Clinical Review Clinical evidence

Atopic eczema

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7198.1600 (Published 12 June 1999) Cite this as: BMJ 1999;318:1600
  1. Carolyn Charman, research fellow in dermatology
  1. Queen's Medical Centre, Nottingham NG7 2UH

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    This review is one of over 60 chapters included in the first issue of Clinical Evidence, a new information resource for clinicians available from 28 June 1999. The compendium will be updated and expanded every six months. Future issues of Clinical Evidence will summarise the evidence on further interventions on eczema, including emolients, ichthammol and tar, PUVA, oral treatments, alternative treatments, and psychological approaches. For more information see the editorial by Fiona Godlee and advertisements facing p 1598 (clinical research), p 1621 (general practice) and p 1567 (other editions).

    Key messages

    • Small RCTs have found that topical corticosteroids relieve symptoms of atopic eczema and are safe in the short term. We found little good information on their long term side effects or on their effects, if any, on the natural history of atopic eczema.

    • We found limited evidence suggesting that the routine addition of antimicrobial agents to topical steroid preparations provides no additional benefit.

    • We found limited evidence that control of house dust mite reduces severity of symptoms, especially in patients with positive mite RAST scores and in children, but only if very low levels are achieved. Bedding covers were found to be the most effective control method.

    • We found insufficient evidence that dietary manipulation in adults or children reduces the severity of symptoms.

    • We found insufficient evidence that either prolonged breast feeding or manipulation of mother's diet during lactation protects against the development of eczema in infants with a family history of atopy.

    Background

    Definition: Atopic eczema (atopic dermatitis) is an inflammatory skin disease, characterised by an itchy, erythematous, poorly demarcated skin eruption, which has a predilection for the skin creases.1

    Incidence/prevalence: In the United Kingdom atopic eczema affects 15-20% of schoolchildren2 and 2-3% of adults. Prevalence has increased substantially over the past 30 years,3 possibly because of …

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