Treatment Of Eczema In Children Research Articles

Clinical Effect of Bifidobacterium Triple Viable Bacteria Combined with Cetirizine in the Treatment of Eczema in Children and its Effect on Immunoglobulin Levels

Objective: To analyze the clinical effect of Bifidobacterium triple viable bacteria combined with cetirizine in the treatment of eczema in children and its impact on the immunoglobulin levels of the children. Methods: 50 children with eczema who received treatment in our hospital from January 2021 to December 2022 were selected as research subjects and divided into 25 cases in a group using the computer randomization method. In addition to basic treatment for both groups, patients in the control group were treated with cetirizine, while the observation group was treated with Bifidobacterium triple viable bacteria and cetirizine. The immunoglobulin levels, inflammatory factor levels, intestinal flora numbers, treatment effects, and recurrence rates within six months were compared between the two groups before and after treatment. Results: Before treatment, there was little difference in the indicators between the two groups of children (P> 0.05). After treatment, various immunoglobulins (IgM and IgG), inflammatory factors (interleukin-4 and interleukin-10), and the number of intestinal flora (including Escherichia coli, Lactobacillus, and Bifidobacterium) in the observation group was better than that of the control group, the total effective rate of treatment was higher than that of the control group, and the recurrence rate within six months was lower than that of the control group (P < 0.05). Conclusion: Bifidobacterium triple viable bacteria combined with cetirizine can actively regulate immunoglobulin levels and the number of intestinal flora, control inflammatory reactions, and have high treatment effectiveness and low recurrence rates in the treatment of pediatric eczema.

Diagnosis and treatment of eczema in children

Eczema in children is usually of mild or moderate severity, but it can have a significant psychosocial impact and be challenging to treat. This article discusses the diagnosis and treatment of mild to moderate eczema in children, which can usually be effectively managed in primary care.

Clinical observation of butyl flufenadate combined with homemade silicone oil cream in the treatment of eczema in children

目的 观察氟芬那酸丁酯乳膏联合自制硅油治疗儿童湿疹的临床疗效。 方法 选择2016年5月至2017年9月大连市皮肤病医院门诊治疗的儿童局限性亚急性和慢性湿疹患者112例为研究对象，采用随机数字表法分成两组各56例。治疗组予外用硅油、氟芬那酸丁酯乳膏及丁酸氢化可的松乳膏，对照组仅外用丁酸氢化可的松乳膏，疗程2周。比较两组疗效。 结果 治疗2周后治疗组总有效率为83.9%，显著高于照组的69.6%(χ2＝5.71，P<0.05)。治疗组有2例出现皮肤发红，轻度刺痛感，与硅油1∶1混合后外用症状消失。 结论 氟芬那酸丁酯乳膏联合自制硅油治疗儿童湿疹疗效确切，可缩短病程，不良反应小，临床应用安全。

Feasibility of weekly participant-reported data collection in a pragmatic randomised controlled trial in primary care: experiences from the BATHE trial (Bath Additives for the Treatment of cHildhood Eczema)

BackgroundPatient-reported outcomes measures in clinical trials ensure that evaluations of effectiveness focus on outcomes that are important to patients. In relapsing-remitting conditions, such as eczema, repeated measurements may allow a more accurate reflection of disease burden and treatment effect than less frequent measurements.We asked parents/carers of children with eczema taking part in a trial of bath emollients to complete weekly questionnaires for 16 weeks.MethodsThe objective of this study was to determine the acceptability and practicality of collecting weekly measures of eczema severity online for 16 weeks in children aged 1 to 11 years as part of the BATHE study.BATHE randomised patients to bath emollients plus standard eczema care or standard eczema care only. The primary outcome was eczema severity, measured by the seven-item Patient-Oriented Eczema Measure (POEM) repeated weekly for 16 weeks. Acceptability was explored through qualitative interviews with 10 participants. Interviews were audio-recorded, transcribed and analysed thematically. Practicality was assessed by exploring the completeness of the data and keeping a log of any problems.ResultsFour hundred and eighty-two participants were recruited to the trial and 429 opted to complete measures online (89.0%). Data were collected online for 83% of time points over the 16-week period and there was no association between socio-demographic characteristics and data completeness. Two hundred and six (48%) completed their weekly data every week for 16 weeks and 341 (79%) completed it at least 80% of the time. The mean number of weeks completed was 13.3 out of 16 (SD 4.2).Interviewees said that they understood the rationale behind weekly collection and some welcomed this as it helped them realise how their child’s eczema changed weekly. Whilst some interviewees spoke of weekly questionnaires as onerous, others said that they found them quick and easy. Reminders were welcomed.Parents/carers seemed happy to receive telephone reminders and it was sometimes useful for eliciting problems relating to obtaining trial medication or password problems for online data collection.ConclusionsAmongst this population, high levels of data completeness suggests that weekly completion of the online questionnaire appears to be acceptable and feasible over a 16-week period.Trial registrationISRCTN84102309. Registered on 9 December 2013.

GP and parent dissonance about the assessment and treatment of childhood eczema in primary care: a qualitative study

ObjectivesTo compare parents’ and clinicians’ perspectives on the assessment and treatment of children with eczema in primary care.DesignQualitative interview study with purposive and snowball sampling and thematic analysis.Setting14 general practices...

Diagnosis, assessment, and treatment of childhood eczema in primary care: cross-sectional study.

BackgroundThe majority of children with eczema in the UK are looked after in primary care yet we know little about their care in this setting.AimTo compare the diagnosis, assessment, and treatment of eczema in primary care with published diagnostic criteria and management guidelines.Design & settingCross-sectional study using data from a randomised controlled feasibility study. General practices, UK.MethodBaseline data from children aged 1 month to 5 years recruited ‘in-consultation’ for the Choice of Moisturiser in Eczema Treatment (COMET) feasibility study was used. These included clinician diagnosis and global severity assessment; the parent-completed Patient Orientated Eczema Measure (POEM); a questionnaire about eczema treatments, including use of topical corticosteroid (TCS); and, the Eczema Area Severity Index (EASI) carried out by trained researchers. Descriptive analyses were undertaken to compare diagnoses with UK diagnostic criteria, severity assessments, and treatment with the National Institute for Health and Care Excellent (NICE) guidance.ResultsData were available for 90 participants. Only 46% of participants labelled as having eczema met the UK diagnostic criteria. Agreement between the global severity assessment by a healthcare practitioner with the EASI and POEM measures of eczema severity were 44% and 48% respectively. Emollients and TCSs were underused with 44% of participants not using any emollient and 46% using one or more TCSs. The ‘match’ between eczema severity and TCSs potency was poor.ConclusionDiscrepancies were found between the diagnosis, assessment, and treatment of children with eczema in primary care, and UK diagnostic criteria and guidelines. Further investigation to explore the reasons for this discordance, and whether it matters, is needed.

Topical Steroids vs. Pimecrolimus for Infants with Eczema

Pimecrolimus 1% cream, a topical calcineurin inhibitor approved for treatment of eczema in children aged ≥2 years, is often used when concerns arise

Diagnosis and treatment of atopic eczema in children and adults

Diagnosis and treatment of atopic eczema in children and adults

A Randomised Controlled Trial of Ion-Exchange Water Softeners for the Treatment of Eczema in Children

Epidemiological studies and anecdotal reports suggest a possible link between household use of hard water and atopic eczema. We sought to test whether installation of an ion-exchange water softener in the home can improve eczema in children. This was an observer-blind randomised trial involving 336 children (aged 6 months to 16 years) with moderate/severe atopic eczema. All lived in hard water areas (≥200 mg/l calcium carbonate). Participants were randomised to either installation of an ion-exchange water softener plus usual eczema care, or usual eczema care alone. The primary outcome was change in eczema severity (Six Area Six Sign Atopic Dermatitis Score, SASSAD) at 12 weeks, measured by research nurses who were blinded to treatment allocation. Analysis was based on the intent-to-treat population. Eczema severity improved for both groups during the trial. The mean change in SASSAD at 12 weeks was -5.0 (20% improvement) for the water softener group and -5.7 (22% improvement) for the usual care group (mean difference 0.66, 95% confidence interval -1.37 to 2.69, p = 0.53). No between-group differences were noted in the use of topical corticosteroids or calcineurin inhibitors. Water softeners provided no additional benefit to usual care in this study population. Small but statistically significant differences were found in some secondary outcomes as reported by parents, but it is likely that such improvements were the result of response bias, since participants were aware of their treatment allocation. A detailed report for this trial is also available at http://www.hta.ac.uk. Current Controlled Trials ISRCTN71423189 Please see later in the article for the Editors' Summary.

A multicentre randomised controlled trial and economic evaluation of ion-exchange water softeners for the treatment of eczema in children: the Softened Water Eczema Trial (SWET)

To determine whether installation of an ion-exchange water softener in the home could improve atopic eczema in children and, if so, to establish its likely cost and cost-effectiveness. An observer-blind, parallel-group randomised controlled trial of 12 weeks duration followed by a 4-week observational period. Eczema was assessed by research nurses blinded to intervention at baseline, 4 weeks, 12 weeks and 16 weeks. The primary outcome was analysed as intent-to-treat, using the randomised allocation rather than actual treatment received. A secondary per-protocol analysis excluded participants who failed to receive their allocated treatment and who were deemed to be protocol violators. Secondary and primary care referral centres in England (UK) serving a variety of ethnic and social groups and including children living in both urban and periurban homes. Three hundred and thirty-six children (aged 6 months to 16 years) with moderate/severe atopic eczema, living in homes in England supplied by hard water (≥ 200 mg/l calcium carbonate). Participants were randomised to either installation of an ion-exchange water softener plus usual eczema care (group A) for 12 weeks or usual eczema care alone (group B) for 12 weeks. This was followed by a 4-week observational period, during which water softeners were switched off/removed from group A homes and installed in group B homes. Standard procedure was to soften all water in the home, but to provide mains (hard) water at a faucet-style tap in the kitchen for drinking and cooking. Participants were therefore exposed to softened water for bathing and washing of clothes, but continued to drink mains (hard) water. Usual care was defined as any treatment that the child was currently using in order to control his or her eczema. New treatment regimens used during the trial period were documented. Primary outcome was the difference between group A and group B in mean change in disease severity at 12 weeks compared with baseline, as measured using the Six Area, Six Sign Atopic Dermatitis (SASSAD) score. This is an objective severity scale completed by blinded observers (research nurses) unaware of the allocated intervention. Secondary outcomes included use of topical medications, night-time movement, patient-reported eczema severity and a number of quality of life measures. A planned subgroup analysis was conducted, based on participants with at least one mutation in the gene encoding filaggrin (a protein in the skin thought to be important for normal skin barrier function). Target recruitment was achieved (n = 336). The analysed population included 323 children who had complete data. The mean change in primary outcome (SASSAD) at 12 weeks was -5.0 [standard deviation (SD) 8.8] for the water softener group (group A) and -5.7 (SD 9.8) for the usual care group (group B) [mean difference 0.66, 95% confidence interval (CI) -1.37 to 2.69, p = 0.53]. The per-protocol analysis supported the main analysis, and there was no evidence that the treatment effect varied between children with and without mutations in the filaggrin gene. No between-group differences were found in the three secondary outcomes that were assessed blindly (use of topical medications; night-time movement; proportion showing reasonable, good or excellent improvement). Small, but statistically significant, differences in favour of the water softener were found in three of the secondary outcomes that were assessed by participants [Patient-Oriented Eczema Measure (POEM); well-controlled weeks (WCWs); Dermatitis Family Index (DFI)]. The results of the economic evaluation, and the uncertainty surrounding them, suggest that ion-exchange water softeners are unlikely to be a cost-effective intervention for children with atopic eczema from an NHS perspective. Water softeners provided no additional benefit to usual care in this study population. Small, but statistically significant, differences were found in some secondary outcomes as reported by parents, but it is likely that such improvements were the result of response bias. Whether or not the wider benefits of installing a water softener in the home are sufficient to justify the purchase of a softener is something for individual householders to consider on a case-by-case basis. This trial demonstrated overwhelming demand for non-pharmacological interventions for the treatment of eczema, and this is something that should be considered when prioritising future research in the field. Current Controlled Trials ISRCTN71423189. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 15, No. 8. See the HTA programme website for further project information. Results of this trial are also published at www.plosmedicine.org.

Comparing homoeopathic with conventional treatment in children with eczema

Objectives To examine the influence of homoeopathic versus conventional treatment, over a period of 1 year, in children with eczema. Methods In this prospective multi-centre cohort study, children with eczema aged 1–16 years were recruited from primary care practices in Germany. They received either conventional or homoeopathic treatment. Outcome measures were self/parents assessed eczema symptoms by numerical rating scales (0=none; 10=worst symptoms) as well as quality of life at 0, 6 and 12 months. Results We included a total of 118 children: 54 from homoeopathic (mean age±S.D. was 5.1±3.3 years; 56% boys) and 64 from conventional practices (6.2±3.8 years; 61% boys). Eczema symptoms improved from 0 to 12 months for both treatment options. There was no significant difference between the homoeopathic group (3.5–2.5, for 0–12 months) versus the conventional treatment group (3.4–2.1), after adjustment for potential confounders ( p =0.447). Furthermore, disease-related quality of life improved in both groups similarly. In the subgroup of children aged 8–16 years, general quality of life was significantly better for children with conventional compared to those with homoeopathic treatment ( p =0.030). Conclusions This observational study is the first long-term prospective investigation to compare homoeopathic and conventional treatment of eczema in children. Over a period of 1 year, both therapy groups improved similarly regarding patient-oriented outcomes. To resolve current uncertainties surrounding both homoeopathic and conventional treatment for children with eczema, further studies are needed including assessments by raters, who are blinded to treatment. A randomized trial could be designed in a way where both groups of patients—i.e. those seeking conventional and those seeking homoeopathic care—are randomized to either verum or placebo treatment within their preferred type of care.

A multicentre randomized controlled trial of ion-exchange water softeners for the treatment of eczema in children: protocol for the Softened Water Eczema Trial (SWET) (ISRCTN: 71423189)

There is epidemiological evidence linking increased water hardness with increased eczema prevalence. A number of plausible mechanisms can be forwarded to suggest why hard water could exacerbate eczema. The most likely explanation is increased soap usage in hard water areas, the deposits of which can cause skin irritation in individuals with eczema. To assess the cost and cost-effectiveness of ion-exchange water softeners for the treatment of eczema in children. Three hundred and ten children aged 6 months to 16 years, with moderate to severe eczema. The children must live in hard water areas (>or= 200 mg L(-1) of calcium carbonate) and have a home that is suitable for the installation of a water softener. This is a single-blind, parallel-group, randomized controlled trial of 12 weeks duration followed by a 4-week cross-over period. RESULTS/ANALYSIS PLAN: difference in the mean change in disease severity (Six Area, Six Sign Atopic Dermatitis score) at 12 weeks compared with baseline. (i) proportion of time spent moving during the night; (ii) self-reported global changes in eczema severity; (iii) amount of topical treatment used; (iv) Patient Oriented Eczema Measure; (v) number of totally controlled and well controlled weeks; (vi) impact on health-related quality of life for the child (EQ-5D) and the family (Dermatitis Family Impact questionnaire); and (vii) cost-effectiveness. It is planned that recruitment will be completed by the end of 2008 and results will be available towards the end of 2009.

Homoeopathic versus conventional treatment of children with eczema: A comparative cohort study

To assess, over a period of 12 months, whether homoeopathic treatment could influence eczema signs/symptoms and quality of life (QoL) compared with conventional treatment. Prospective multi-centre cohort study. Children with eczema aged 1-16 years were recruited from primary care practices. Conventional versus homoeopathic treatment. Patients (or parents) assessed eczema symptoms by numerical rating scales as well as disease-specific Atopie Lebensqualitaets-Fragebogen (ALF) and general quality of life (KINDL, KITA) at 0, 6 and 12 months. A total of 118 children were included: 54 from homoeopathic (mean age+/-S.D. was 5.1+/-3.3 years; 56% boys) and 64 from conventional practices (6.2+/-3.8 years; 61% boys). Eczema symptoms (assessed by patients or their parents) improved from 0 to 12 months for both treatment options, but did not differ between the two groups: 3.5-2.5 versus 3.4-2.1; p=0.447 (adjusted). Disease-related quality of life improved in both groups similarly. In the subgroup of children aged 8-16 years the general quality of life showed a better trend for conventional treatment compared with homoeopathic treatment (p=0.030). This observational study is the first long-term prospective investigation to compare homoeopathic and conventional treatment of eczema in children. Over a period of 12 months, both therapy groups improved similarly regarding perception of eczema symptoms (assessed by patients or parents) and disease-related quality of life.

The Role of Probiotics in the Management of Allergic Disease

Probiotics have recently been advocated for the prevention and treatment of allergic disease (AD). In clinical practice they are increasingly being used for these purposes. Here we review the evidence base for the use of probiotics in the management of AD. We find support for their use in the treatment of childhood eczema, but the clinical significance of any treatment effect is uncertain. There is also evidence to support the use of probiotics in the prevention of childhood eczema. However the available evidence suggests that probiotics are not an effective treatment for allergic airway diseases. Probiotics may be more effective when used early in life, and they may have a particular role in gastrointestinal AD. The relative efficacy of different probiotic strains in the management of AD is not well established, and further work is needed to establish their mechanisms of action. In summary probiotics are likely to play a part in the management of childhood eczema in the future, and further studies are warranted to precisely define their role.

Treatment of childhood eczema.

Eczema in childhood is almost always atopic eczema, a common disease with huge impact on the quality of life of the child and family. Although atopic eczema constitutes part of the atopic syndrome, avoidance of allergens is never enough for disease control. Treatment of eczema in childhood has the same components as in adults. Emollients constitute the preventive background therapy in all stages of eczema, and topical corticosteroids are still the mainstay of treatment. Infectious exacerbation may require the use of a short course of topical or systemic antimicrobials. UV phototherapy should be considered as an adjunctive treatment to assist topical corticosteroids after an acute exacerbation of the disease. Cyclosporine can also be used in the treatment of childhood eczema in severe cases. Maternal allergen avoidance for disease prevention, oral antihistamines, Chinese herbs, dietary restriction in established atopic eczema, homeopathy, house-dust mite reduction, massage therapy, hypnotherapy, evening primrose oil, emollients, and topical coal tar are other temporarily used treatment modalities, without, however, firm evidence of efficacy from proper controlled trials. Calcineurin inhibitors constitute a new generation of drugs for both adult and childhood eczema already marketed in some countries. It is postulated that they will replace topical corticosteroids as first-line treatment of eczema.

Treatment of Childhood Eczema

Treatment of Childhood Eczema