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About the evidence on childhood eczema

This Highlight is based on the following 8 NIHR studies:

  • Setting priorities and reducing uncertainties in the prevention and treatment of people with skin diseases

Thomas KS, Batchelor JM, Bath-Hextall F, Chalmers JR, Clarke T, Crowe S, et al. A programme of research to set priorities and reduce uncertainties for the prevention and treatment of skin disease. Programme Grants Appl Res 2016;4(18). https://dx.doi.org/10.3310/pgfar04180

  • Randomised controlled trial of silk therapeutic clothing for the long-term management of eczema in children (CLOTHES Trial: CLOTHing for the relief of Eczema Symptoms)

Thomas KS, Bradshaw LE, Sach TH, Cowdell F, Batchelor JM, Lawton S, et al.Randomised controlled trial of silk therapeutic garments for the management of atopic eczema in children: the CLOTHES trial. Health Technol Assess 2017;21(16). https://dx.doi.org/10.3310/hta21160

  • The CREAM Study - Children With Eczema, Antibiotic Management study

Francis NA, Ridd MJ, Thomas-Jones E, Shepherd V, Butler CC, Hood K, et al. A randomised placebo-controlled trial of oral and topical antibiotics for children with clinically infected eczema in the community: the ChildRen with Eczema, Antibiotic Management (CREAM) study. Health Technol Assess 2016;20(19). https://dx.doi.org/10.3310/hta20190

  • Emollients and moisturisers for eczema

van Zuuren EJ, Fedorowicz Z, Christensen R, Lavrijsen APM, Arents BWM. Emollients and moisturisers for eczema. Cochrane Database of Systematic Reviews 2017, Issue 2. Art. No.: CD012119. DOI: 10.1002/14651858.CD012119.pub2.

  • Randomised controlled trial of ion-exchange water softeners for the treatment of atopic eczema in children (SWET)

Thomas K, Koller K, Dean T, O'Leary C, Sach T. A multicentre randomised controlled trial and economic evaluation of ion-exchange water softeners for the treatment of eczema in children: the Softened Water Eczema Trial (SWET). Health Technol Assess 2011;15(8). https://dx.doi.org/10.3310/hta15080

  • Dietary supplements for established atopic eczema

Bath-Hextall FJ, Jenkinson C, Humphreys R, Williams HC. Dietary supplements for established atopic eczema. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD005205. DOI: 10.1002/14651858.CD005205.pub3.

  • Oral evening primrose oil and borage oil for eczema

Bamford JTM, Ray S, Musekiwa A, van Gool C, Humphreys R, Ernst E. Oral evening primrose oil and borage oil for eczema. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD004416. DOI: 10.1002/14651858.CD004416.pub2.

  • Psychological and educational interventions for atopic eczema in children

Ersser SJ, Cowdell F, Latter S, Gardiner E, Flohr C, Thompson AR, Jackson K, Farasat H, Ware F, Drury A. Psychological and educational interventions for atopic eczema in children. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD004054. DOI: 10.1002/14651858.CD004054.pub3.

You may also want to visit the Journals Library to discover further projects on skin conditions:

https://www.journalslibrary.nihr.ac.uk/#/

Going forward - Ongoing research

The NIHR has a portfolio of ongoing studies around eczema research, with several focusing on severe childhood eczema.

A brief summary is provided for each study, but for more information you can follow the link to the project page.

  • BATHE (Bath Emollients for Treatment of cHildhood Eczema). Chief investigator: Dr Miriam Santer.

https://www.journalslibrary.nihr.ac.uk/programmes/hta/1115301/#/

The BATHE study is comparing the use of regular bath emollients alongside usual care, with usual care alone. Children aged between 1 – 11 years are taking part in this 16 week trial.  Results are expected in 2018.

  • A randomised placebo-controlled study examining the role of anti-IgE in severe recalcitrant paediatric atopic eczema (ADAPT trial). Chief Investigaor: Dr Susan Chan.

https://www.journalslibrary.nihr.ac.uk/programmes/eme/111424/#/

The ADAPT trial is finding out whether anti-IgE (omalizumab) injections is a beneficial treatment for severe eczema that has failed to respond to other treatments. Young people aged between 6-19 years will receive either anti-IgE injections or a placebo injection. Researchers will assess the severity of eczema after 16 weeks. Results are expected in 2018.  

  • Assessing the efficacy and safety of methotrexate vs ciclosporin in the treatment of severe atopic eczema in children: the TREatment of severe Atopic eczema in children Taskforce (TREAT) randomised controlled trial. Chief investigator: Dr Carsten Flohr.

https://www.journalslibrary.nihr.ac.uk/programmes/eme/135012/#/

The TREAT trial is evaluating the use of oral methotrexate (MTX) compared to ciclosporin (CyA) in the treatment of severe atopic eczema in children aged 2-16 years. Both drugs will be given for nine months. Severity of eczema symptoms will be measured after 12 weeks of treatment and 6 months after treatment has ended. Results are expected in late 2019/early 2020.

  • A randomised controlled trial to determine whether skin barrier enhancement with emollients can prevent eczema in high risk children. (BEEP trial). Chief investigator: Professor Hywel Williams.

https://www.journalslibrary.nihr.ac.uk/programmes/hta/126712/#/

This study is recruiting parents whose children are at high risk of developing eczema. Half the parents receive a skin care advice package which includes a daily moisturiser to use on their baby every day from birth until 12 months. The other group of parents receive the skin care advice package without the moisturiser.  As of August 2017, almost 1400 families have been recruited. The children will be assessed at the age of 2 years for eczema symptoms and followed up until the age of 5 so researchers can assess for signs of asthma, hay fever and food allergies. Results are expected in 2022.

  • Best Emollient for Eczema (BEE): Pragmatic, primary care, multi-centre, individually randomised superiority trial of four emollients in children with eczema, with internal pilot and nested qualitative study. Chief investigator: Dr Matthew Ridd.

https://www.journalslibrary.nihr.ac.uk/programmes/hta/1513007/#/

This new study is comparing four different emollients (a lotion, cream, gel and ointment) to treat mild, moderate or severe eczema. The researchers aim to recruit 520 children (130 per group) aged 6 months to 12 years who will use one of four emollients for 16 weeks. They will receive either Aveeno® lotion, Diprobase® cream, Doublebase® gel, or Epaderm® ointment. Eczema severity will be measured every week during the course of treatment and at a 12 month review. Interviews will also be conducted with participants to discuss their use of the moisturisers. Results are expected in 2020.

  • The TEST (Trial of Eczema allergy Screening Tests) Study: feasibility randomised controlled trial with economic scoping and nested qualitative study. Chief investigator: Dr Matthew Ridd.

https://www.spcr.nihr.ac.uk/projects/the-test-trial-of-eczema-allergy-screening-tests-study-feasibility-randomised-controlled-trial-with-economic-scoping-and-nested-qualitative-study

This small study, carried out by the NIHR School for Primary Care Research, will be looking at whether it is useful to conduct routine allergy tests for children with eczema. The researchers aim to recruit 80 children. Half of the children will receive usual care from their GP. The other half will be asked extra questions about food intake and offered skin prick allergy tests consisting of six common allergy-causing foods (cow’s milk, peanut, hen’s egg, codfish, wheat and cashew). Parents will be advised on any allergies and what food to avoid if necessary. All children will be followed up for 6 months. Results are expected in 2019 and funding for a larger trial may be pursued if appropriate.

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