Various types of dressings have been used successfully in the treatment of atopic dermatitis. In this study we looked at the efficacy of two of the newer topical steroids when applied under wet wrap dressings for the treatment of refractory atopic dermatitis in children. Forty children with moderate to severe disease were randomized to receive either one‐tenth‐strength diluted 0.1% mometasone furoate ointment or one‐tenth‐strength diluted 0.005% fluticasone proprionate ointment. These were applied once a day over a 4‐week period without wet wraps, or for 2 weeks without wet wraps followed by 2 weeks of application under wet wraps. There was a 2‐week period for all patients when the topical treatment was standardized. At weekly follow‐ups, patients were assessed by a single, blinded observer and objectively scored for disease extent and severity. A subjective score was also given for the impact of eczema on daily living. There was significant improvement in the disease severity from baseline during the first 2 weeks of the open application arm (p=0.043), however, additional beneficial effects were limited after week 2. Wet wraps further improved the disease severity and extent after week 2 (p < 0.05), and were well tolerated. We concluded that both 0.1% mometasone furoate and 0.005% fluticasone proprionate ointments are effective in the treatment of atopic dermatitis, and that wet wraps are useful in further improving refractory disease in children.

SummaryBackground The International Study of Asthma and Allergies in Childhood (ISAAC) was designed to allow international comparison of epidemiological data on atopic conditions in childhood. In so doing, further aetiological information would be obtained that in turn would provide a framework for future studies. The global ISAAC results on the prevalence of atopic dermatitis indicated a 60-fold variation recorded in different countries. Such a degree of difference may be partially due to the translated questionnaires that were not validated in all of the involved countries. Objective To validate the Chinese version of the ISAAC core questions for atopic eczema. Methods One thousand nine hundred and twenty children aged between 3 and 5 were randomly recruited from 13 kindergartens in Hong Kong. Using a dermatologist's clinical examination as the gold standard, we validated the Chinese version of the ISAAC core questions for atopic eczema. The Youden's Indexes obtained in our study were compared with those obtained in the United Kingdom's validation study. Results The Youden's Indexes obtained in our study were significantly lower than those from the United Kingdom. The low scores were likely to be due to a reduction in the sensitivity of the Chinese questionnaire, which ranged from 23.5% to 70.6%. Conclusion Our findings indicate that the translated questionnaire is less effective than the English version in assessing the prevalence of atopic eczema. The indication of a low prevalence of atopic eczema among the Chinese population reported in previous studies was at least partially due to problems with the translated questionnaire.

The primary action of leukotrienes includes contraction of human airway muscle, chemotaxis, and increased vascular permeability, with secondary effects of inhibiting allergen-induced early and late responses. Although there is limited available information and research regarding leukotrienes in atopic dermatitis (AD), there is evidence to support their role in the pathogenesis of the disease. We conducted a pilot study to test the efficacy of montelukast, a cysteinyl-leukotriene-1 receptor antagonist, in 15 patients (6-16 years of age) with moderate-to-severe AD, using a randomized double-blind placebo-controlled crossover study. These patients had chronic moderate-to-severe AD, despite being on conventional therapy. They were randomized either to placebo for 4 weeks and then the study drug for 4 weeks, or vice versa. There was a 2-week run-in period for all participants before commencement of the study, and a 2-week washout before crossover. At enrollment and on each follow-up visit, every patient was assessed by a single observer and objectively scored for disease extent and severity. A subjective score was given for the impact of eczema on daily living. There was statistical improvement in patents on active treatment compared with placebo in the severity of AD (p < 0.05). Our findings suggest that leukotriene receptor antagonist as an adjunct treatment has an anti-inflammatory effect on moderate-to-severe AD. A larger trial is needed to ascertain its efficacy fully.