Topical treatment with fresh human milk versus emollient on atopic eczema spots in young children: a small, randomized, split body, controlled, blinded pilot study.

BACKGROUND: Public health nurses report on effects of fresh human milk as treatment for conjunctivitis, rhinitis and atopic eczema (AE), the latter being highly prevalent in early childhood. Emollients and topical corticosteroids are first line treatment of AE. As many caregivers have steroid phobia, alternative treatment options for mild AE are of interest. The aim of this small pilot study was to assess the potential effects and risks of applying fresh human milk locally on eczema spots in children with AE. METHODS: This was a split body, controlled, randomized and physician blinded pilot study, of children with AE with two similar contralateral eczema spots having a mother breastfeeding the child or a sibling. Fresh expressed milk and emollient was applied on the intervention spot and emollient alone on the control area, three times a day for four weeks. The severity and area of the eczema spots was evaluated weekly, and samples from milk and the spots were analysed weekly with respect to bacterial colonisation. RESULTS: Of nine patients included, six completed the study. Mean age at inclusion was 18.5 months. The spots examined were localized on the arms, legs or cheeks. The spots were similar in severity, but differed in area. In one patient the eczema ceased after inclusion. In four patients both control and intervention areas increased during the intervention. The relative change in eczema area compared to baseline showed less increase in the intervention spots in two patients, whereas the opposite was observed in three. In four children Staphylococcus aureus was found in their eczema once or more. In three of the 28 human milk samples, Staphylococcus aureus, alfa haemolytic streptococci or coagulase negative staphylococci were detected. Staphylococcus aureus was found once both in human milk and in the eczema spots, no clinical signs of infection were however observed. No secondary infection due to milk application was detected. CONCLUSION: In this small pilot study, no effect was found on eczema spots treated with topical application of fresh human milk. (ClinicalTrials.gov Identifier, NCT02381028 ).

Estimated ultraviolet doses to psoriasis patients during climate therapy.

BACKGROUND/PURPOSE: Psoriasis is a chronic inflammatory disease affecting about 2-3% of the population. Sun exposure has a positive effect on most lesions, but ultraviolet (UV) radiation also constitutes a carcinogenic potential. Climate therapy is frequently used to treat patients, with the consequence that they may receive high doses of UV. This paper explores UV doses to patients treated in Gran Canaria. METHODS: Patient UV doses have been estimated for 20 psoriasis patients during a 15-day climate therapy study and compared with the predetermined exposure schedule and doses reported from other studies. Estimates were based on UV measurements and the patients' diaries with information on the time spent in the sun. RESULTS: On the first day of exposure, the patients received on average 5.1 standard erythema doses (SED) estimated to the skin. The average dose for the 15-day study was 166 SED (250 SED for a regular 3-week treatment period). We found no significant correlation between the reduction in psoriasis area severity index scores and UV doses. CONCLUSION: The UV doses were higher than if they had followed the prescribed exposure schedule and also higher than those reported from other climate therapy studies. It seems beneficial to focus on following the prescribed exposure schedule.