Evidence-based management of eczema: five things that should be done more and five things that should be dropped

Olabi, Bayanne; Williams, Hywel C.

Abstract

Purpose of review

We provide readers with an evidence-informed opinion on current treatments for eczema (atopic dermatitis) with the intention of improving patient care. We suggest five treatment aspects that should be promoted and five that should be demoted. Evidence sources include key randomized controlled trials and systematic reviews.

Recent findings

Under-treatment of eczema can be countered by more aggressive use of topical therapies including the ‘get control then keep control’ regimen, and systemics for severe disease, supplemented with good patient education. Topical corticosteroids should be used once daily rather than twice daily. Topical calcineurin inhibitors are useful for sensitive sites. There is little evidence to support the continued use of oral antihistamines, oral or topical antistaphylococcal treatments for infected eczema or probiotics for treating eczema.

Nonpharmacological treatments including silk clothing, ion-exchange water softeners and emollient bath additives have not been shown to benefit eczema patients. Despite promising pilot studies, large trials suggest that emollients from birth do not prevent eczema and may result in harms such as increased skin infections and food allergy.

Summary

New evidence-based insights on existing and newer treatments allow clinicians the opportunity to change their practice in a way that enhances patients’ quality of life.

Citation

Olabi, B., & Williams, H. C. (2021). Evidence-based management of eczema: five things that should be done more and five things that should be dropped. Current Opinion in Allergy and Clinical Immunology, 21(4), 386-393. https://doi.org/10.1097/ACI.0000000000000750

• Journal Article Type: Article
• Acceptance Date: Mar 23, 2021
• Online Publication Date: May 14, 2021
• Publication Date: Aug 1, 2021
• Deposit Date: May 18, 2021
• Publicly Available Date: May 15, 2022
• Journal: Current Opinion in Allergy and Clinical Immunology
• Print ISSN: 1528-4050
• Electronic ISSN: 1473-6322
• Publisher: Lippincott, Williams & Wilkins
• Peer Reviewed: Peer Reviewed
• Volume: 21
• Issue: 4
• Pages: 386-393
• DOI: https://doi.org/10.1097/ACI.0000000000000750
• Keywords: Immunology; Immunology and Allergy
• Public URL: https://nottingham-repository.worktribe.com/output/5559922
• Publisher URL: https://journals.lww.com/co-allergy/Abstract/9000/Evidence_based_management_of_eczema__five_things.99006.aspx