Anna B Fishbein1, Kelly Mueller2, Jennifer Lor3, Patricia Smith4, Amy S Paller5, Aaron Kaat6. 1. Department of Pediatrics, Division of Pediatric Allergy & Immunology, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, United States of America. Electronic address: afishbein@luriechildrens.org. 2. Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America. 3. Department of Pediatrics, Division of Pediatric Allergy & Immunology, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, United States of America. 4. Galter Health Sciences Library, Northwestern University, Chicago, IL, United States of America. 5. Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America; Department of Pediatrics, Division of Dermatology, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, United States of America. 6. Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
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.
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.
Authors: Anna B Fishbein; Kelly Mueller; Lacey Kruse; Peter Boor; Stephen Sheldon; Phyllis Zee; Amy S Paller Journal: J Am Acad Dermatol Date: 2017-10-28 Impact factor: 11.527
Authors: Gordon H Guyatt; Andrew D Oxman; Gunn E Vist; Regina Kunz; Yngve Falck-Ytter; Pablo Alonso-Coello; Holger J Schünemann Journal: BMJ Date: 2008-04-26
Authors: Jochen Schmitt; Phyllis I Spuls; Kim S Thomas; Eric Simpson; Masutaka Furue; Stefanie Deckert; Magdalene Dohil; Christian Apfelbacher; Jasvinder A Singh; Joanne Chalmers; Hywel C Williams Journal: J Allergy Clin Immunol Date: 2014-10 Impact factor: 10.793
Authors: Emma Axon; Joanne R Chalmers; Miriam Santer; Matthew J Ridd; Sandra Lawton; Sinead M Langan; Douglas J C Grindlay; Ingrid Muller; Amanda Roberts; Amina Ahmed; Hywel C Williams; Kim S Thomas Journal: BMJ Open Date: 2021-07-07 Impact factor: 2.692