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What causes worsening of eczema? A systematic review.
Br J Dermatol 2006; 155(3):504-14BJ

Abstract

BACKGROUND

Flares of eczema are attributed to many factors, often with minimal scientific evidence.

OBJECTIVES

Systematically to search, summarize and critically appraise the scientific evidence to support the roles of individual 'flare factors' in eczema.

METHODS

We searched Medline from 1966 until 20 April 2005 to identify relevant articles for inclusion in this review. No language restrictions were imposed. All study designs were included and were ranked according to the strength of evidence. Experimental and provocation studies were restricted to those using a double-blind design. We included randomized controlled trials if they were provocation studies. Meta-analysis was not possible due to differences in study populations and methodology. The studies are therefore described qualitatively.

RESULTS

The roles of foodstuffs (13 studies), house dust mite (three), other aeroallergens (two), seasonality (two), bacterial infections (one), textiles (three), detergents (one), sunlight (one) and stress (two) were assessed in different study populations, using a variety of study designs. All studies were performed on selected groups and only four were longitudinal in design. Collectively, these studies provide some evidence that certain foods, house dust mite, stress and seasonal factors are relevant causes of disease worsening in certain subgroups with eczema. No good evidence could be found to support the role of detergents, textiles and irritants in causing worsening of eczema.

CONCLUSIONS

Despite anecdotal lists in textbooks and review articles, very little good evidence exists for 'flare factors' in eczema. The focus of all of the included studies was on disease worsening rather than clinically relevant flares. Studies of longitudinal design are required to clarify the roles of these and other putative flare factors in eczema.

Authors+Show Affiliations

Centre of Evidence-based Dermatology, Queen's Medical Centre, Nottingham NG7 2UH, UK. sinead.langan@nottingham.ac.ukNo affiliation info available

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

16911274

Citation

Langan, S M., and H C. Williams. "What Causes Worsening of Eczema? a Systematic Review." The British Journal of Dermatology, vol. 155, no. 3, 2006, pp. 504-14.
Langan SM, Williams HC. What causes worsening of eczema? A systematic review. Br J Dermatol. 2006;155(3):504-14.
Langan, S. M., & Williams, H. C. (2006). What causes worsening of eczema? A systematic review. The British Journal of Dermatology, 155(3), pp. 504-14.
Langan SM, Williams HC. What Causes Worsening of Eczema? a Systematic Review. Br J Dermatol. 2006;155(3):504-14. PubMed PMID: 16911274.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - What causes worsening of eczema? A systematic review. AU - Langan,S M, AU - Williams,H C, PY - 2006/8/17/pubmed PY - 2007/1/12/medline PY - 2006/8/17/entrez SP - 504 EP - 14 JF - The British journal of dermatology JO - Br. J. Dermatol. VL - 155 IS - 3 N2 - BACKGROUND: Flares of eczema are attributed to many factors, often with minimal scientific evidence. OBJECTIVES: Systematically to search, summarize and critically appraise the scientific evidence to support the roles of individual 'flare factors' in eczema. METHODS: We searched Medline from 1966 until 20 April 2005 to identify relevant articles for inclusion in this review. No language restrictions were imposed. All study designs were included and were ranked according to the strength of evidence. Experimental and provocation studies were restricted to those using a double-blind design. We included randomized controlled trials if they were provocation studies. Meta-analysis was not possible due to differences in study populations and methodology. The studies are therefore described qualitatively. RESULTS: The roles of foodstuffs (13 studies), house dust mite (three), other aeroallergens (two), seasonality (two), bacterial infections (one), textiles (three), detergents (one), sunlight (one) and stress (two) were assessed in different study populations, using a variety of study designs. All studies were performed on selected groups and only four were longitudinal in design. Collectively, these studies provide some evidence that certain foods, house dust mite, stress and seasonal factors are relevant causes of disease worsening in certain subgroups with eczema. No good evidence could be found to support the role of detergents, textiles and irritants in causing worsening of eczema. CONCLUSIONS: Despite anecdotal lists in textbooks and review articles, very little good evidence exists for 'flare factors' in eczema. The focus of all of the included studies was on disease worsening rather than clinically relevant flares. Studies of longitudinal design are required to clarify the roles of these and other putative flare factors in eczema. SN - 0007-0963 UR - https://www.unboundmedicine.com/medline/citation/16911274/full_citation L2 - https://doi.org/10.1111/j.1365-2133.2006.07381.x DB - PRIME DP - Unbound Medicine ER -