Systematic review and meta-analysis comparing topical corticosteroids with vehicle/moisturizer in childhood atopic dermatitis

Anna Fishbein*, Kelly Mueller, Jennifer Lor, Patricia Smith, Amy Paller, Aaron James Kaat

*Corresponding author for this work

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)36-43
Number of pages8
JournalJournal of Pediatric Nursing
Volume47
DOIs
StatePublished - Jul 1 2019

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Keywords

  • Atopic dermatitis
  • Moisturizer
  • Pediatrics
  • Placebo
  • Topical corticosteroids

ASJC Scopus subject areas

  • Pediatrics

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