Eczema (previously known as atopic dermatitis or atopic eczema)1 affects up to 20% of children worldwide.2 Although most eczema in children is mild,3 caring for a child with chronic severe eczema can be distressing. Sleep disturbance from scratching affects the whole family,4 and witnessing a child scratching their limbs until they bleed is agonising. In this week's BMJ a randomised controlled trial by Staab and colleagues (p 933) reports an evaluation of educational programmes for young people with eczema and their families, and provides new and useful evidence.5

Eczema carries a high economic burden, with costs comparable to asthma.6 The causes of eczema are unclear, and treatment is geared largely around restoring the barrier function of the dry skin typical of eczema, and by suppressing skin inflammation with topical corticosteroids and other topical or systemic agents.7

A systematic review of 272 randomised controlled trials of eczema treatments concluded that most trials were of poor quality, too small, and too short in duration for such a chronic relapsing disease.8 Most of the trials in this review had evaluated questions about similar drugs rather than other potentially important interventions—such as special clothing, diets, …