Dietary supplements for established atopic eczema

Bath‐Hextall, Fiona; Jenkinson, Claire; Humphreys, Rosemary; Williams, Hywel C

doi:10.1002/14651858.cd005205.pub3

Cited by 73 publications

(53 citation statements)

References 63 publications

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“…Five reviews 79,[272][273][274][275] specifically examine probiotic supplementation, a Cochrane review 276 and subsequent non-Cochrane updated review 277 specifically evaluate dietary exclusions, another Cochrane review 278 specifically explores dietary supplementation and other reviews 35,41,42,93,94,[279][280][281][282][283] cover more than one dietary intervention. A Cochrane review of evening primrose oil and borage oil supplementation has also recently been published.…”

Section: Existing Systematic Reviewsmentioning

confidence: 99%

Scoping systematic review of treatments for eczema

Nankervis

Kim

Delamere

et al. 2016

Programme Grants Appl Res

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BackgroundEczema is a very common chronic inflammatory skin condition.ObjectivesTo update the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) systematic review of treatments for atopic eczema, published in 2000, and to inform health-care professionals, commissioners and patients about key treatment developments and research gaps.Data sourcesElectronic databases including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Skin Group Specialised Register, Latin American and Caribbean Health Sciences Literature (LILACS), Allied and Complementary Medicine Database (AMED) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from the end of 2000 to 31 August 2013. Retrieved articles were used to identify further randomised controlled trials (RCTs).Review methodsStudies were filtered according to inclusion criteria and agreed by consensus in cases of uncertainty. Abstracts were excluded and non-English-language papers were screened by international colleagues and data were extracted. Only RCTs of treatments for eczema were included, as other forms of evidence are associated with higher risks of bias. Inclusion criteria for studies included availability of data relevant to the therapeutic management of eczema; mention of randomisation; comparison of two or more treatments; and prospective data collection. Participants of all ages were included. Eczema diagnosis was determined by a clinician or according to published diagnostic criteria. The risk of bias was assessed using the Cochrane Collaboration risk-of-bias tool. We used a standardised approach to summarising the data and the assessment of risk of bias and we made a clear distinction between what the studies found and our own interpretation of study findings.ResultsOf 7198 references screened, 287 new trials were identified spanning 92 treatments. Trial reporting was generally poor (randomisation method: 2% high, 36% low, 62% unclear risk of bias; allocation concealment: 3% high, 15% low, 82% unclear risk of bias; blinding of the intervention: 15% high, 28% low, 57% unclear risk of bias). Only 22 (8%) trials were considered to be at low risk of bias for all three criteria. There was reasonable evidence of benefit for the topical medications tacrolimus, pimecrolimus and various corticosteroids (with tacrolimus superior to pimecrolimus and corticosteroids) for both treatment and flare prevention; oral ciclosporin; oral azathioprine; narrow band ultraviolet B (UVB) light; Atopiclair™ and education. There was reasonable evidence to suggest no clinically useful benefit for twice-daily compared with once-daily topical corticosteroids; corticosteroids containing antibiotics for non-infected eczema; probiotics; evening primrose and borage oil; ion-exchange water softeners; protease inhibitor SRD441 (Serentis Ltd); furfuryl palmitate in emollient; cipamfylline cream; andMycobacterium vaccaevaccine. Additional research evidence is needed for emollients, bath additives, antibacterials, specialist clothing and complementary and alternative therapies. There was no RCT evidence for topical corticosteroid dilution, impregnated bandages, soap avoidance, bathing frequency or allergy testing.LimitationsThe large scope of the review coupled with the heterogeneity of outcomes precluded formal meta-analyses. Our conclusions are still limited by a profusion of small, poorly reported studies.ConclusionsAlthough the evidence base of RCTs has increased considerably since the last NIHR HTA systematic review, the field is still severely hampered by poor design and reporting problems including failure to register trials and declare primary outcomes, small sample size, short follow-up duration and poor reporting of risk of bias. Key areas for further research identified by the review include the optimum use of emollients, bathing frequency, wash products, allergy testing and antiseptic treatments. Perhaps the greatest benefit identified is the use of twice weekly anti-inflammatory treatment to maintain disease remission. More studies need to be conducted in a primary care setting where most people with eczema are seen in the UK. Future studies need to use the same core set of outcomes that capture patient symptoms, clinical signs, quality of life and the chronic nature of the disease.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Existing Systematic Reviewsmentioning

confidence: 99%

Scoping systematic review of treatments for eczema

Nankervis

Kim

Delamere

et al. 2016

Programme Grants Appl Res

Self Cite

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“…12,25,27 Despite the considerable number of Cochrane reviews, eight of them did not present any reliable evidence regarding benefits or harm from vitamin D, including reviews on clinical situations in which use of vitamin D is frequently observed in clinical practice, such as in relation to multiple sclerosis 9 and atopic eczema. 7 Thus, in those reviews, the authors were unable to provide recommendations regarding the benefits and risks of vitamin D. A second point that deserves discussion is that many of the reviews included were planned, conducted or published some years ago, and therefore were based on early versions of the Cochrane Handbook, which were less detailed and complex than the current version (http:// training.cochrane.org/handbook). As an example, the inclusion criteria and methods for assessing the quality of clinical trials were not refined as they are now.…”

Section: Discussionmentioning

confidence: 99%

What do Cochrane systematic reviews say about interventions for vitamin D supplementation?

et al. 2017

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CONTEXT AND OBJECTIVE: Despite the high prevalence of vitamin D supplementation, its use remains controversial. outcomes assessed under various conditions, the current quality of evidence is low or unknown, and therefore insufficient for any recommendation. CONCLUSION: Based on moderate to high quality of evidence, the Cochrane systematic reviews included here showed that there were some benefits from vitamin D supplementation for pregnant women and asthma patients and no benefits for preventing fractures.

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“…24 Nonetheless, a pilot study showed an important difference in change of AD scores after treatment, 25 and a subsequent study revealed a significant difference in SCORAD reduction in comparison with baseline in the VD group. 26 A larger trial also showed a significant reduction in SCORAD after VD supplementation but not after placebo.…”

Section: Figurementioning

confidence: 93%

Vitamin D Deficiency Rickets in an Adolescent With Severe Atopic Dermatitis

et al. 2014

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Atopic dermatitis (AD) affects 10% to 20% of children worldwide. Its severity may be inversely correlated with 25-hydroxyvitamin D (25OHD) levels. Although low levels of vitamin D (VD) can cause rickets in infants, VD deficiency rickets is an unusual presentation in teenagers. We report the case of a 14-year-old girl with severe AD and fish allergy since early childhood. She lived at high latitude (with less sun exposure) and, because of her atopic disorders, avoided sunlight and fish. Laboratory studies showed elevated alkaline phosphatase and parathyroid hormone levels and low serum calcium; her serum 25OHD level was ,12 nmol/L. A radiograph of the wrist showed a radiolucent band in the distal metaphysis of the radius with marginal sclerosis. She was diagnosed as having hypocalcemic rickets due to VD deficiency. Treatment with VD increased her 25OHD level to 44 nmol/L, with normalization of alkaline phosphatase, parathyroid hormone, and calcium. Moreover, we observed a dramatic improvement in her AD severity with VD treatment. This case demonstrates the complex interaction between VD deficiency, AD, and food allergy. We advise a high index of suspicion of VD deficiency rickets in children of all ages with AD, particularly during accelerated growth periods and in the presence of other risk factors such as darker skin, living at high latitude, sun avoidance, and low intake of VD-rich foods. The concomitant improvement in bone-related parameters and AD severity may reflect a double benefit of VD treatment, a possibility that warrants research on VD as potential treatment for AD.

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Dietary supplements for established atopic eczema

Cited by 73 publications

References 63 publications

Scoping systematic review of treatments for eczema

Scoping systematic review of treatments for eczema

What do Cochrane systematic reviews say about interventions for vitamin D supplementation?

Vitamin D Deficiency Rickets in an Adolescent With Severe Atopic Dermatitis

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