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PRIMARY CARE: John Berth-Jones, Robert J Damstra, Stefan Golsch, John K Livden, Oliver Van Hooteghem, Fulvio Allegra, and Christine A Parker Twice weekly fluticasone propionate added to emollient maintenance treatment to reduce risk of relapse in atopic dermatitis: randomised, double blind, parallel group study BMJ 2003; 326: 1367 [Abstract] [Full text]

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John Berth-Jones et al

Jeremy Stephen Chowings   (2 July 2003)

topical maintenance treatment in atopic dermatitis in children

Egidio Barbi, Giorgio Longo, Alessandro Ventura   (15 July 2003)

John Berth-Jones et al 2 July 2003
Jeremy Stephen Chowings, GP Principal Long Lane Medical Centre, Long Lane, Aintree, Liverpool, L9 6DQ Send response to journal: Re: John Berth-Jones et al	The article by John Berth-Jones et al highlighted an interesting alternative for the treatment of atopic dermatitis which might very well prove to be steroid sparing. I was surprised however that the editorial team of the British Medical Journal (BMJ) thought this a good article to place in the primary care section of the BMJ. While I admit, the article was interesting to me as a family doctor, its setting in dermatology outpatient clinics would suggest a very different group of patients from those seen in the traditional general practice setting. Very few patients with atopic dermatitis will ever be referred from primary care to dermatology outpatient departments and those that are may well not be typical of the majority of patients with this condition. I would suggest, that in this era of concern for good evidence, it is just as important for editorial teams to consider what messages they send by placing articles under particular headings as it is for the authors to have conducted a rigourous scientific experiment. Competing interests:   None declared
topical maintenance treatment in atopic dermatitis in children 15 July 2003
Egidio Barbi, paediatrician clinica pediatrica university of trieste, Giorgio Longo, Alessandro Ventura Send response to journal: Re: topical maintenance treatment in atopic dermatitis in children	To the editor, The paper by Berth-Jones and others about the twice weekly use of fluticasone propionate in maintenance treatment of atopic dermatitis in adults finally gives a clear cut evidence of the efficacy of a diffuse clinical practice. We have been using a similar therapeutic approach to treat moderate and severe atopic dermatitis in children for many years using hydrocortisone . We retrospectively reviewed the data of the last five years of our outpatients service about treatment and follow up of 167 children ( mean age 13 months , range 3- 37 months ) with moderate to severe atopic dermatitis. We used hydrocortisone as maintenance treatment twice weekly for two consecutive days for 6 weeks after 5 consecutive days of daily use as “induction treatment”. 127 out off 167 ( 76% ) of parents complied with treatment, while the others could not win “steroid phobia” . Remission lasting more than 4 weeks after the end of treatment was achieved in 109 (86%) out off 127 of patients who complied with treatment without significant side effects . Moreover during 6 months-4 years follow up, several parents repeated successfully the same treatment scheme by their own in occasion of flares of the dermatitis. Even if prospective , controlled trials are needed , our data suggest that a medium term maintenance twice weekly topical hydrocortisone treatment can be effective and safe in children with atopic dermatitis as it has been shown by Berth-Jones and others for fluticasone in adults . Giorgio Longo, Egidio Barbi , Alessandro Ventura Clinica Pediatrica, IRCCS Burlo Garofolo, Universita’ di Trieste-Italy Competing interests:   None declared