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Hywel C Williams - One of the best experts on this subject based on the ideXlab platform.
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What's new in atopic Eczema? An analysis of systematic reviews published in 2009-2010.
Clinical and Experimental Dermatology, 2011Co-Authors: K. Shams, Douglas J.c. Grindlay, Hywel C WilliamsAbstract:Summary This review provides a summary of key findings from 18 systematic reviews on atopic Eczema, published or indexed between January 2009 and 24 August 2010. There was no good evidence on the possible benefit of organic food consumption and Eczema. Maternal intake of fish or fish oil may be associated with a reduced risk of Eczema in offspring, although further studies are needed. There is some evidence that partially hydrolysed infant formulas rather than standard formulas may be associated with a reduced risk of Eczema in infants, but there are shortcomings in the existing evidence. An inverse relationship has been found between gliomas/acute lymphoblastic leukaemia and allergic disease/Eczema, but there appears to be no association between multiple sclerosis and Eczema. Attention deficit hyperactivity disorder does appear to be associated with Eczema, but there is no evidence of a causal link. The risk of Eczema seems to be increased in urban compared with rural areas. Some new evidence has suggested superiority of 1% pimecrolimus over potent and mild corticosteroids at 6 months but not 12 months, and there is some evidence for superiority of 0.03% and 0.1% tacrolimus over 1% pimecrolimus. An updated Cochrane Review still found no evidence of a benefit from any form of antistaphylococcal treatment in managing clinically infected or uninfected Eczema. The evidence base is poor for bath emollients, occlusive treatments (e.g. wet and dry wraps) and woven silk clothing in treating Eczema. In general, the methods used in most systematic reviews of Eczema need to be reported more clearly, especially with regard to a more vigorous quality assessment of included studies. Included studies are frequently heterogeneous, proxy reporting is common, and appropriate disease definitions are often lacking. Better adherence to existing guidance on trial reporting and prospective registration of clinical trials may help improve the quality of studies.
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harmonising outcome measures for Eczema home report from the first international consensus meeting home 1 24 july 2010 munich germany
British Journal of Dermatology, 2010Co-Authors: Jochen Schmitt, Hywel C WilliamsAbstract:Current clinical research in Eczema (atopic dermatitis) is hampered by a profusion of outcome measures, most of which have not been developed or tested adequately. The first Harmonising Outcome Measures for Eczema meeting (HOME 1) was an exploratory meeting to determine whether there was sufficient interest and enthusiasm in the international scientific community to form a collaborative group to define a minimum set of core outcomes for future Eczema (atopic dermatitis) research. The meeting was open to all participants of the 6th Georg Rajka Symposium/International Symposium on Atopic Dermatitis/New Trends in Allergy VII meeting in Munich, 22-24 July 2010. Approximately 40 individuals attended. Prior to the meeting, an international Delphi exercise was performed to develop consensus-based sets of core outcome domains for Eczema for'controlled trials' and'clinical recordkeeping'. The results of this Delphi exercise were presented at the meeting and critically discussed by the attendees. The constructive group discussion identified several important issues for future Eczema outcomes research such as the degree to which patients and carers can be involved and the importance of involving colleagues from countries not represented at the meeting. In summary, this exploratory meeting indicated a genuine interest in the academic Eczema community to form an international multiprofessional group dedicated to harmonizing outcomes research in Eczema. The group decided to continue collaboratively with the HOME initiative.
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interventions to reduce staphylococcus aureus in the management of atopic Eczema an updated cochrane review
British Journal of Dermatology, 2010Co-Authors: F J Bathhextall, A J Birnie, J Ravenscroft, Hywel C WilliamsAbstract:Summary Background An association between the bacterium Staphylococcus aureus and atopic Eczema has been recognized for many years. Although few would dispute the benefit of systemic antibiotics in people with overtly clinically infected Eczema, the clinical role of S. aureus in causing inflammatory flares in clinically uninfected Eczema is less clear. Objectives/Methods To see if atopic Eczema can be improved by antistaphylococcal agents, we performed a systematic review of randomized controlled trials (RCTs) using Cochrane Skin Group’s Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE (from 2000), EMBASE (from 1980), the metaRegister of Current Controlled Trials (to March 2009), plus manual searching of references and conference proceedings. RCTs that compared interventions to reduce S. aureus in people with atopic Eczema with no treatment, vehicle, or another active compound were included. Publication status and language were not barriers to inclusion. Results Twenty-six studies involving 1229 participants were included. The studies were generally short term and of poor quality. There was no significant difference in global outcome for clinically infected Eczema when oral antibiotics were compared with placebo [one study, relative risk (RR) 0·40, 95% confidence interval (CI) 0·13–1·24] or when topical steroid antibiotic combinations were compared with steroid alone (two studies, RR 0·52, 95% CI 0·23–1·16). One study of children with infected Eczema that added bleach to bathwater showed a significant improvement in Eczema severity when compared with bathwater alone, although the difference could have been explained by regression to the mean. Although antistaphylococcal interventions reduced S. aureus numbers in people with clinically uninfected Eczema, none of the studies showed any clinical benefit. Conclusions We failed to find any evidence that commonly used antistaphylococcal interventions are clinically helpful in people with Eczema that is not clinically infected. Their continued use should be questioned in such situations, until better and longer-term studies show clear evidence of clinical benefit.
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global variations in prevalence of Eczema symptoms in children from isaac phase three
The Journal of Allergy and Clinical Immunology, 2009Co-Authors: Joseph Odhiambo, Hywel C Williams, Colin F Robertson, Tadd Clayton, Innes M AsherAbstract:BACKGROUND: In 1999, The International Study of Asthma and Allergies in Childhood (ISAAC) Phase One reported the prevalence of Eczema symptoms in 715,033 children from 154 centers in 56 countries by using standardized epidemiologic tools. OBJECTIVE: To update the world map of Eczema prevalence after 5 to 10 years (ISAAC Phase Three) and include additional data from over 100 new centers. METHODS: Cross-sectional surveys using the ISAAC questionnaire on Eczema symptoms were completed by adolescents 13 to 14 years old and by parents of children 6 to 7 years old. Current Eczema was defined as an itchy flexural rash in the past 12 months and was considered severe Eczema if associated with 1 or more nights per week of sleep disturbance. RESULTS: For the age group 6 to 7 years, data on 385,853 participants from 143 centers in 60 countries showed that the prevalence of current Eczema ranged from 0.9% in India to 22.5% in Ecuador, with new data showing high values in Asia and Latin America. For the age group 13 to 14 years, data on 663,256 participants from 230 centers in 96 countries showed prevalence values ranging from 0.2% in China to 24.6% in Columbia with the highest values in Africa and Latin America. Current Eczema was lower for boys than girls (odds ratio, 0.94 and 0.72 at ages 6 to 7 years and 13 to 14 years, respectively). CONCLUSION: ISAAC Phase Three provides comprehensive global data on the prevalence of Eczema symptoms that is essential for public health planning. New data reveal that Eczema is a disease of developing as well as developed countries.
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is Eczema really on the increase worldwide
The Journal of Allergy and Clinical Immunology, 2008Co-Authors: Hywel C Williams, A W Stewart, Erika Von Mutius, William O C M Cookson, Ross H AndersonAbstract:Background It is unclear whether Eczema prevalence is truly increasing worldwide. Objective We sought to investigate worldwide secular trends in childhood Eczema. Methods Children (n = 302,159) aged 13 to 14 years in 105 centers from 55 countries and children aged 6 to 7 years (n = 187,943) in 64 centers from 35 countries were surveyed from the same study centers taking part in Phase One and Three of the International Study of Asthma and Allergies in Childhood by using identical validated and translated questionnaires. Eczema was defined as an itchy, relapsing, flexural skin rash in the last 12 months, and it was termed severe Eczema when it was associated with 1 or more disturbed nights per week. Results Annual prevalence changes in relation to average prevalence across Phase One and Three were generally small and differed in direction according to the age of the participants and world region. For children 13 to 14 years old, Eczema symptom prevalence decreased in some previously high-prevalence centers from the developed world, such as the United Kingdom and New Zealand, whereas centers with previously high prevalence rates from developing countries continued to increase. In the children 6 to 7 years old, most centers showed an increase in current Eczema symptoms. Similar patterns to these were present for severe Eczema at both ages. Conclusion The epidemic of Eczema seems to be leveling or decreasing in some countries with previously high prevalence rates. The picture elsewhere is mixed, with many formerly low-prevalence developing countries experiencing substantial increases, especially in the younger age group.
B Zhao - One of the best experts on this subject based on the ideXlab platform.
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skin colonization by staphylococcus aureus in patients with Eczema and atopic dermatitis and relevant combined topical therapy a double blind multicentre randomized controlled trial
British Journal of Dermatology, 2006Co-Authors: J Q Gong, F Q Zeng, Zhixian Bi, D Yi, B ZhaoAbstract:Summary Background Staphylococcus aureus has a peculiar ability to colonize the skin of patients with Eczema and atopic dermatitis (AD), and is consistently found in Eczematous skin lesions in these patients. A correlation between the severity of the Eczema and colonization with S. aureus has been demonstrated, and it has been determined that bacterial colonization is an important factor aggravating skin lesions. Patients colonized with S. aureus have been treated with antibiotics in several open and double-blind placebo-controlled studies, with conflicting results. Objectives To investigate the colonizing features of S. aureus in the lesional and nonlesional skin of patients with Eczema and AD in China and to compare the therapeutic effect of mupirocin plus hydrocortisone butyrate with vehicle ointment plus hydrocortisone butyrate. Methods A multicentre, double-blind randomized trial was conducted. Eczema Area and Severity Index (EASI) scores were evaluated before the start of the trial and on the 7th, 14th and 28th day of treatment. Swabs for bacterial isolation were taken from lesional skin before the start of the trial and on the 7th, 14th and 28th day of treatment, and from nonlesional skin only before the start of the trial. A combination topical therapy with mupirocin plus hydrocortisone butyrate ointment was used in the experimental group, with vehicle ointment plus hydrocortisone butyrate ointment as a control. Results Of 327 patients enrolled in the study, 208 had Eczema and 119 had AD. Bacteria were isolated from 70·2% of lesional and 32·7% of nonlesional skin samples from patients with Eczema, of which S. aureus accounted for 47·3% and 27·9%, respectively. Bacteria were isolated from 74·8% of lesional and 34·5% of nonlesional skin samples from patients with AD, of which S. aureus accounted for 79·8% and 80·5%, respectively. The colonization density of S. aureus was markedly higher in lesional than in nonlesional skin, both in patients with Eczema and with AD (P 0·05). However, in patients with Eczema with a clinical score of > 8 or in patients with AD with a clinical score of > 7, the therapeutic effect in the experimental groups was superior to that in the control groups (P 0·05). Following the improvement of symptoms and signs of Eczema and AD, the positive rates of bacteria and S. aureus were reduced on the 7th day of treatment. Conclusions This study confirmed that lesional skin of patients with Eczema and AD was more frequently colonized with S. aureus than was nonlesional skin. The more severe the Eczema, the higher the colonization rate of S. aureus, and S. aureus was also more often present in lesional and nonlesional skin in patients with AD than in those with Eczema. Staphylococcus aureus infection is related to the pathogenesis of Eczema and AD. An antibiotic–corticosteroid combination and corticosteroid alone both gave good therapeutic effect in Eczema and in AD, and both reduced colonization by S. aureus. Early combined topical therapy is beneficial to patients with moderate to severe Eczema and AD, and it is unnecessary to use antibiotics at later stages of disease or in mild Eczema or AD.
Tove Agner - One of the best experts on this subject based on the ideXlab platform.
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Hand Eczema: treatment.
Journal of The European Academy of Dermatology and Venereology, 2019Co-Authors: P. Elsner, Tove AgnerAbstract:Hand Eczema is a highly prevalent, multietiological disease with a wide spectrum of severity and chronicity. The treatment of hand Eczema, especially in severe and chronic cases, is a challenge to the dermatologist requiring not only diagnostic and therapeutic, but also excellent patient communication skills. This review discusses the spectrum of therapeutic options for hand Eczema, the evidence for their efficacy and safety, and proposes a stepwise approach of intensity of treatment depending on disease severity and chronicity. In the near future, hand Eczema patients may benefit from new therapeutic principles such as biologics for the treatment of atopic Eczema and topical Janus Kinase inhibitors.
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Hand Eczema: Treatment Options
Current Treatment Options in Allergy, 2017Co-Authors: Tamara Theresia Lund, Tove AgnerAbstract:Purpose of review Hand Eczema is a common disease, it affects young people, is often work-related, and the burden of the disease is significant for the individual as well as for society. Factors to be considered when choosing a treatment strategy are, among others, whether the Eczema is acute or chronic, the severity of the disease, and the specific sub-diagnosis of hand Eczema, which relates to the etiology as well as the morphology of the disease. Optimal treatment is still a challenge. This review seeks to provide an overview of the most updated treatment of hand Eczema. Recent findings Treatment options comprise patient education with information on hand Eczema prevention and basic treatment and for patients with allergic contact dermatitis also with information about allergen avoidance. Topical treatment is primarily topical topical corticosteroids, which is—and has been for many years—first-line treatment for hand Eczema, to be used for a limited period of time. Topical calcineurin inhibitors are widely used as off-label treatment for hand Eczema; however, evidence for efficacy is sparse. Physical treatment with UVB and PUVA is effective, although time-consuming and sometimes too troublesome for the patients. With respect to systemic therapy, this is reserved for a patient with severe and long-lasting hand Eczema. Alitretinoin is the only systemic therapy, which is licensed for severe chronic hand Eczema, while other systemic therapies are also effective, but off-label use. Systemic treatment will in most cases be prescribed from 4 months and up to several years, and should always be accompanied by regular blood sample check. Summary topical corticosteroids are the mainstay primary choice of medical treatment, but should not be continued on a daily basis for more than 8 weeks. Second-line treatment comprises topical calcineurin inhibitors, phototherapy, and systemic treatment.
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skin care education and individual counselling versus treatment as usual in healthcare workers with hand Eczema randomised clinical trial
BMJ, 2012Co-Authors: Kristina Sophie Ibler, Thomas L Diepgen, Gregor B E Jemec, Christian Gluud, Jane Lindschou Hansen, Per Winkel, Simon Francis Thomsen, Tove AgnerAbstract:Objective To evaluate the effect of a secondary prevention programme with education on skin care and individual counselling versus treatment as usual in healthcare workers with hand Eczema. Design Randomised, observer blinded parallel group superiority clinical trial. Setting Three hospitals in Denmark. Participants 255 healthcare workers with self reported hand Eczema within the past year randomised centrally and stratified by profession, severity of Eczema, and hospital. 123 were allocated to the intervention group and 132 to the control group. Interventions Education in skin care and individual counselling based on patch and prick testing and assessment of work and domestic related exposures. The control was treatment as usual. Main outcome measures The primary outcome was clinical severity of disease at five month follow-up measured by scores on the hand Eczema severity index. The secondary outcomes were scores on the dermatology life quality index, self evaluated severity of hand Eczema, skin protective behaviours, and knowledge of hand Eczema from onset to follow-up. Results Follow-up data were available for 247 of 255 participants (97%). At follow-up, the mean score on the hand Eczema severity index was significantly lower (improved) in the intervention group than control group: difference of means, unadjusted −3.56 (95% confidence interval −4.92 to −2.14); adjusted −3.47 (−4.80 to −2.14), both P Conclusion A secondary prevention programme for hand Eczema improved severity and quality of life and had a positive effect on self evaluated severity and skin protective behaviour by hand washings and wearing of protective gloves. Trial registration ClinicalTrials.gov NCT01012453.
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Hand Eczema: prevalence and risk factors of hand Eczema in a population of 2274 healthcare workers.
Contact Dermatitis, 2012Co-Authors: Kristina Sophie Ibler, Thomas L Diepgen, Gregor B E Jemec, Mari-ann Flyvholm, Askel Jensen, Tove AgnerAbstract:Background. Healthcare workers are at increased risk of developing hand Eczema. Objectives. To investigate the prevalence and severity of self-reported hand Eczema, and to relate the findings to demographic data, occupation, medical speciality, wards, shifts, and working hours. Patients/materials/methods. A survey of 3181 healthcare workers was performed. Data were analysed with logistic regression. Data on sick leave and notification to the authorities were obtained. Results. The response rate was 71% (2274 of 3181). The 1-year prevalence of hand Eczema was 21%, and was positively associated with atopic dermatitis, younger age, male sex (male doctors), and working hours. Eighty nine per cent of subjects reported mild/moderate lesions. Atopic dermatitis was the only factor significantly related to severity. Sick leave was reported by 8% of subjects, and notification to the authorities by 12%. Conclusions. The 21% prevalence of hand Eczema in healthcare workers is double the prevalence in the background population. Eleven per cent of hand Eczema patients reported severe/very severe Eczema. No significant differences were found between professions or medical specialities with respect to prevalence or severity, but cultural differences between professions with respect to coping with the Eczema were significant. Atopic dermatitis was related to increased prevalence and severity, and preventive efforts should be made for healthcare workers with atopic dermatitis.
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hand Eczema severity and quality of life a cross sectional multicentre study of hand Eczema patients
Contact Dermatitis, 2008Co-Authors: Tove Agner, Klaus Ejner Andersen, F M Brandao, M Bruze, D P Bruynzeel, P J Frosch, Margarida Goncalo, A Goossens, Thomas Rustemeyer, Ian R WhiteAbstract:Background and Objectives: Hand Eczema is a chronic disease with negative impact on quality of life (QoL). In this study, QoL in hand Eczema patients is assessed and related to age, sex, severity, and diagnostic subgroups. Methods: A total of 416 patients with hand Eczema from 10 European patch test clinics participated in the study. Data on QoL were obtained from a self-administered questionnaire using the Dermatology Life Quality Index (DLQI). Severity was assessed by a scoring system (Hand Eczema Severity Index, HECSI) as well as frequency of eruptions and sick leave due to hand Eczema. Results: No significant difference was found between males and females with respect to QoL [DLQI median values and 25/75 percentiles for males and females being 7.0 (3-14) and 8.0 (3-13), respectively], although males were more severely affected than females (P < 0.025). A significant positive correlation was found for hand Eczema severity and age (P < 0.001), while no significant correlation was found for QoL and age. QoL was found increasingly reduced when sick leave was getting higher (P < 0.001). A statistically significant correlation between QoL (as measured by DLQI) and hand Eczema severity as measured by HECSI was found (P < 0.001). No significant difference in QoL was found between diagnostic subgroups. Conclusions: QoL was found markedly negatively affected in hand Eczema patients and was significantly correlated to disease severity. No significant difference in QoL was found between males and females, in spite of significantly more severe Eczema in males, indicating that QoL in female patients is more easily affected.
Jochen Schmitt - One of the best experts on this subject based on the ideXlab platform.
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towards global consensus on outcome measures for atopic Eczema research results of the home ii meeting
Allergy, 2012Co-Authors: Jochen Schmitt, Phyllis I Spuls, Maarten Boers, K S Thomas, Joanne R Chalmers, Evelien Roekevisch, M E Schram, Richard Allsopp, Valeria Aoki, Christian ApfelbacherAbstract:The use of nonstandardized and inadequately validated outcome measures in atopic Eczema trials is a major obstacle to practising evidence-based dermatology. The Harmonising Outcome Measures for Eczema (HOME) initiative is an international multiprofessional group dedicated to atopic Eczema outcomes research. In June 2011, the HOME initiative conducted a consensus study involving 43 individuals from 10 countries, representing different stakeholders (patients, clinicians, methodologists, pharmaceutical industry) to determine core outcome domains for atopic Eczema trials, to define quality criteria for atopic Eczema outcome measures and to prioritize topics for atopic Eczema outcomes research. Delegates were given evidence-based information, followed by structured group discussion and anonymous consensus voting. Consensus was achieved to include clinical signs, symptoms, long-term control of flares and quality of life into the core set of outcome domains for atopic Eczema trials. The HOME initiative strongly recommends including and reporting these core outcome domains as primary or secondary endpoints in all future atopic Eczema trials. Measures of these core outcome domains need to be valid, sensitive to change and feasible. Prioritized topics of the HOME initiative are the identification/development of the most appropriate instruments for the four core outcome domains. HOME is open to anyone with an interest in atopic Eczema outcomes research.
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harmonising outcome measures for Eczema home report from the first international consensus meeting home 1 24 july 2010 munich germany
British Journal of Dermatology, 2010Co-Authors: Jochen Schmitt, Hywel C WilliamsAbstract:Current clinical research in Eczema (atopic dermatitis) is hampered by a profusion of outcome measures, most of which have not been developed or tested adequately. The first Harmonising Outcome Measures for Eczema meeting (HOME 1) was an exploratory meeting to determine whether there was sufficient interest and enthusiasm in the international scientific community to form a collaborative group to define a minimum set of core outcomes for future Eczema (atopic dermatitis) research. The meeting was open to all participants of the 6th Georg Rajka Symposium/International Symposium on Atopic Dermatitis/New Trends in Allergy VII meeting in Munich, 22-24 July 2010. Approximately 40 individuals attended. Prior to the meeting, an international Delphi exercise was performed to develop consensus-based sets of core outcome domains for Eczema for'controlled trials' and'clinical recordkeeping'. The results of this Delphi exercise were presented at the meeting and critically discussed by the attendees. The constructive group discussion identified several important issues for future Eczema outcomes research such as the degree to which patients and carers can be involved and the importance of involving colleagues from countries not represented at the meeting. In summary, this exploratory meeting indicated a genuine interest in the academic Eczema community to form an international multiprofessional group dedicated to harmonizing outcomes research in Eczema. The group decided to continue collaboratively with the HOME initiative.
Paul L P Brand - One of the best experts on this subject based on the ideXlab platform.
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risk of developing asthma in young children with atopic Eczema a systematic review
The Journal of Allergy and Clinical Immunology, 2007Co-Authors: Annelies E Van Der Hulst, Helen Klip, Paul L P BrandAbstract:Background It is commonly believed that the majority of infants and young children with early atopic Eczema will develop asthma in later childhood. This belief is mainly based on cross-sectional population studies. Recent evidence suggests a more complex relationship between early Eczema and asthma. Objective This systematic review was conducted to assess the risk of developing asthma in children with atopic Eczema during the first 4 years of life. Methods A sensitive search was performed to identify all prospective cohort studies on the topic. By pooling the eligible reports, we calculated the risk of developing asthma at 6 years of age or older in children with atopic Eczema in the first 4 years of life. Results Thirteen prospective cohort studies were included, with 4 representing birth cohort studies and 9 representing Eczema cohort studies. The pooled odds ratio for the risk of asthma after Eczema, compared with children without Eczema, in birth cohort studies was 2.14 (95% CI, 1.67-2.75). The prevalence of asthma at the age of 6 years in Eczema cohort studies was 35.8% (95% CI, 32.2% to 39.9%) for inpatients and 29.5% (95% CI, 28.2% to 32.7%) for a combined group of inpatients and outpatients. Conclusion Although there is an increased risk of developing asthma after Eczema in early childhood, only 1 in every 3 children with Eczema develops asthma during later childhood. This is lower than previously assumed. Clinical implications Our results may have important consequences for counseling patients with atopic Eczema and their parents.
