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Background: A hand photography protocol was needed to ascertain the presence and severity of dermatitis in a trial testing the effectiveness of a behaviour change intervention to prevent hand dermatitis in nurses. Methods: We developed the protocol in 3 stages: (1) we established a procedure for collecting hand photographs; (2) we conducted a stepwise validation process to agree rules for diagnosing and determining the severity of hand dermatitis; and (3) we trained a research nurse to screen out “clear” cases. Results: We developed and trained fieldworkers (n = 97) in a procedure for collecting hand photographs. Study dermatologists established interpretation rules to diagnose and determine the severity of dermatitis from photographs. Prior to the establishment of the rules, interobserver agreement between the 2 dermatologists on the presence or absence of hand dermatitis was moderate (κ = 0.5). At the final stage of the validation process, the dermatologists agreed on 88% cases from independent assessments, with consensus being reached for the remaining 12% following joint deliberation. Following training, a subgroup analysis of 250 cases screened by the nurse and characterized as “clear” found that 2 (0.8%) “positive” cases were missed. Conclusion: We have developed a hand photography protocol that may be used in other studies or in hand dermatitis health surveillance programmes. [ABSTRACT FROM AUTHOR]

Background: Atopic eczema (AE) is a common skin problem that impairs quality of life and is associated with the development of other atopic diseases including asthma, food allergy and allergic rhinitis. AE treatment is a significant cost burden for health care providers. The purpose of the trial is to investigate whether daily application of emollients for the first year of life can prevent AE developing in high-risk infants (first-degree relative with asthma, AE or allergic rhinitis).Methods: This is a protocol for a pragmatic, two-arm, randomised controlled, multicentre trial. Up to 1400 term infants at high risk of developing AE will be recruited through the community, primary and secondary care in England. Participating families will be randomised in a 1:1 ratio to receive general infant skin-care advice, or general skin-care advice plus emollients with advice to apply daily to the infant for the first year of life. Families will not be blinded to treatment allocation. The primary outcome will be a blinded assessment of AE at 24 months of age using the UK Working Party Diagnostic Criteria for Atopic Eczema. Secondary outcomes are other definitions of AE, time to AE onset, severity of AE (EASI and POEM), presence of other allergic diseases including food allergy, asthma and hay fever, allergic sensitisation, quality of life, cost-effectiveness and safety of the emollients. Subgroup analyses are planned for the primary outcome according to filaggrin genotype and the number of first-degree relatives with AE and other atopic diseases. Families will be followed up by online and postal questionnaire at 3, 6, 12 and 18 months with a face-to-face visit at 24 months. Long-term follow-up until 60 months will be via annual questionnaires.Discussion: This trial will demonstrate whether skin-barrier enhancement through daily emollient for the first year of life can prevent AE from developing in high-risk infants. If effective, this simple and cheap intervention has the potential to result in significant cost savings for health care providers throughout the world by preventing AE and possibly other associated allergic diseases.Trial Registration: ISRCTN registry; ID: ISRCTN21528841 . Registered on 25 July 2014. [ABSTRACT FROM AUTHOR]

Effectiveness and safety of lotion, cream, gel, and ointment emollients for childhood eczema: a pragmatic, randomised, phase 4, superiority trial. Derek Chu is the 2022 atopic dermatitis guideline co-chair with the American Academy of Allergy, Asthma & Immunology (AAAAI) and the American College of Allergy, Asthma & Immunology. [Extracted from the article]

Background: Massive duplication of effort occurs when researchers all over the world undertake extensive searches for randomized controlled trials when preparing systematic reviews, when developing evidence-based guidelines and when applying for research funding for eczema treatments. Such duplication wastes valuable resources. Searching for randomized controlled trials of eczema is a laborious task involving scrutiny of thousands of individual references from diverse electronic databases in order to obtain a few papers of interest. Clinicians and patients who wish to find out more about a particular treatment are at risk of missing the relevant evidence if they are not trained in electronic bibliographic searching. Systematic reviews cannot be relied upon to comprehensively inform current optimal eczema treatments due to incomplete coverage and because many may be out of date. An international, publically available and comprehensive resource which brings together all randomized controlled trials on eczema treatment using a highly sensitive search has the potential to release more filtered knowledge about patient care to those who need it most and to significantly shorten the duration and costs of many clinical eczema research and guideline projects. Description: The Global Resource of EczemA Trials brings together information on all randomized controlled trials of eczema treatments published from the beginning of 2000 up to the end of 2010 and will be updated every month. We searched the Cochrane Central Register of Controlled Trials in The Cochrane Library and the Cochrane Skin Group Specialised Register, MEDLINE, EMBASE, LILACS, AMED and CINHAL databases. We included 268 RCTs (24th March 2011) covering over 70 different treatment interventions. The structure of the Global Resource of Eczema Trials allows the user as much, or as little, specificity when retrieving information on trials as they wish, in an easy to use format. For each trial, the database gives the citation for the published report and also provides enough information to enable a user to decide whether the trial is worth further scrutiny. Conclusions: The Global Resource of Eczema Trials has been created to facilitate knowledge mobilization into healthcare and to reduce wastage of research time through unnecessary duplication. The collective time saved by research groups around the world can now be used to make strides in optimising the treatment of eczema, in order to further benefit people with eczema. The database can be accessed free of charge at http://www.greatdatabase.org.uk [ABSTRACT FROM AUTHOR]

The objective of this systematic review, which was performed following the guidelines of the Cochrane collaboration, was to assess the effects of interventions for treatment of atopic dermatitis (AD) in dogs. Citations identified from three databases (MEDLINE, Thomson’s Science Citation Index Expanded and CAB Abstracts) and trials published by December 2007 were selected. Proceedings books from the major veterinary dermatology international congresses were hand searched for relevant citations. The authors selected randomized controlled trials (RCTs), published from January 1980 to December 2007, which reported the efficacy of topical or systemic interventions for treatment or prevention of canine AD. Studies had to report assessments of either pruritus or skin lesions, or both. Studies were selected and data extracted by two reviewers, with discrepancies resolved by a third arbitrator. Missing data were requested from study authors of recently published trials. Pooling of results and meta-analyses were performed for studies reporting similar interventions and outcome measures. A total of 49 RCTs were selected, which had enrolled 2126 dogs. This review found some evidence of efficacy of topical tacrolimus (3 RCTs), topical triamcinolone (1), oral glucocorticoids (5), oral ciclosporin (6), subcutaneous recombinant γ-interferon (1) and subcutaneous allergen-specific immunotherapy (3) to decrease pruritus and/or skin lesions of AD in dogs. One high-quality RCT showed that an oral essential fatty acid supplement could reduce prednisolone consumption by approximately half. Additional RCTs of high design quality must be performed to remedy previous flaws and to test interventions for prevention of flares of this disease. [ABSTRACT FROM AUTHOR]

In the course of producing the 2009 NHS Evidence - skin disorders Annual Evidence Update on Acne Vulgaris, 25 randomised controlled trials were examined. From these, at least 12 potentially serious problems of trial reporting were identified. Several trials concluded no effect of a treatment yet they were insufficiently powered to exclude potentially useful benefits. There were examples of duplicate publication and "salami publication", as well as two trials being combined and reported as one. In some cases, an incorrect "within-groups" statistical comparison was made and one trial report omitted original efficacy data and included only P values. Both of the non-inferiority studies examined failed to pre-specify a non-inferiority margin. Trials reported as "double-blind" compared treatments that were dissimilar in appearance or had differing adverse effect profiles. In one case an intention-to-treat analysis was not performed and there was a failure to account for all of the randomized participants. Trial results were made to sound more impressive by selective outcome reporting, emphasizing the statistical significance of treatment effects that were clinically insignificant, and by the use of larger-sounding odds ratios rather than rate ratios for common events. Most of the reporting problems could have been avoided by use of the CONSORT guidelines and prospective trial registration on a public clinical trials database. [ABSTRACT FROM AUTHOR]

Background: Valid and reliable outcome measurements are a prerequisite for evidence-based practice. The comparative validity and reliability of outcome measurements for assessing atopic eczema (AE) severity is unclear. Objective: We sought to assess the validity, reliability, sensitivity to change, and ease of use of outcome measurements for AE. We also sought to give recommendations on which outcomes to use in clinical research and for clinical monitoring. Methods: We performed a systematic review and survey of clinical experts and patients. Results: Twenty published outcome measurements were identified. There is evidence of adequate construct validity for 3 measurements (Severity Scoring of Atopic Dermatitis index [SCORAD], Eczema Area and Severity Index [EASI], and Three Item Severity Score), adequate internal consistency of 1 scale (Patient-oriented Eczema Measure [POEM]), adequate interobserver reliability of 5 measurements (Basic Clinical Scoring System; Nottingham Eczema Severity Score; Objective Severity Assessment of Atopic Dermatitis; Six Area, Six Sign Atopic Dermatitis severity score; and SCORAD), adequate test-retest reliability of 1 scale (POEM), and adequate sensitivity to change of 3 measurements (EASI, SCORAD, and Investigators'' Global Atopic Dermatitis Assessment). Most outcome measurements have adequate content validity, as assessed by patients and experts. Data on the time to perform the assessment was identified for 8 outcome measurements. Only SCORAD, EASI, and POEM have been tested sufficiently and performed adequately. Conclusion: There are too many published outcome measures for AE. Most have not been tested properly or perform adequately when tested, and their continued use hampers scientific communication. Clinical implications: Only SCORAD, EASI, and POEM currently perform adequately. These scales should be used in future studies. [Copyright &y& Elsevier]

Background: Occupational dermatitis is a problem in the printing industry but can be avoided through adequate protective measures. Research into intervention implementation is fundamental to the success of a formal intervention effectiveness trial. Objectives: The preliminary testing of four risk reduction strategies for occupationally caused dermatitis, which represent a range of approaches and cost implications. Patients/Methods: The strategies, the provision of (i) skin checks plus treatment advice; provision of (ii) gloves of the correct type/size plus use of an after-work cream; provision of (iii) information highlighting the problem of occupational dermatitis and (iv) development of a best practice skin care policy, were evaluated over 3 months in two non-randomly selected companies. A post-intervention evaluation into the effectiveness and efficacy of the intervention was also carried out. Results and Conclusions: All interventions were found to be acceptable to some extent. No single intervention appeared to be completely effective. The most practical intervention appeared to be the regular use of gloves of the correct type and size. This preliminary intervention study has demonstrated an improvement in the skin condition of workers examined and points towards the need for further testing of risk reduction strategies for the prevention of dermatitis in the printing industry on a much larger scale. [ABSTRACT FROM AUTHOR]

Objective: To develop a simple, valid, repeatable, and readily understandable patient-oriented assessment measure for monitoring disease activity in children and adults with atopic eczema. Design: Qualitative semistructured patient interviews identified a list of symptoms of atopic eczema. These symptoms were quantitatively analyzed in a larger patient population to identify which symptoms were important to patients and amenable to monitoring as part of a scoring system. Setting: The outpatient Department of Dermatology at the Queen's Medical Centre, University Hospital, Nottingham, England, and 5 local general practices. Patients: Four hundred thirty-five patients with atopic eczema. Results: Seven symptoms were incorporated into the final patient-oriented eczema measure using a simple 5-point scale of frequency of occurrence during the previous week, with a maximum total score of 28. Validity testing against the Dermatology Life Quality Index, Children's Dermatology Life Quality Index, and patients' global severity assessments showed good correlation (r=0.78, r=0.73, and r=0.81, respectively; P<.001). Internal consistency was high (Cronbach α=0.88), and test-retest reliability was good, with 95% of scores falling within 2.6 points on repeat testing (mean score difference, 0.04; SD, 1.32). Individual variables in the measure demonstrated sensitivity to change during a 4-week in-clinic period and an 18-week randomized controlled clinical trial. Conclusion: The patient-oriented eczema measure is a practical self-assessed measurement tool for monitoring aspects of atopic eczema that are important to patients in routine clinical practice or in the clinical trial setting. [ABSTRACT FROM AUTHOR]

This article focuses on the practical management of (atopic eczema) AE from a pediatric perspective, with an emphasis on relating treatment decisions to the currently available evidence. Sufficient evidence from clinical trials is now available to inform many areas of AE management, although some gray areas and some areas of relative ignorance remain. Authors in this article illustrate common AE management issues in case scenarios and use these to discuss the place of emollients, topical steroids, the new topical immunomodulators, wet wrap bandages, as well as systemic treatment options, phototherapy, and advice on allergen avoidance and complementary therapies.

Perkin MR, Strachan DP, Williams HC, Kennedy CTC, Golding J and the ALSPAC Study Team. Natural history of atopic dermatitis and its relationship to serum total immunoglobulin E in a population-based birth cohort study. Pediatr Allergy Immunol 2004: 15: 221–229. © 2004 Blackwell Munksgaard We investigated the natural history of atopic dermatitis (AD) in a population-based birth cohort and assessed whether children at risk of visible eczema at 5 years of age can be identified from total immunoglobulin E (IgE) levels measured at 8, 12 and 18 months. AD data collected included a whole body examination for visible eczema at 49 months (4 years) and 61 months (5 years) of age and parent completed questionnaire data throughout their early lives. Children were divided into four groups based on their natural history of early AD: persistent (AD at 1, 6, 18, 30 and 42 months, n = 34), intermittent early onset (before 18 months of age, n = 495), intermittent late onset (18–42 months of age, n = 273) and unaffected ( n = 429). Visible eczema at 5 years of age was present in 12.2% (117/957) (95% confidence interval [CI] 10.1–14.3%) of the children. Levels of total IgE at 8, 12 and 18 months of age were associated with early onset of AD, but not with AD of later onset. For all four natural history groups, the geometric mean total IgE at 12 months was higher in those who subsequently had visible eczema than those who did not. However, the degree of overlap was such that total IgE at 12 months of age was a poor predictor of eczema at age five. A cutoff point of 78 kU/l had the highest positive predictive value for visible eczema at 5 years of age of 28.6%, with a sensitivity of 12% and specificity of 95%. [ABSTRACT FROM AUTHOR]

Several studies have suggested that the prevalence of atopic dermatitis has increased over the last three decades,[SUP1-7] and similar trends have been reported with asthma and hay fever. However, in common with other 'allergic' disease, the definition and measurement of atopic dermatitis in populations has been fraught with problems and has led to difficulties in separating any real changes in disease prevalence from secular changes in diagnosis. In this article, the evidence surrounding the claims of an increased prevalence of atopic dermatitis is examined, and possible reasons for such a change are suggested. [ABSTRACT FROM AUTHOR]

Children with chronic skin diseases often experience significant psychological difficulties, yet pediatric dermatologists rarely have psychology professionals on hand to help address them. This article presents personalized stories as a technique for integrating psychologically developed interventions into day-to-day clinical practice with a view to improving treatment outcomes. [ABSTRACT FROM AUTHOR]

Cleverly using records obtained from the 2003 National Survey of Children's Health (NSCH), Shaw et al. provide a pioneering glimpse into the burden of eczema across the United States. Using parental reports of a doctor's diagnosis of eczema in the past 12 months, the authors show that eczema affects around 9-18% of children age 17 and under. The study confirms reported associations such as living in metropolitan areas, higher household education level, and black ethnicity. Novel findings include the demonstration of higher eczema prevalence along the East Coast. The study correlates well with previous reports and may help point to environmental factors that contribute to the development of eczema. [ABSTRACT FROM AUTHOR]

This article discusses educational programs focused around individuals with eczema. Staab and colleagues have created the German Atopic Dermatitis Intervention Study, which is the largest trial of the results of eczema. Results are measured on SCORAD, which is an eczema severity scale that measures severity from 0-103. Educational programs teach complex interventions including better use of existing treatments such as topical corticosteroids and other agents that help suppress dry skin and skin inflammation.

Comments on the study on the use of fluticasone propionate added to emollient maintenance treatment to reduce the risk of relapse in atopic dermatitis (AD). Short duration of most clinical trials for the treatment of AD; Relapse of the disease over a 16-week period; Quality of the study; Side effects; Effectiveness of fluticasone.

The article reports on changes which have been suggested by medical research concerning the use of topical steroids for atopic eczema. The steroids, including betamethasone have typically been used twice daily or more but researchers have found that reducing the frequency of application to once daily does not seem to result in loss of efficacy, could lead to lower side effects, and may be more convenient for patients. A discussion of several preparations that have ben developed for once daily use is presented.

Focuses on the case of a 10-year-old girl with atopic dermatitis or atopic eczema which is an itchy inflammation skin condition with a predilection for the skin flexures. The difficulty of defining atopic dermatitis; Prevalence of the condition in children in Iran, China, Australia, England, and Australia; Stress the condition can cause due to sleeplessness and the costs of treatment; Treatments used including corticosteroids and topical calcineurin inhibitors.

Presents a letter to the editor on childhood granulomatous periorificial dermatitis.

There is wide variation in the use of outcome measures for eczema. We performed a three-stage web-based international Delphi exercise to develop consensus-based sets of core outcome domains for eczema for 'controlled trials' and 'clinical recordkeeping'. A total of 57 individuals from four stakeholder groups (consumers, clinical experts, regulatory agency representatives, and journal editors) representing 13 countries were asked to rate the importance of 19 outcome domains for eczema and to choose which domains should be included in two core sets of outcomes. Forty-six individuals (81%) participated. Participants received standardized feedback, including the group median, interquartile range, and previous responses, and the assessment was repeated in two subsequent rounds. We defined consensus a priori if at least 60% of the members of at least three stakeholder groups, including consumers, recommended domain inclusion in the core set. Consensus was achieved for inclusion of symptoms, physician-assessed clinical signs, and a measurement for long-term control of flares in the core set of outcome domains for eczema trials. We recommend including these three core outcomes in future eczema trials in order to enhance clinical interpretability and to enable meta-analyses across different studies. For recordkeeping, consensus was reached to regularly monitor eczema symptoms in clinical practice. Future work is needed to select which existing or new scales should be used to measure the domains identified as relevant for the core set. [ABSTRACT FROM AUTHOR]