Tuesday 21 October 2008, 12:00AM
PEARLS 114, October 2008, written by Brian R
McAvoy
Clinical question
How effective are interventions to reduce Staphylococcus aureus
(SA) in treating infected or non-infected atopic eczema?
Bottom line
A range of anti-staphylococcal treatments were trialled - oral
antibiotics, antibacterial soaps, topical steroids combined with
antibacterials, antibacterial bath additives, topical
antiseptic/antibiotic creams and silver-impregnated textiles. None
of the trials showed any clear benefit in terms of short term
eczema control, although several interventions were associated with
decreased numbers of SA on the skin.There was no clear evidence
that widely-used topical steroid/antibiotic combinations were
better than use of the topical steroid alone. Only one small
inconclusive study evaluated people with clinically infected
eczema.
Caveat
Care should be taken in interpreting these results as failure to
show benefit in a series of small, poorly reported studies does not
mean that anti-staphylococcal interventions may not be helpful for
eczema. It is clinical common sense to treat overtly infected
eczema with oral antibiotics, and that practice should continue
until good evidence suggests otherwise. However, given that none of
the studies showed clear clinical benefit for anti-staphylococcal
interventions in non-infected eczema, their continued use should be
questioned in such circumstances.
Context
Atopic eczema is a common problem, affecting around 15% of
schoolchildren.1 Symptoms usually appear before the age of two
years and around 60% of cases will be clear of eczema by early
adolescence.The skin of people with atopic eczema often contains
high numbers of SA. Even when the eczema does not look infected, SA
may still play a part in promoting skin inflammation.
Cochrane Systematic Review
Birnie AJ et al. Interventions to reduce Staphylococcus
aureus in the management of atopic eczema. Cochrane Reviews 2008,
Issue 3. Article No. CD003871. DOI: 10.1002/14651858.CD003871.pub2.
This review contains 21 studies involving 1018 participants.
Further references
1. Emerson RM et al. Br J Dermat 1998; 139:73-76.