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Randomised controlled trial of short bursts of a potent topical corticosteroid versus prolonged use of a mild preparation for children with mild or moderate atopic eczema

BMJ 2002; 324 doi: (Published 30 March 2002) Cite this as: BMJ 2002;324:768
  1. K S Thomas, trial coordinatora,
  2. S Armstrong, lecturer in medical statisticsc,
  3. A Avery, professor of primary healthcareb,
  4. A Li Wan Po, professor of clinical pharmaceuticsd,
  5. C O'Neill, reader in health economics and policye,
  6. S Young, directorf,
  7. H C Williams, professor of dermatoepidemiology (hywel.williams{at}
  1. a Centre of Evidence-Based Dermatology, Queen's Medial Centre, Nottingham NG7 2UH
  2. b Division of General Practice, Queen's Medical Centre
  3. c Trent Institute for Health Services Research, Queen's Medical Centre, Nottingham NG12 2HJ
  4. d Centre for Evidence Based Pharmacotherapy, Aston University, Birmingham B4 ET
  5. e School of Public Policy, Law and Economics, University of Ulster and Harkness, Newtonabbey, Northern Ireland
  6. f Tissue Viability Unit, Nuffield House, Guy's Hospital, London SE1 1YR
  1. Correspondence to: H C Williams
  • Accepted 19 December 2001


Objective: To determine whether a three day burst of a potent corticosteroid is more effective than a mild preparation used for seven days in children with mild or moderate atopic eczema.

Design: Randomised, double blind, parallel group study of 18 weeks' duration.

Setting: 13 general practices and a teaching hospital in the Nottingham area.

Participants: 174 children with mild or moderate atopic eczema recruited from general practices and 33 from a hospital outpatient clinic.

Interventions: 0.1% betamethasone valerate applied for three days followed by the base ointment for four days versus 1% hydrocortisone applied for seven days.

Main outcome measures: Primary outcomes were total number of scratch-free days and number of relapses. Secondary outcomes were median duration of relapses, number of undisturbed nights, disease severity (six area, six sign atopic dermatitis severity scale), scores on two quality of life measures (children's life quality index and dermatitis family impact questionnaire), and number of patients in whom treatment failed in each arm.

Results: No differences were found between the two groups. This was consistent for all outcomes. The median number of scratch-free days was 118.0 for the mild group and 117.5 for the potent group (difference 0.5, 95% confidence interval −2.0 to 4.0, P=0.53). The median number of relapses for both groups was 1.0. Both groups showed clinically important improvements in disease severity and quality of life compared with baseline.

Conclusion: A short burst of a potent topical corticosteroid is just as effective as prolonged use of a milder preparation for controlling mild or moderate atopic eczema in children.

What is already known on this topic

What is already known on this topic Topical corticosteroids have been used to control atopic eczema for 40 years

No studies have compared short bursts of a potent preparation with prolonged use of a weak preparation for controlling mild or moderate disease

What this study adds

What this study adds A short burst of a potent topical steroid is as effective and safe as prolonged use of a weak preparation for mild or moderate atopic eczema

The type of preparation is immaterial provided that the dosage is adequate


  • Funding NHS research and development programme (Trent).

  • Competing interests MW has received funds from the NHS health technology assessment programme. It is possible that the NHS could gain from this research. ALWP is a consultant to Medical Solutions, a company that markets benzoyl peroxide formulations and anti-eczema products.

  • Accepted 19 December 2001
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