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An in-depth look at the research

An NIHR-funded programme grant for applied research aimed to review all available evidence on skin conditions and identify gaps that could be addressed in future studies. This included looking at different treatment options. Key findings about eczema included:

  • A comprehensive review on eczema prevention and treatment. Thirty-nine trials involving over 11,000 participants aged 0-18 years were included in this ‘review of reviews’. No clear benefits from any of the interventions were found.
  • A pilot randomised controlled trial to see if it was feasible for parents to apply moisturisers on their baby every day from birth to six-months to prevent eczema. Clinical results from the 124 families who took part indicated that this treatment had a positive effect. The NIHR subsequently funded a larger definitive trial which is currently underway (BEEP trial). You can read more about this in the ‘Going Forward – Ongoing Research’ Section.
  • Identification of four top priorities for both healthcare professionals and patients: 1) the best and safest way of using topical corticosteroids; 2) long-term safety of corticosteroids; 3) the role of allergy tests in eczema management; and 4) the most effective emollients.
  • The proposal of a randomised controlled trial of silk therapeutic clothing for eczema management in children. The trial was later funded by the NIHR and results have recently been published as an NIHR Signal.

The following studies are a selection of recent NIHR projects focusing on possible treatments for childhood eczema.

Silk clothing (CLOTHES study)

This was the first large, independent trial to investigate the benefits of specialist silk clothing (long-sleeve tops and leggings) for the management of moderate and severe childhood eczema. Over 300 children aged 1-15 years took part, wearing therapeutic silk clothing for 6 months alongside their standard eczema care. Children were asked to wear the clothing as often as possible, day and night. Alongside data collection, parents and children were invited to discuss their experiences. The study found that there was no benefit of wearing silk clothing over and above routine care (moisturisers and topical corticosteroids) in terms of eczema severity as measured by nurses. Questionnaires completed by families indicated that eczema symptoms in the silk clothing group may have improved more than for those children receiving only standard treatment. However the differences between the two groups were small and mainly seen in the first few months of the study. The researchers therefore concluded that silk clothing does not provide useful extra benefits over standard care and are not value for money.

Use of antibiotics (CREAM study)

This study investigated the use of antibiotics in children with clinically infected eczema. Over 100 children aged 3 months to 8 years took part. To treat their potential infection they were given one of three treatments: oral antibiotic and topical placebo, topical antibiotic and oral placebo or an oral and topical placebo, all for 1 week. Placebos have no medical effect but look identical to the medication. The children also continued with their standard eczema treatment of steroid creams and moisturisers. Most children in the study had clinical indications of a skin infection, and primarily had mild to moderate eczema. After measuring severity of eczema symptoms at week 2, it was found that oral and topical antibiotics had no effect. The researchers concluded that antibiotics should only be prescribed to children with severely infected eczema. There are no beneficial effects of using antibiotics in mild eczema flare-ups, and steroid creams and moisturisers are sufficient when there are no signs of severe infection. This is particularly important given the emerging evidence that bacteria are becoming more resistant to antibiotics.

Types of moisturisers for eczema

This project rigorously reviewed 77 randomised controlled trials that investigated the use of different moisturisers to treat eczema. In the studies, moisturisers were compared to either a placebo, other treatments or no treatments. The age range of participants was between 4 months to 84 years (mean age 18.6 years) who had mild to moderate eczema. Of the 77 studies, 42 were based in Europe and 20 in North America. Forty-six of the studies were funded by pharmaceutical companies. Although the results were not clinically significant, using a moisturiser reduced eczema severity slightly and the time between flare ups was reduced. There was no evidence that one type of moisturiser was better than another. However, it was found that adding a moisturiser to a topical active treatment had a better outcome than using an active treatment alone during an eczema flare-up.

Alternative interventions for eczema

“It can be hard for children and their families to adjust to a life with eczema. I have to be open and honest with them from the start so that they understand what eczema is how it tends to develop. Eczema can’t be cured but it can be treated with much success, provided that children and families work at managing the condition. I don’t underestimate the effort it takes to do this and I will always support families who want to explore alternative, non-traditional treatments – who wouldn’t look at other possibilities that might help their child feel more comfortable?”
Dr Jane Coleman, non-specialist GP, Nottingham

Families are keen to find non-pharmacological and/or complementary treatments for their child’s eczema. The NIHR has funded a number of studies looking at a range of possible options. Here are a few completed projects:

Water Softeners (SWET study)

In a study involving over 300 children aged 6-16 years, researchers investigated whether installing ion-exchange water softeners could improve moderate to severe eczema symptoms. Water softener devices were installed in the family home to soften hard water used for bathing and washing clothes, but mains drinking water was not affected. Children also continued with their normal treatment. After 12 weeks, there was no additional benefit of water softening on the children’s eczema symptoms, which was objectively measured by research nurses. The researchers concluded that water softeners provided no additional benefit to usual care in treating childhood eczema.

Dietary Supplements

A Cochrane review looked at the use of dietary supplements for atopic eczema. Eleven studies were identified, involving almost 600 individuals (including children and adults). A range of supplements were assessed, including fish oil, zinc, selenium, vitamin D, vitamin E, vitamin B6, sea buckthorn oil, hempseed oil, and sunflower oil. The review found there was no evidence of any beneficial effect on eczema symptoms by taking these supplements.

Another review examined 27 studies that used evening primrose oil and borage oil to treat eczema. The studies included in this review involved over 1500 adults and children from 12 different countries. The researchers concluded there was no evidence to indicate that either supplement had any beneficial effect on eczema.

Psychological and Educational Interventions              

This Cochrane review looked at studies which focused on educational and/or psychological interventions for managing childhood eczema alongside usual pharmacological treatments. Educational and psychological interventions may be delivered in the community or hospital setting. Such interventions typically aim to provide useful information and strategies for dealing with eczema for the whole family. The review identified ten studies. Unfortunately, the researchers could not draw definite conclusions due variations between the studies. However, they did suggest that educational interventions and certain techniques such as relaxation methods could be beneficial in reducing eczema severity and improving quality of life, but more high-quality research is needed.

 

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