Efficacy of moisturizers in paediatric atopic dermatitis: A systematic review and meta-analysis of randomised controlled trials.

BACKGROUND: Topical moisturizer is recommended for atopic dermatitis. AIMS: The aim of the study was to investigate the knowledge gap regarding the efficacy of moisturizer in young patients. METHODS: A systematic review and meta-analysis were conducted on randomised controlled trials comparing participant's ≤15 years with atopic dermatitis, receiving either topical moisturizer or no moisturizer treatment. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. RESULTS: Six trials were included (intervention n= 436; control n= 312). Moisturizer use extended time to flare by 13.52 days (95% confidence interval 0.05-26.99, I2 88%). Greater reduction in risk of relapse was observed during the first month of latency (pooled risk ratio 0.47, 95% confidence interval 0.31-0.72, I2 28%) compared to the second and third months (pooled risk ratio 0.65, 95% confidence interval 0.47-0.91, I2 35% and pooled risk ratio 0.63, 95% confidence interval 0.47-0.83, I2 33%, respectively).Treated patients were 2.68 times more likely to experience a three-six months remission (95% confidence interval1.18-6.09, I2 56%). Moisturizer minimally improved disease severity and quality of life. LIMITATIONS: There is a dire need to conduct randomised controlled trials with more robust and standardised designs. CONCLUSION: Moisturizer benefits young patients with atopic dermatitis. However, more research is needed to better estimate its efficacy.

Hand eczema: an update.

Eczema, the commonest disorders afflicting the hands, is also the commonest occupational skin disease (OSD). In the dermatology outpatient departments, only the severe cases are diagnosed since patients rarely report with early hand dermatitis. Mild forms are picked up only during occupational screening. Hand eczema (HE) can evolve into a chronic condition with persistent disease even after avoiding contact with the incriminated allergen / irritant. The important risk factors for hand eczema are atopy (especially the presence of dermatitis), wet work, and contact allergy. The higher prevalence in women as compared to men in most studies is related to environmental factors and is mainly applicable to younger women in their twenties. Preventive measures play a very important role in therapy as they enable the affected individuals to retain their employment and livelihood. This article reviews established preventive and therapeutic options and newer drugs like alitretinoin in hand eczema with a mention on the etiology and morphology. Identifying the etiological factors is of paramount importance as avoiding or minimizing these factors play an important role in treatment.

A study to evaluate the efficacy and safety of hydrocortisone aceponate 0.127% lipophilic cream in steroid responsive dermatoses in Indian patients.

BACKGROUND: Topical corticosteroids (CSs) are the mainstay of therapy in various steroid responsive dermatoses. Newer CSs are more efficacious and safer than the older ones. There is no published data on the efficacy and safety of a new steroid hydrocortisone aceponate in the Indian population. AIM: To evaluate the efficacy and safety of hydrocortisone aceponate (0.127%) lipophilic cream in the treatment of steroid responsive dermatoses in Indian patients. METHODS: Four hundred and fifteen patients with clinically diagnosed steroid responsive dermatoses enrolled in this study. They were advised to apply hydrocortisone aceponate (0.127%) lipophilic cream as a thin film to all the affected areas twice daily. Cleansing was done prior to the application with either soap-free cleanser or soap (that would not affect the study result). Use of oral antihistamines and/or antibiotics was permissible. However, other oral/topical steroid use was not permitted during the study. Patients were evaluated at day 0 and at day 21. Data were recorded regarding clinical improvement and side-effects, if any. They were then analyzed to determine the efficacy and safety of the cream. RESULTS: Physician's global evaluation of therapy showed that lesions were cleared in 82 (22.10%), excellent result in 200 (53.91%), good result in 72 (19.41%), fair response in 15 (4.04%) and no change in 2 (0.54%) patients. There was no history of exacerbation in any patient. CONCLUSION: The study showed that hydrocortisone aceponate (0.127%) lipophilic cream is an effective therapeutic agent with a very good safety profile in various steroid responsive dermatoses in the Indian patient population.

Activated charcoal dressing in malodorous leg ulcers.

Leg ulcers are commonly associated with malodour. Reduction of malodour in foul smelling ulcers is an adjuvant therapy in the management of ulcers. We report two patients with leg ulcer who got benefited with activated charcoal dressing for malodour.

Topical betamethasone for prevention of radiation dermatitis.

BACKGROUND: Although acute radiation dermatitis (ARD) is a common side-effect of radiotherapy (RT), currently there is no general consensus about its prevention or treatment of choice. AIMS: The purpose of this study was to investigate whether prophylactic use of topical betamethasone 0.1% can prevent ARD caused by chest wall irradiation. METHODS: Fifty-one patients who underwent modified radical mastectomy for breast cancer and were going to receive RT, were randomly assigned to receive topical betamethasone 0.1%, petrolatum or none during RT. The frequency and severity of ARD (measured using Radiation Therapy Oncology Group acute radiation morbidity scoring criteria) were recorded at the end of each week during RT and two weeks after its completion. Clinical outcomes were analyzed by relevant statistical methods. RESULTS: All patients developed some degree of ARD, the frequency and severity of which increased with time and reached the maximum at the end of the seventh week for all groups. Patients receiving betamethasone had less severe ARD than the other two groups throughout the course of the study, but this difference was significant only at the end of the third week (p = 0.027). No significant difference was observed between the petrolatum and control arms. CONCLUSION: Prophylactic and ongoing use of topical betamethasone 0.1% during chest wall RT for breast cancer delays occurrence of ARD but does not prevent it. Petrolatum has no effect on the prevention of ARD in these patients.