Do nonmedicated topicals relieve childhood eczema?

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Clinical Inquiries

Do nonmedicated topicals relieve childhood eczema?

J Fam Pract. 2009 May;58(5):280-281

References

1. Grimalt R, Mengeaud V, Cambazard F. Study Investigators’ Group. The steroid-sparing effect of an emollient therapy in infants with atopic dermatitis: a randomized controlled study. Dermatology. 2007;214:61-67.

2. Leung DY, Nicklas RA, Li JT, et al. Disease management of atopic dermatitis: an updated practice parameter. Joint Task Force on Practice Parameters. Ann Allergy Asthma Immunol. 2004;93(3 suppl 2):S1-S21.

3. Hanifin JM, Cooper KD, Ho VC, et al. Guidelines of care for atopic dermatitis, developed in accordance with the American Academy of Dermatology (ADA)/American Academy of Dermatology Association “Administrative Regulations for Evidence-Based Clinical Practice Guidelines.” J Am Acad Dermatol. 2004;50:391-404.

4. Munkvad M. A comparative trial of Clinitar versus hydrocortisone cream in the treatment of atopic eczema. Br J Dermatol. 1989;121:763-766.

5. Anstey A, Quigley M, Wilkinson JD. Topical evening primrose oil as treatment for atopic eczema. J Dermatol Treat. 1990;1:199-201.

6. Kanehara S, Ohtani T, Uede K, et al. Clinical effects of undershirts coated with borage oil on children with atopic dermatitis: a double-blind, placebo-controlled trial. J Dermatol. 2007;34:811-815.

7. Boguniewicz M, Ziechner JA, Eichenfield LF, et al. MAS063DP is effective monotherapy for mild to moderate atopic dermatitis in infants and children: a multicenter, randomized, vehicle-controlled study. J Pediatr. 2008;152:854-859.

8. Kubota K, Machida I, Tamura K, et al. Treatment of refractory cases of atopic dermatitis with acidic hot-spring bathing. Acta Derm Venereol. 1997;77:452-454.

9. Ross SM. An integrative approach to eczema atopic dermatitis. Holist Nurs Pract. 2003;17:56-62.

10. Devillers AC, Oranje AP. Efficacy and safety of “wet-wrap” dressings as an intervention treatment in children with severe and/or refractory atopic dermatitis: a critical review of the literature. Br J Dermatol. 2006;154:579-585.

11. Hindley D, Galloway G, Murray J, et al. A randomised study of “wet wraps” versus conventional treatment for atopic eczema. Arch Dis Child. 2006;91:164-168.

12. Anderson C, Lis-Balchin M, Kirk-Smith M. Evaluation of massage with essential oils on childhood eczema. Phytother Res. 2000;14:452-456.

13. Korting HC, Schäfer-Korting M, Klövekorn W, et al. Comparative efficacy of hamamelis distillate and hydrocortisone cream in atopic eczema. Eur J Clin Pharmacol. 1995;48:461-465.

Hot spring baths, chamomile may help

In a case control study of 70 patients (ages 12-80 years, mean 23 years,) bathing in acidic hot spring water (42° C) helped control edema, erythema, exudation, and excoriation in refractory cases of eczema.⁸

Several adult and mixed adult-child studies have found mild efficacy for chamomile extracts. One RCT demonstrated topical chamomile to be equivalent to 0.25% hydrocortisone cream for treating mild eczema.⁹

Wet wraps may help, but may raise skin infection risk

A critical review suggests that short-term use of wet wraps in combination with topical steroids and emollients is effective for severe eczema. However, a small RCT of 50 children found no additional benefit over standard care and an increased risk of skin infection (95% CI, 5%-42%; P=.05) with a number needed to harm of 5.^10,11

Essential oils, hamamelis distillate don’t work

In 1 case control study, massage with essential oils didn’t improve eczema compared with massage without essential oils.¹² Hamamelis (witch hazel) distillate cream was inferior to steroid creams.¹³

Recommendations

The American Academy of Dermatology guidelines state that emollients are the standard of care for childhood eczema and have a steroid-sparing effect (level of evidence [LOE]: A). Tar preparations have therapeutic benefits, but compliance is a major limitation (LOE: B). Not enough evidence exists to recommend acidic baths. The guidelines make no recommendations about other topical therapies.

FAST TRACK

Topical corticosteroids are the standard of care for Rx therapy in kids, but their potential side effects argue for safer, nonmedicated treatments.

A task force to formulate practice parameters has been created by the American College of Allergy, Asthma, and Immunology; the American Academy of Allergy, Asthma, and Immunology; and the Joint Council of Allergy, Asthma, and Immunology. The task force’s latest recommendations suggest that emollients, tar preparations, and wet dressings are beneficial for treating eczema.²

Evidence-based answers from the Family Physicians Inquiries Network

Do nonmedicated topicals relieve childhood eczema?

References

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