Abstract
Using a systematic review and network meta-analysis (NMA), we aimed to compare the efficacy of existing treatments for childhood atopic dermatitis (AD), with special focus on the complementary and alternative medicine. Articles in the literature via PubMed/MEDLINE, and Scopus were searched from the inception of all databases till August 2019. We included all published randomized clinical trials of treatments for AD which has clearly defined the intervention and must have included an assessment of AD disease severity. Multiple observers independently extracted the data and cross-checked to avoid bias. The quality of studies was critically examined following the Cochrane guidelines. Data were pooled using a random-effects model. The outcomes were the SCORAD index and the number of patients improving. We also calculated the ranking probability for each treatment based on surface under the cumulative ranking curve (SUCRA). A total of 19,091 articles were retrieved through searched databases, with 29 randomized clinical trials (6,910 children) finally enrolled for meta-analysis. Pooled analysis revealed in the forest plots of the overall improvements of the symptoms, most of the comparisons between treatments crossed the null hypothesis line, only few have statistical significance, where the natural oils in emollient are less potent than the mineral oils (OR = 2.48, 95% CI 0.14, 4.83), and the externally applied steroids are also less effective than the placebo (OR = 1.02, 95% CI 0.20, 1.83). Moreover, we performed SUCRA ranking, which indicated that mineral oils, immunosuppressant with glucoside, hydrocortisone, immunosuppressant and probiotics had the highest probability to be the best treatment for AD. The steroids and immune suppressants remain the first-line treatment for the AD, but some auxiliary therapy also showed promising efficacy such as the probiotics and emollient with mineral oil. The wide uncertainty margins indicate the heterogeneity of the available evidence and the need for further research.
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