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Evidence at a glance on childhood eczema

The NIHR has invested significant research activity into identifying treatment options for childhood eczema that are helpful, and those that are probably ineffective. Whilst there is no cure, treatments aim to sooth sore skin, reduce itching, or prevent infection. The main types of treatment are moisturisers (emollients) and topical corticosteroids. These can be onerous to apply so parents and children are keen to search for other things that might work for eczema; NIHR research is helping.

The Cochrane Skin Group

The NIHR provides funding to the Cochrane Skin Group. This review group is based in Nottingham but consists of a network of individuals from across the world who review trials on skin conditions and summarises findings for healthcare professionals and service users. You can view their full range of systematic reviews, which include many reviews on childhood eczema.

What do the research findings tell us?

The NIHR has funded a variety of projects into skin conditions. Here are a few key findings on treatments for childhood eczema:

  • During an eczema flare up, using a moisturiser alongside a topical active treatment had a better outcome that the active treatment alone. However, there are no particular moisturisers that are more beneficial than others for eczema. These were the results from a systematic review comparing over 70 trials of different types of moisturisers.
  • Antibiotics to treat infections in mild to moderate eczema did not have any beneficial effect and researchers concluded that antibiotics should only be prescribed in cases of severely infected eczema. In this study oral and topical (applied to the skin) antibiotics were used to treat infections developed by children with eczema aged 3 months to 8 years (CREAM study).
  • In a study of over 300 children aged 1-15 years, it was found there was no clear benefit of wearing silk clothing in terms of eczema severity (CLOTHES study). The children wore the silk clothing for 6 months and eczema symptoms were independently assessed by research nurses.
  • Installing water softeners at home to soften hard water used for washing had no beneficial effect over and above treatment as usual on eczema severity in children aged 6-16 years (SWET study).
  • Two Cochrane reviews found no evidence that dietary supplements reduced the severity of eczema symptoms. The supplements reviewed included: fish oil, zinc, selenium, vitamin D, vitamin E, vitamin B6, sea buckthorn oil, hempseed oil, sunflower oil, evening primrose oil and borage oil.

Although many of the projects above do not have positive findings, these ‘negative studies’ provide us with a better understanding of interventions that are not beneficial. Research can then focus on established interventions that do have beneficial effects, such as moisturisers, and the best way to use these in a treatment plan. Ongoing NIHR studies are highlighted in the “Going forward - Ongoing research” section.  

“I estimate that I refer less than five percent of children that I see with eczema to the dermatology team at the hospital in Nottingham. These are children with much more extensive or severe eczema or whose situation is complicated by other conditions. I may see them a few times before we conclude that they need the input of the dermatology doctors and nurses. If they are discharged from the hospital they will come back to my care but they will sometimes be offered an ‘open appointment’. This means they can go back to the hospital service for up to a year without needing to be referred again.”
Dr Jane Coleman, non-specialist GP, Nottingham

“We have to be honest with parents. Eczema can be managed but there isn’t a cure. We can’t know whether any given child will grow out of their eczema but we do know we’ve got to find the best treatment for them and ensure that the child and the parents are confident to use the treatments.”
Dr Sarah El-Heis, Dermatology Clinical Research Fellow in an NHS Secondary Care Trust

The GREAT Database

A recent NIHR programme of research led to the development of the GREAT database (Global Resource of Eczema Trials), which brings together eczema studies from across the globe. Here you can freely and easily access results from hundreds of eczema studies. This database provides a comprehensive collection of different eczema treatments based on randomised controlled trials from 1967 and systematic reviews published after 2000. As of July 2017, this included over 800 randomised controlled trials and 115 systematic reviews.

Key Questions for Patients and Families

  • Has your GP/practice nurse explained the most beneficial treatment options to you?
  • Are there specialist services available in your GP surgery?
  • Do you know the different types of moisturisers available?
  • How severe is your/your child’s eczema?
  • How do I support my child to manage their eczema symptoms?
  • Do I/does my child need a referral to a dermatologist?

“I probably see children with eczema in our practice every week. The practice team can manage most children’s eczema.  We work out – by trying treatments - what works best for the child and then we stick with that, encouraging the child and their family to manage the eczema, using the prescribed medication and recommended self-management techniques. We look at each child’s progress at a medication review each year, but of course parents will bring the child back in to see us if something changes in the meantime.”
Dr Jane Coleman, non-specialist GP, Nottingham

 

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