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

1 Citation (Scopus)

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

Fingerprint

Atopic Dermatitis
Meta-Analysis
Adrenal Cortex Hormones
Age Groups
Outcome Assessment (Health Care)
Guidelines
Safety
Therapeutics

Keywords

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

ASJC Scopus subject areas

  • Pediatrics

Cite this

@article{2390661b441945f88581fe14fd38fd79,
title = "Systematic review and meta-analysis comparing topical corticosteroids with vehicle/moisturizer in childhood atopic dermatitis",
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.",
keywords = "Atopic dermatitis, Moisturizer, Pediatrics, Placebo, Topical corticosteroids",
author = "Anna Fishbein and Kelly Mueller and Jennifer Lor and Patricia Smith and Amy Paller and Kaat, {Aaron James}",
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Systematic review and meta-analysis comparing topical corticosteroids with vehicle/moisturizer in childhood atopic dermatitis. / Fishbein, Anna; Mueller, Kelly; Lor, Jennifer; Smith, Patricia; Paller, Amy; Kaat, Aaron James.

In: Journal of Pediatric Nursing, Vol. 47, 01.07.2019, p. 36-43.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Systematic review and meta-analysis comparing topical corticosteroids with vehicle/moisturizer in childhood atopic dermatitis

AU - Fishbein, Anna

AU - Mueller, Kelly

AU - Lor, Jennifer

AU - Smith, Patricia

AU - Paller, Amy

AU - Kaat, Aaron James

PY - 2019/7/1

Y1 - 2019/7/1

N2 - 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.

AB - 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.

KW - Atopic dermatitis

KW - Moisturizer

KW - Pediatrics

KW - Placebo

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