Management Of Eczema Research Articles

Guidelines for diagnosis, prevention, and treatment of hand eczema.

Hand eczema is a common inflammatory skin disorder. Health care providers need continuously updated information about the management of hand eczema to ensure best treatment for their patients. To update the European Society of Contact Dermatitis guideline on the diagnosis, prevention, and treatment on of hand eczema. The Guideline Development Group (GDG) was established on behalf of the ESCD. A call for interest was launched via the ESCD website and via the ESCD members' mailing list. Appraisal of the evidence for therapeutic and preventive interventions was applied and a structured method of developing consensus was used and moderated by an external methodologist. The final guideline was approved by the ESCD executive committee and was in external review on the ESCD webpage for 1 month. Consensus was achieved for several statements and management strategies. The updated guideline should improve management of hand eczema.

Supporting families managing childhood eczema: developing and optimising eczema care online using qualitative research.

BackgroundChildhood eczema is often poorly controlled owing to underuse of emollients and topical corticosteroids (TCS). Parents/carers report practical and psychosocial barriers to managing their child’s eczema, including child resistance. Online interventions could potentially support parents/carers; however, rigorous research developing such interventions has been limited.AimTo develop an online behavioural intervention to help parents/carers manage and co-manage their child’s eczema.Design and settingIntervention development using a theory-, evidence-, and person-based approach (PBA) with qualitative research.MethodA systematic review and qualitative synthesis of studies (n = 32) and interviews with parents/carers (n = 30) were used to identify barriers and facilitators to effective eczema management, and a prototype intervention was developed. Think-aloud interviews with parents/carers (n = 25) were then used to optimise the intervention to increase its acceptability and feasibility.ResultsQualitative research identified that parents/carers had concerns about using emollients and TCS, incomplete knowledge and skills around managing eczema, and reluctance to transitioning to co-managing eczema with their child. Think-aloud interviews highlighted that, while experienced parents/carers felt they knew how to manage eczema, some information about how to use treatments was still new. Techniques for addressing barriers included providing a rationale explaining how emollients and TCS work, demonstrating how to use treatments, and highlighting that the intervention provided new, up-to-date information.ConclusionParents/carers need support in effectively managing and co-managing their child’s eczema. The key output of this research is Eczema Care Online for Families, an online intervention for parents/carers of children with eczema, which is being evaluated in a randomised trial.

Six habits to introduce for eczema management: a guide for community nurses.

Six habits to introduce for eczema management: a guide for community nurses.

Atopic Eczema: How Genetic Studies Can Contribute to the Understanding of this Complex Trait

Atopic eczema is an itchy inflammatory skin disease. This complex trait results from multiple genetic and environmental factors, but atopic eczema also shows great complexity in its heterogeneous presentation, clinical signs, and longitudinal trajectory, with or without comorbid conditions. The past 50 years have resulted in substantial improvements in the management of atopic eczema, but many patients still suffer a burden of disease affecting personal, social, and family life. Genetic research refocused interest on skin barrier function, but effective targeting of this central pathomechanism remains elusive. This perspective highlights the progress in understanding the molecular mechanisms and translational opportunities for the future.

Vehicles for Drug Delivery and Cosmetic Moisturizers: Review and Comparison.

Many dermatological conditions, such as eczema and psoriasis, are treated with topical therapeutic products. Instead of applying the active drug directly onto the skin, it is combined with a vehicle to aid in its delivery across the stratum corneum (SC) and into deeper regions of the skin, namely the epidermis and dermis. Absorption into the systemic circulation is minimized. Topical vehicles are also used as cosmetic moisturizers (often termed emollient therapy) to ameliorate dry skin, which is a cornerstone of the management of various dermatological conditions, including xerosis, eczema, psoriasis, and aging. The most common topical vehicles include ointments, creams, gels, and lotions, among others. It is crucial that topical vehicles are chosen based upon the size and properties (wet/dry, mucous/non-mucous, healthy/diseased) of the skin to be treated in order to optimize application and contact of the product with the skin, as this can have profound impacts on potency, efficacy, and patient compliance. This review examines common topical vehicles used for drug delivery and cosmetic moisturizers, including their formulation, advantages and disadvantages, and effects on the skin. The unique rules imposed by governing regulatory bodies in Australia and around the world, in terms of topical product claims, are also briefly examined.

Epidemiology and management of asthma and atopic dermatitis in Sub-Saharan Africa

Sub-Saharan Africa (SSA) is currently undergoing a transformation process of unprecedented magnitude owing to economic development and urbanization. This process is paralleled by a dramatic increase in prevalence and incidence of noncommunicable diseases. In this article we analyze the current situation with regard to 1 group of the earliest noncommunicable diseases in a person's life, namely, allergies and asthma. This article provides an update on the epidemiology, availability, and access to management strategies by patients experiencing bronchial asthma or atopic dermatitis in SSA. Despite all of the progress, there is still a tremendous need to support education and training, transfer of resources, and cooperation with pharmaceutical and diagnostic companies to achieve adequate treatment and sustainability in SSA with regard to allergy, asthma, and eczema management.

Role of Raktmokshana (Siravedh) & Shaman Chikitsa in Vicharchika - A Case Study

In ayurvedic texts, all skin diseases are classified under Mahakushtha and Kshudrakushtha. Vicharchika is a type of Kshudrakushtha. It can be correlated with eczema according to modern science. Eczema is characterised by dry itchy skin with areas of poorly demarcated scales. In acute phase eczema may be vesicular and oozing. In chronic phase, it may become hyperpigmented and lichenified. Modern dermatology employs systemic and local administration of steroids for the management of eczema. Despite an initial response, maintenance therapies with small doses of systemic and topical glucocorticoids usually produce hazardous ill effects. So attempt has been made to treat eczema by Ayurvedic medicine. Ayurveda focuses on underlying etiopathogenesis and treats the root cause of the disease. The present study has been done to evaluate the efficacy of Shodhana i.e.Raktamokshan(siravedha) and Shaman Chikitsa in Vicharchika.

Antibacterial and Anti-Inflammatory Potential of Polyherbal Formulation Used in Chronic Wound Healing.

Objective Polyherbal formulations Jathyadi Thailam and Jatyadi Ghritam (JT) are used in Indian traditional medicine for diabetic chronic wounds, fistula, fissure, eczema, and burn management. We aimed to investigate the antibacterial and anti-inflammatory properties of crude hexane and ethanol extracts of JT formulations. Methods Antibacterial activity of JT extracts was tested to estimate minimum inhibitory concentrations (MICs) against nine reference bacterial strains, including one methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant (MDR) Pseudomonas aeruginosa, and clinical strains of methicillin-susceptible S.aureus (MSSA), all involved in diabetic foot infection. The anti-inflammatory activity of plant extracts was evaluated in LPS-treated macrophage cells by measuring the mRNA levels and secretion of inflammatory mediators. Results The antibacterial activity of JT extracts was higher against Gram (+) bacteria, with the MICs varying from 1.95 to 62.5 mg/mL. Gram (−) bacteria were only susceptible to ethanol extracts of JT. Plant extracts were found to be the most active against the reference and clinical strains of MSSA, MRSA, and biofilm-forming S. epidermidis. JT extracts efficiently inhibited in a dose-dependent manner the mRNA expression and protein secretion of proinflammatory cytokines IL-6 and IL-1β, and chemokines MCP-1 and CXCL10 in LPS-challenged macrophages. Conclusion In the present study, we have shown that extracts of JT formulations possess potent antibacterial and anti-inflammatory properties that could be involved in chronic wound healing activity and has the potential to be used as external add-on therapy in the management of multidrug-resistant bacterial infections at the wound.

Quantification of zinc concentrations in serum, milk and faeces of dairy cattle as a measure of effective zinc supplementation for management of facial eczema

Aims: To investigate the relationship between Zn concentrations in serum and those in milk or faeces, and to assess the ability of the Zn concentrations in milk, serum and faeces to predict intake of ZnO in dairy cattle. Method Seventy cows from one commercial farm in the Waikato region of New Zealand received one of seven dose rates (0, 1.0, 1.5, 2.0, 2.5, 3.0, 3.5 g/100 kg bodyweight (BW)) of ZnO given by oral drench, every morning, for 7 consecutive days. Every afternoon, milk and blood samples were collected from all cows. Free-catch faecal samples were collected during the afternoon milking on 3 days throughout the trial. Linear mixed models were used to assess the relationship between the concentration of Zn in serum and that in milk, and in faeces, respectively, and the relationship between dose rate of ZnO and concentrations of Zn in serum, faeces and milk, respectively. Receiver operating characteristic curve analysis was used to determine the ability of the Zn concentration in serum, milk and faeces to predict that a cow had been treated with a dose of ZnO ≥2.5 g/100 kg, the industry-recommended dose rate needed to protect against facial eczema. Results: A 1-µmol/L increase in Zn concentration in milk was associated with a 0.14 (95% CI=0.11–0.17) µmol/L increase in Zn concentration in serum. Zn concentration in faeces was scaled by its SD; a 1 SD increase was associated with a 1.83 (95% CI=0.54–3.12) µmol/L increase in zinc concentration in serum. Zn concentrations in serum and faeces increased with increasing dose rates of ZnO. No differences in Zn concentrations in milk were noted between animals dosed with 1.5–3.5 g ZnO/100 kg BW, inclusive. At the optimal threshold for Zn concentration in serum, 22 µmol/L, the sensitivity was 0.76 (95% CI=0.69–0.82) and specificity 0.85 (95% CI=0.80–0.89). For the concentration of Zn in faeces, the optimal threshold was defined as 17.36 mmol/kg, with a corresponding sensitivity of 0.84 (95% CI=0.84–0.85) and specificity of 0.85 (95% CI=0.73–0.94). At the optimal threshold for the Zn concentration in milk (76.6 µmol/L), the sensitivity was lower than the other two sample types at 0.59 (95% CI=0.52–0.67), but with a similar specificity of 0.84 (95% CI=0.79–0.88). Conclusions and clinical relevance: The concentration of Zn in milk shows promise as an initial screening test to identify dairy farms that do not provide adequate zinc to provide protection against FE.

PA09: Efficacy of an online educational video in improving parents’ knowledge of eczema management

PA09: Efficacy of an online educational video in improving parents’ knowledge of eczema management

A real world retrospective analysis of comparison of effectiveness and safety of mometasone furoate and fluticasone propionate in the management of eczema and dermatitis

Contact dermatitis is one the commonest dermatological condition which is managed by topical corticosteroids. Mid potent topical corticosteroids are commonly prescribed but there is no any comparative data between mometasone furoate and fluticasone propionate in the management of dermatitis.A real world retrospective study was conducted across India to compare the clinical assessment of mometasone 0.1% cream and fluticasone 0.005% cream in the management of contact dermatitis at 236 dermatology clinics.A data of 1106 patients were included in this analysis in which 598 were included in mometasone group while 508 in fluticasone group. At the end of 2 weeks, 216 patients (36.1%) in mometasone and 129 patients (25.4%) in fluticasone group achieved complete clearance of symptoms (p<0.05). Additionally, in mometasone group, 354 patients (59.2%) were found to achieve improvement whereas 293 patients (57.7%) achieved the same in fluticasone group. On further sub group analysis on aggravating factors, it was found that, mometasone was statistically significant in relieving symptoms of dermatitis due to artificial jewellery, detergent and occlusive foot ware than fluticasone. Moreover, mometasone demonstrated significant results in physician and patient global assessment as well. Patients in both groups tolerated therapy well.Both, mometasone furoate and fluticasone propionate were effective and safe in treatment of eczema/dermatitis. But mometasone furoate had shown significantly better effectiveness as compared to fluticasone in all predisposing factors for the disease.

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

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. 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. 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.

Impact of daily wearing of fabric gloves on the management of hand eczema: A pilot study in health-care workers.

Hand eczema is a major occupational disease, especially in medical workers, reducing their quality of life (QOL) and work productivity. Daily wearing of fabric gloves to prevent loss of moisture and lipids from the surface of the hands has been regarded as good in the management of hand eczema. However, limited evidence is available regarding the efficacy of moisturizing care with daily gloves on hand eczema. This pilot study was performed to evaluate the efficacy of moisturizing intervention with daily wearing of fabric gloves on skin barrier function, disease severity, and microbiome in health-care workers with hand eczema. Study 1: Nurses in the neonatal intensive care unit or growing care unit with and without hand eczema were recruited in the study. Subjects were instructed to apply moisturizer and wear two types of fabric gloves, common cotton gloves and moisturizing fabric gloves containing malate, for 4weeks. Study 2: Physicians and health-care workers were recruited and instructed to wear a cotton glove on one hand at nighttime for 4weeks. Disease severity, skin barrier function, QOL, and hand microbiome (Study 1) were evaluated. Study 1 found that daily wearing of both types of fabric gloves accompanied by use of topical moisturizers reduced the severity of hand eczema without changing the variation of microbiome. Study 2 found no apparent change between wearing and not wearing cotton gloves. In summary, topical moisturizer is of fundamental importance, and concomitant use of fabric gloves may merely enhance the efficacy of moisturizer in the management of hand eczema.

Test-guided dietary management of eczema in children: A randomized controlled feasibility trial (TEST).

Parents commonly ask about food allergy tests, to find a cause for their child's eczema, yet the value of routine testing is uncertain. To determine whether a clinical trial comparing test-guided dietary advice versus usual care, for the management of eczema, is feasible. Children (>3months and <5years) with mild-to-severe eczema, recruited via primary care, were individually randomized (1:1) to intervention or usual care. Intervention participants underwent structured allergy history and skin prick tests (SPT) with dietary advice for cow's milk, hen's egg, wheat, peanut, cashew and codfish. All participants were followed up for 24weeks. A sample of doctors and parents was interviewed. Registration ISRCTN15397185. From 1059 invitation letters sent to carers of potentially eligible children, 84 were randomized (42 per group) with mean age of 32.4months (SD 13.9) and POEM of 8.7 (4.8). Of the 42, 6 (14%) intervention participants were advised to exclude one or more foods, most commonly egg, peanut or milk. By participant, 1/6 had an oral food challenge (negative); 3/6 were told to exclude until review in allergy clinic; and 6/6 advised a home dietary trial (exclusion and reintroduction of food over 4-6weeks) - with 1/6 partially completing it. Participant retention (four withdrawals) and data completeness (74%-100%) were acceptable and contamination low (two usual care participants had allergy tests). There were three minor SPT-related adverse events. During follow-up, 12 intervention and 8 usual care participants had minor, unrelated adverse events plus one unrelated hospital admission. It is possible to recruit, randomize and retain children with eczema from primary care into a trial of food allergy screening and to collect the outcomes of interest. Changes to recruitment and inclusion criteria are needed in a definitive trial, to ensure inclusion of younger children from more diverse backgrounds.

Taking charge of eczema self-management: a qualitative interview study with young people with eczema

ObjectivesTo explore young people’s experiences of eczema self-management and interacting with health professionals.DesignSecondary qualitative data analysis of data sets from two semistructured interview studies. Data were analysed using inductive thematic...

A case study on management of Shushka Vicharchika (Eczema) through Shamana Chikitsa (palliative ayurveda treatment)

Eczema is a common, and at times challenging, condition to manage, and it is caused by a defect in skin barrier function; it is treated with corticosteroids and immunosuppressants in conventional medicine with periods of remission and flare-ups, which adversely affects the quality of life of patients and their families. Ayurveda classics have mentioned curative and safely management in the condition of Vicharchika (~Eczema). In this particular case of Shushka Vicharchika, oral Ayurveda drugs such as Mahamanjisthadi Kwatha, Panchanimba Churna, Gandhaka Rasayana, and Agasthya Rasayana (Ayurveda formulations) ere given for a period of two months. The assessment was done on the 0th day, 58th day, 98th day, and 123rd day; the criteria were EASI score and signs and symptoms of Shushka Vicharchika. The outcomes on EASI score per body region was found to be highly significant [BT(0th day)–4.5 AT3(123th day)-0.1] and improvement in cardinal sign and symptoms, total score was 8 on before treatment (0th day) which was reduced to 0 on 123rd day after the treatment. This study shows that oral administration of Shamana Chikitsa (Palliative Ayurveda treatment) is highly effective in the management of eczema, as evidenced by the reduction in EASI score assessed on the basis of improvement in both signs and symptoms.

Uses of Antidepressant as Adjunct Treatment of Very Severe Atopic Dermatitis

This is a case of severe atopic dermatitis in a young married male age 37 years. This patient was very anxious and frustrated. The patient was using all the standard treatments for severe atopic dermatitis for e.g azathioprine, cyclosporine, tab deltacortril, applying emollients with clobetasol in it but he was not getting better. By chance the patient's family dragged him to visit a psychiatrist and the patient was advised to start venlafaxine and within 15 days the patient started getting better miraculously. Atopic Dermatitis is a very frustrating disease and patients face severe depression and bouts of severe itching exacerbated by exposure to dust, stress, sweating, changing and wearing clothes, etc. The use of antidepressants is not common practice in treating atopic dermatitis. Most general practitioners and dermatologists don't pay attention to how much a patient is suffering not only physically but also mentally and because of this, they don't suggest antidepressants. The role of antidepressants as an anti-inflammatory is still needed to be educated among physicians. This is a vicious cycle. The stress causes the exacerbation of this disease in which patients start itching all over the body and because of itching, lesions all over the body start getting infected as during itching staphylococcus aureus which resides under the nail enter in the lesion and cause infection and because of infection patients have a fever, lethargy, and weakness. The use of antidepressants is a game-changer in the management of atopic eczema.

2020 Korean Consensus Guidelines for Diagnosis and Treatment of Chronic Hand Eczema.

BackgroundHand eczema refers to eczema located on the hands, regardless of its etiology or morphology. Despite its high prevalence and significant impact on patients' quality of life, treatment is frequently challenging because of its heterogeneity, chronic and recurrent course, and lack of well-organized randomized controlled trials of the various treatment options.ObjectiveThese consensus guidelines aim to provide evidence-based recommendations on the diagnosis and management of hand eczema to improve patient care by helping physicians make more efficient and transparent decisions.MethodsA modified Delphi method, comprising two rounds of email questionnaires with face-to-face meetings in between, was adopted for the consensus process that took place between February and September 2020. Forty experts in the field of skin allergy and contact dermatitis were invited to participate in the expert panel.ResultsConsensus was reached for the domains of classification, diagnostic evaluation, and treatment; and a therapeutic ladder to manage chronic hand eczema was developed.ConclusionThese are the first consensus guidelines for chronic hand eczema in the Asian population, which will help standardize care and assist clinical decision-making in the diagnosis and treatment of chronic hand eczema.

Probiotics in the Management of Atopic Dermatitis for Children: A Case-Based Review

Background Atopic dermatitis or eczema is one of the most common dermatologic problems, especially in children. Several studies have hypothesized that alteration of gut-colonizing microbes might have induced and conditioned the development of the disease. Thus, modulation of microbial diversity and abundance might help alleviate symptoms and conditions for patients. Given the ability of commensal and symbiotic microorganisms in modulating the immune system, probiotics administration has been studied in previous research in the management of eczema. However, until today, there are conflicting results between studies making inconclusive recommendations towards probiotics supplementation in the management of atopic dermatitis. This case-based review was done to assess and evaluate the therapeutic efficacy of probiotics supplementation in the management of eczema in children. Method An electronic database search was conducted in PubMed-NCBI, Cochrane, EBSCO, ProQuest, and SCOPUS in March 2020. Individual studies and reviews were then gathered for screening using predetermined inclusion and exclusion criteria. The included studies were then critically appraised for their validity and importance. Result A total of 5 studies, all of which were RCTs, were included in this review. Out of all the studies included, 4 showed no clinically significant improvements in using probiotics in the management of eczema in children as they did not pass the minimal clinically important difference (MCID) of eczema severity as determined by SCORAD (SCORing Atopic Dermatitis). Conclusion Supplementation of probiotics in the management of eczema in children does not show a clinically relevant difference vs. standard treatment in reducing eczema severity.

Exploring the Effect of Nice Guidelines on Prescribing for Childhood Atopic Eczema in Primary Care with An Interrupted Time Series

IntroductionAtopic eczema (AE) is a chronic inflammatory skin condition affecting 20-32% of UK children, typically diagnosed and treated in primary care. National Institute of Health and Clinical Excellence (NICE, 2007) guidelines recommend all children presenting with AE in primary care are prescribed emollient; topical corticosteroids (TCS) are co-prescribed if indicated by severity. The proportion of children receiving recommended treatment and NICE guideline impact on prescribing practices is unknown. This study was the first to access population-level UK-wide primary care dermatology data from SystmOne.&#x0D; Objectives and ApproachWe explored treatment patterns for childhood AE documented in primary care data from SystmOne.&#x0D; Secondary analysis of retrospective, longitudinal primary care data for childhood (&lt;12yo) AE-related consultations from 2002 to 2013. Four treatment scenarios were compared: 1) emollient and TCS co-prescribed (NICE-recommended for moderate-high severity presentation), 2) emollient only (NICE-recommended for mild severity presentation), 3) TCS only (not recommended), or 4) no topical treatment prescribed (not recommended). ARIMA used to examine step and trend-change in prescribing following guideline release.&#x0D; ResultsNICE-recommended treatments were more common following guideline release: emollient+TCS increased 8% (95%CI 7.7,8.7%); emollient alone increased 8% (95%CI 7.8,8.8%); TCS alone decreased 5% (95%CI -4.2,-5.1%); and no treatment decreased 11% (95%CI -11.3,-12.3%).&#x0D; Longitudinal analysis indicated increased NICE-recommended prescribing was due to pre-existing trends not significantly altered by the guideline release. By December 2013, ~334 children per month were still not receiving recommended AE treatment (37% of ~900 first-time consultations/month).&#x0D; Conclusion / ImplicationsAdherence to best practice guidelines for treatment and management of childhood atopic eczema is currently sub-optimal. Significant barriers to optimal use of this data could be achieved by improving design of data input interfaces with secondary use for research in mind. As well as study findings, this presentation will share challenges associated with utilising routinely collected SystmOne data for research purposes for the first time in the UK.