One RCT evaluated a combination of topical steroid/antibiotic/antifungal versus topical steroid/antiseptic in clinically infected atopic eczema (Table 17.6).18 Both combinations produced a highly significant reduction in clinical scores and bacterial counts, with no significant difference between treatments.18
We located two further RCTs evaluating topical antifungals in non-clinically infected atopic eczema.20,21 The first small study compared topical steroid/antibiotic/antifungal against topical steroid/ antibiotic, and showed a significant improvement in the four patients treated with 0-1% triamcinolone acetonide/0-35% neomycin/ undecylenic acid compared with the six receiving the same steroid/antibiotic combination but without undecylenic acid.20 In the second study, Broberg et a/.21 attempted to evaluate the role of antifungals in atopic eczema of the head and neck area. All patients received oral antibiotics, followed by randomisation to either miconazole-hydrocortisone cream plus ketoconazole shampoo or hydrocortisone cream plus placebo shampoo. There was no significant difference between the groups in clinical outcome.21
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