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my personal edition > dermatitis > news
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DGReview
Childhood Atopic Eczema Responds Equally To Potent Or Mild Therapy
A DGReview of :"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"
British Medical Journal (BMJ)
04/01/2002
By Harvey McConnell
A short burst of a potent topical corticosteroid is as effective and safe as prolonged use of a weak preparation for treatment of mild or moderate atopic eczema in children.
The type of preparation is immaterial provided that the dosage is adequate, according to clinicians at the Center of Evidence Based Dermatology, Queen's Medical Center, Nottingham, England, following a randomized, double blind, parallel group 18 week study.
Clinicians enrolled 174 children with mild or moderate atopic eczema recruited from 13 family practices and 33 children from the outpatient clinic at a teaching hospital in Nottingham.
Atopic eczema, or atopic dermatitis affects around 15 percent of British school children and usually follows a chronic relapsing course, the clinicians point out. Topical corticosteroids have been the mainstay of treatment four decades, yet few clinical trials have studied their optimum use.
Doctors and patients are concerned about the known side effects from the corticosteroids, including thinning of the skin. This is often the main reason for poor compliance with treatment.
This study aimed to determine whether a three day burst of a potent topical corticosteroid was more effective than a mild preparation used continuously for seven days, without causing an increase in thinning of the skin. Children between the ages of one and 15 with atopic eczema as defined by Hanifin and Rajka's modified diagnostic criteria were enrolled. The subjects exhibited mild or moderate atopic eczema within the past month. but those with severe eczema were excluded on ethical grounds.
The children were given either 0.1% betamethasone valerate applied for three days followed by the base ointment for four days, or 1% hydrocortisone applied for seven days. Primary outcomes were total number of scratch-free days and number of relapses.
The clinicians found no differences between the two groups. Median number of scratch-free days was 118.0 for the mild treatment group and 117.5 for the potent treatment group. Both groups demonstrated clinically important improvements in the severity of the disease and their equality of life, and the number of relapses was small.
They conclude: "The liberal use of an emollient might achieve similar control to topical steroids for children with mild or moderate eczema. Researchers should consider a treatment arm of emollient only for trials based in primary care."
BMJ 2002;324:768.
"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"
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