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Systematic Review and Meta-analysis Comparing Topical Corticosteroids With Vehicle/Moisturizer in Childhood Atopic
Anna B Fishbein1, Kelly Mueller2, Jennifer Lor1
1Department of Pediatrics, Division of Pediatric Allergy & Immunology, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, United States of America.
Insights
Topical corticosteroids are more effective than moisturizers for children under two, with similar safety profiles. However, more high-quality research is needed for this age group.
Area of Science:
- Dermatology
- Pediatrics
- Pharmacology
Background:
- Eczema and other inflammatory skin conditions are common in infants.
- Topical corticosteroids are frequently prescribed, but their safety and efficacy in children under two years old require careful evaluation.
Purpose of the Study:
- To systematically review and meta-analyze the safety and efficacy of topical corticosteroids compared to vehicle/moisturizer in children under two years old.
Main Methods:
- A comprehensive search of multiple databases (PubMed MEDLINE, Embase, Web of Science, etc.) was conducted.
- Included were randomized controlled trials (RCTs) comparing topical corticosteroids to vehicle/moisturizer in children under two years.
- Data extraction was performed by two authors, with a meta-analysis of the findings.
Main Results:
- Topical corticosteroids showed a higher response rate (0.65) compared to vehicle/moisturizer (0.32).
- Adverse event proportions were similar between groups (0.17 vs. 0.12), with mild adrenal suppression in 3% of participants on topical corticosteroids.
- Significant heterogeneity in treatment response was observed, and limitations included few RCTs, inclusion of older children, and inconsistent reporting standards.
Conclusions:
- Topical corticosteroids appear more effective and equally safe as vehicle/moisturizers for young children, though generalizability is limited.
- The lack of well-designed studies specifically for children under two years old necessitates further research.
- Potential under-treatment with vehicle/moisturizers might lead to higher perceived adverse events.
Problem:
To determine the safety and efficacy of topical corticosteroid versus vehicle/moisturizer in children under 2 years old (<2 y).
Eligibility Criteria:
A systematic review and meta-analysis searching PubMed MEDLINE, Embase, Web of Science, Cochrane Database of Controlled Trials, Cochrane Database of Systematic Reviews, DARE, NHS Economic Evaluation, CINAHL, GREAT, and Clinicaltrials.gov. We selected randomized controlled trials (RCTs) comparing topical corticosteroids to vehicle/moisturizer and included children <2 y. Two authors extracted data.
Sample:
Only one study limited analyses to children <2 y, so our review included participants older than 2 years. Twelve RCTs were included with 2224 participants. Ten studies were industry-sponsored.
Results:
The proportion of responders to topical corticosteroid across studies was 0.65 (95% CI, 0.54-0.74), as compared to vehicle/moisturizer 0.32 (95% confidence interval (CI), 0.20-0.48). The proportion of adverse events were similar between groups (topical steroids 0.17 (95% CI, 0.08-0.33) vs. vehicle/moisturizer 0.12 (CI 0.02-0.42)). High heterogeneity in treatment response occurred across studies that could not be explained by potential moderators. Mild adrenal suppression occurred in 4 of 157 measured participants (3%) receiving topical corticosteroids. Limitations include the few RCTs on this topic, the inclusion of participants >2 y and outcome measures and reporting methods rarely met CONSORT guidelines.
Conclusions:
Topical corticosteroids trended to being more effective and equally safe to vehicle/moisturizers, but generalizability is limited given the dearth of well-designed studies focused on children <2 y. Adverse events from vehicle/moisturizer may be greater than topical corticosteroid due to under treatment.
Implications:
Further work is needed in this age group.
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