Authors' objectives:

The objectives of this scoping review are: - To produce an up-to-date coverage map of randomised controlled trials (RCTs) of treatments of atopic eczema. - To assist in making treatment recommendations by summarising the available RCT evidence using qualitative and quantitative methods.

Authors' results and conclusions: A total of 1165 possible RCTs were retrieved in hard copy form for further scrutiny. Of these, 893 were excluded from further analysis because of lack of appropriate data. The 272 remaining RCTs of atopic eczema covered at least 47 different interventions, which could be broadly categorised into ten main groups. Quality of reporting was generally poor, and limited statistical pooling was possible only for oral cyclosporin, and only then after considerable data transformation. There was reasonable RCT evidence to support the use of oral cyclosporin, topical corticosteroids, psychological approaches and ultraviolet light therapy. There was insufficient evidence to make recommendations on maternal allergen avoidance for disease prevention, oral antihistamines, Chinese herbs, dietary restriction in established atopic eczema, homeopathy, house dust mite reduction, massage therapy, hypnotherapy, evening primrose oil, emollients, topical coal tar and topical doxepin. There was no RCT evidence to support any clear clinical benefit on the use of avoidance of enzyme washing powders, cotton clothing as opposed to soft-weave synthetics, biofeedback, twice-daily as opposed to once-daily topical corticosteroids, topical antibiotic/steroid combinations versus topical steroids alone and antiseptic bath additives. There was complete absence of RCT evidence on short bursts of potent versus longer-term weaker topical steroids, dilution of topical corticosteroids, oral prednisolone and azathioprine, salt baths, impregnated bandages, wet-wrap bandages, water softening devices, allergy testing, and different approaches to organisation of care.

Authors' recommendations: The evidence base for the prevention and treatment of atopic eczema has many limitations. It is characterised by a profusion of short-term trials of 'me too' products, a lack of common outcome measures which measure things that are important to patients, poor standards of clinical trial reporting, and a lack of data on questions that physicians and people with atopic eczema deem to be important. Little research has evaluated commonly used treatments compared with each other or in combination. This mismatch is probably due to a combination of the questions not being asked coupled with a lack of independent investment in primary atopic eczema research.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.hta.ac.uk/1039

Year Published: 2000

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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