What adjuvant treatments work for Atopic Eczema? An Updated Review of Clinical Trial Evidence.
- zeemfindsout
- Mar 22
- 2 min read
The big idea:
The aim of this review was to create an updated summary of randomised controlled trials (RCTs) that tested different treatments for atopic eczema.
By reviewing and combining the results of these trials, researchers hoped to make clearer, evidence-based treatment recommendations using both descriptive summaries and statistical analysis.
What the study asked:
What evidence supports the usefulness of different treatments, including adjuvant (supportive) therapies, for eczema?
What the study did:
Researchers carried out a very thorough search.
They looked through major medical databases, checked clinical trial registers, reviewed records from the Cochrane Skin Group, examined conference proceedings, checked reference lists of relevant articles, contacted leading experts, and reached out to pharmaceutical companies for additional data.
Only RCTs were included, and these had to focus on treatments for preventing or managing atopic eczema in people of any age.
All participants had to be diagnosed by a doctor.
Two researchers independently extracted the data from each study, resolving disagreements through discussion.
The quality of each study was carefully assessed.
Researchers checked whether:
Participants were properly randomised into groups
The allocation process was concealed
Participants and outcome assessors were blinded to the treatment given
All participants were included in the final analysis
When possible, similar studies were combined statistically to produce overall results.
If the studies were too different from one another (for example, different patient groups, treatment doses, or additional therapies), the results were described individually instead.
What the study found:
Out of 1,165 possible RCTs identified, 893 were excluded because they did not contain suitable or sufficient data.
This left 272 RCTs covering at least 47 different treatments, grouped into 10 main categories.
However, the overall quality of reporting was generally poor.
Statistical pooling was only possible for oral cyclosporin (a potent immunosuppressant used for short-term treatment of severe eczema that has not responded to topicals).
Even then, substantial data adjustments were needed.
There was reasonably strong RCT evidence supporting oral cyclosporin, topical corticosteroids, psychological therapies, and ultraviolet (UV) light therapy.
For many other treatments and prevention strategies, there was not enough good-quality evidence to make firm recommendations.
Importantly, there were no RCTs at all addressing key clinical questions such as:
Short-term strong versus long-term mild topical steroids
Diluting topical steroids
Oral prednisolone or azathioprine
Salt baths
Wet-wrap bandages
Water softeners
Allergy testing
Or different models of care
The review also highlighted the need for further detailed reviews of certain treatment groups, such as antihistamines and essential fatty acids.
What this means for eczema:
Overall, the evidence base for eczema treatments has important gaps.
Not all complementary or over-the-counter treatments are supported by strong research.
This suggests patients may benefit more from focusing on proven treatments and lifestyle management strategies recommended by healthcare professionals, rather than relying on unproven alternatives.
Link to study:
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