize the evidence base for atopic eczema (AE). The aim is to provide a succinct guide for clinicians on the key findings from 14 systematic reviews on the prevention and topical treatment of AE published or indexed in 2018. Various supplements, including long‐chain polyunsaturated fatty acids, vitamin D and the probiotic Lactobacillus rhamnosus GG, given prenatally and postnatally, have not been shown to prevent AE in infants, although mixed strains of probiotics may decrease the risk of AE if given to the mother during pregnancy and to the infant for the first 6 months of life. In the postnatal period, there is no evidence that hydrolysed formula, compared with cow’s milk formula (CMF), reduces the risk of AE in partially breastfed infants. However, weak evidence suggests that a specific partially hydrolysed whey formula decreases the risk of AE compared with CMF. No specific skin practices can be recommended to reduce the eczema risk in healthy term babies. There is weak evidence of a low risk of reversible hypothalamic–pituitary–adrenal axis suppression following 2–4 weeks of treatment with low‐potency topical steroids, and conflicting evidence as to whether bleach bathing affects skin flora or AE severity. A single study demonstrated that the topical Janus kinase inhibitor tofacitinib at 2% significantly reduces the Eczema Area and Severity Index compared with vehicle. Topical naltrexone cream 1% improves pruritus (measured using a visual analogue scale) by 30% more than placebo. There is weak evidence that topical alternative therapies, including antioxidants, micronutrients and some herbal medicines, may improve AE.

Long-Term Use of Oral Corticosteroids and Safety Outcomes for Patients With Atopic Dermatitis

“…Although previous studies among patients with asthma or rheumatic disease have suggested associations between long-term use of oral corticosteroids and various adverse events (AEs), there are few studies of patients with AD, to our knowledge . In addition, existing studies about corticosteroid use among patients with AD were conducted to evaluate the safety concerns primarily about topical corticosteroids . Considering the frequent use of oral corticosteroids among adults with AD and the potential association between long-term use of oral corticosteroids and AEs, some of which are severe, there is a need to investigate the safety of the long-term use of oral corticosteroids among adults with AD .…”

“… 15 , 16 , 17 , 18 , 19 , 20 , 21 In addition, existing studies about corticosteroid use among patients with AD were conducted to evaluate the safety concerns primarily about topical corticosteroids. 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 Considering the frequent use of oral corticosteroids among adults with AD and the potential association between long-term use of oral corticosteroids and AEs, some of which are severe, there is a need to investigate the safety of the long-term use of oral corticosteroids among adults with AD. 6 , 30 , 31 Accordingly, we aimed to investigate the association between long-term use of oral corticosteroids and AEs among adult patients with AD in South Korea.…”

Evidence-based management of eczema: five things that should be done more and five things that should be dropped

“…Over the last 12 years, the Centre of Evidence-Based Dermatology (CEBD) has conducted annual updates of systematic reviews related to various aspects of eczema management [1][2][3] with a focus on critical appraisal, in order to inform clinical practice. Topics include epidemiology [4], disease mechanisms [5], risk factors [6,7], prevention [8], topical [3] and systemic therapies [2]. We use this comprehensive resource of appraised systematic reviews as the main evidence source for this article, supplemented by key randomized controlled trials (RCTs).…”

“…Over the last 12 years, the Centre of Evidence-Based Dermatology (CEBD) has conducted annual updates of systematic reviews related to various aspects of eczema management [1–3] with a focus on critical appraisal, in order to inform clinical practice. Topics include epidemiology [4], disease mechanisms [5], risk factors [6,7], prevention [8], topical [3] and systemic therapies [2].…”