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Therapy of atopic eczema
Thomas Werfel1, Christa Claes, Werner Kulp
1Klinik und Poliklinik der Dermatologie und Venerologie der Medizinische Hochschule Hannover, Deutschland.
GMS Health Technology Assessment
|February 4, 2011
Summary
This study evaluates therapies for atopic dermatitis, finding topical corticosteroids and calcineurin-inhibitors effective. Further research is needed for new topical treatments for early childhood and severe adult atopic dermatitis.
Area of Science:
- Dermatology
- Health Technology Assessment
- Pharmacology
Background:
- Atopic dermatitis is a chronic inflammatory skin disease with various treatment options.
- Current therapies include topical corticosteroids, calcineurin-inhibitors, and supportive measures.
- The medical and cost-effectiveness of these treatments require ongoing evaluation.
Purpose of the Study:
- To evaluate the medical and cost-effectiveness of different therapeutic approaches for atopic dermatitis.
- To provide relevant insights for treatment decisions in Germany.
- To update existing health technology assessment reports.
Main Methods:
- Systematic review of randomized controlled studies (RCTs) published between 1999 and 2004.
- Inclusion of key clinical studies published after 2004.
- Health technology assessment (HTA) methodology applied.
Main Results:
- Topical corticosteroids and calcineurin-inhibitors demonstrate significant efficacy.
- Interval therapy with topical corticosteroids may reduce flares.
- Emollient therapy is crucial, though evidence level is low.
- Antimicrobial/antiseptic treatments lack strong evidence for non-infected skin.
- Oral antihistamines may help with itching but not skin condition.
- Dietary restrictions are only advised after specific allergological diagnostics.
- House dust mite reduction and immunotherapy show potential benefits.
- Phototherapy (UVB, UVA-1, balneo-phototherapy) is effective for adolescents and adults.
- Systemic treatments like cyclosporine A and azathioprine are effective for severe cases.
- Cost-effectiveness data for calcineurin-inhibitors are unreliable; topical corticosteroids should prioritize low-cost options.
Conclusions:
- The range of therapeutic procedures for atopic dermatitis has expanded but remains insufficient.
- There is a significant need for novel topical treatments for early childhood and severe adult atopic dermatitis.
- Clinical decision criteria should guide therapy in the absence of comprehensive health economic evaluations.
- Prioritizing low-cost topical corticosteroids is recommended.
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