Evidence-Based Management of Eczema

Five Things That Should Be Done More and Five Things That Should Be Dropped

Bayanne Olabi; Hywel C. Williams


Curr Opin Allergy Clin Immunol. 2021;21(4):386-393. 

In This Article


We have suggested five interventions for eczema that should be promoted and five that should be demoted based on results of robust evidence. We also highlight some limitations of current RCT evidence including lack of common outcome measures and too many placebo-controlled trials that make it difficult for doctors to compare new treatments. There is a clear need for platform studies such as BEACON that test new treatments against active comparators on a level playing field. We also highlight research waste, for example, by continuing to test the effect of probiotics for active eczema or conducting more and more systematic reviews that seek to answer the same questions.[47]

Existing guidelines have generally improved in their systematic approach to searching and appraising evidence, but they give rise to different recommendations. For example, once daily use of TCSs is recommended by NICE,[48] whereas twice daily use is recommended in American[49] and Japanese[50] guidelines. European guidelines[51] are silent on TCS frequency. With regards to oral antihistamines, some guidelines recommend them as adjuvant therapy,[50] whereas others highlight their lack of efficacy[51] or only recommend their use in specific settings, such as treating eczema associated with disturbed sleep.[48,49] Ideally, living guidelines[52] are needed alongside living network meta-analyses in order to provide up-to-date best evidence.