What’s new in Atopic Eczema

Dr. Simon Dawe Consultant Dermatologist

West Hertfordshire NHS trust

Prevention of Eczema (Breastfeeding)

Yang et al systematic review 34227 participants 27 studies

No strong evidence that exclusive breastfeeding for at least 3 months protects against atopic eczema

Excusive Breastfeeding and incident atopic dermatitis e.t.c Yang et al Br J Dermatol 2009; 161: 737-83

Prevention of Eczema (Breastfeeding)

51119 randomly selected 8- to 12-year-old schoolchildren in 21 countries

Risk estimates were very similar for exclusive breastfeeding < 2 months, 2-4 months and > 4 months and for eczema symptoms in the past 12 months and eczema on skin examination

As for more severe eczema, breastfeeding per se conveyed a risk reduction on sleep disturbed eczema

Although there was a protective effect of ever having been breastfed on more severe disease (pooled adjusted OR 1.11) , no evidence that exclusive breastfeeding for 4 months or longer protects against eczema Lack of evidence for a protective effect of prolonged breastfeeding on childhood

eczema: lessons from the International Study of Asthma and Allergies in Childhood

(ISAAC) Phase Two Br J Dermatol. 2011 Aug 24

Prevention of Eczema

Omega -3 and -6 oils Anandan et al four studies omega-3 679 participants Two studies omega-6 259 participants Non-significant increased risk of developing

eczema after omega-3 supplementation Non-significant decreased risk of developing

eczema after omega-6 supplementation No effect on asthma allergic rhinitis or food

allergyOmega 3 and 6 oils for primary prevention e.t.c Anandan C et al Allergy 2009; 64:840-8

Treatment

Dietary exclusion Cochrane review by Bath-Hextall et al No evidence of benefit but poor trails

and data

Ion-exchange water softeners

This was an observer-blind randomised trial involving 336 children (aged 6 months to 16 years) with moderate/severe atopic eczema

randomised to either installation of an ion-exchange water softener plus usual eczema care, or usual eczema care alone

The primary outcome was change in eczema severity (Six Area Six Sign Atopic Dermatitis Score, SASSAD) at 12 weeks

The mean change in SASSAD at 12 weeks was -5.0 (20% improvement) for the water softener group and -5.7 (22% improvement) for the usual care group

A randomised controlled trial of ion-exchange water softeners for the treatment of eczema in childrenThomas KS, Dean T, O'Leary C, Sach TH, Koller K, Frost A,

Williams HC; SWET Trial Team.

PLoS Med. 2011 Feb 15;8(2)

Probiotics

A cochrane review 2008 Boyle et al 2009 12 RCT’s (781 children) SCORAD reduction

of 0.9 non significant (95% CI -2.84 to 1.04) QOL for two studies demonstrated no

difference Michail et al 2008 further review further

meta analysis showed no clear benefit

Chinese Herbal medicine Four trials located The trials randomised 159 participants aged from

1 to 60 years Three trials were randomised placebo controlled,

two-phase cross-over designs assessing the same Chinese herbal mixture, Zemaphyte

In two of these three trials the reduction in erythema and surface damage was greater on Zemaphyte than on placebo, and participants slept better and expressed a preference for Zemaphyte

Zemaphyte is no longer being manufactured. Results not reproducible in chinese patients

Chinese herbal medicine for atopic eczema Cochrane reviewZhang W, Leonard T, Bath-Hextall FJ, Chambers C, Lee C, Humphreys R, Williams HC

What's new in atopic eczema? An analysis of systematic reviews

published in 2009-2010Shams K, Grindlay DJ, Williams HC.

Clin Exp Dermatol. 2011 Aug;36(6):573-7; quiz 577-8

There was no good evidence on the possible benefit of organic food consumption and eczema

An inverse relationship has been found between gliomas/acute lymphoblastic leukaemia and allergic disease/eczema

The risk of eczema seems to be increased in urban compared with rural areas

An updated Cochrane Review still found no evidence of a benefit from any form of antistaphylococcal treatment in managing clinically infected or uninfected eczema

Attention deficit hyperactivity disorder does appear to be associated with eczema, but there is no evidence of a causal link

Thankyou