Summary of the evidence base for atopic eczema

• Although around 300 RCTs have been conducted for atopic dermatitis, they have a limited ability to inform us about everyday management of patients. This is partly due to a generally poor quality of study reporting. All dermatology journals have a role to play here by insisting on basic standard of clinical trial reporting, as outlined in the CONSORT statement (http://www.consort-statement.org).

• Most of the trials of people with atopic dermatitis have reflected the agenda of the drug industry. This has meant introducing more "me-too" drugs on to the market and cleverly introducing them in a way that makes comparison with existing treatments impossible.

• Independent trials are needed to make head-to-head comparisons.

• Cost-effectiveness studies of topical steroids compared with the newer topical immunomodulatory agents are needed.

• Cheap and well-tried systemic agents such as oral steroids and azathioprine need to be compared against each other and against the more expensive agents such as ciclosporin that have found their way on to the market through mainly placebo-controlled studies.

• Some interventions (for example topical steroids and ultraviolet light therapy) are well supported by RCT evidence.

• For other interventions (such as Chinese herbs and house dust mite reduction) there is simply insufficient evidence to decide whether they are effective - better research is needed.

• In some areas (for example topical steroid/antibiotic combinations or bath antiseptics) the RCT evidence did not support a clinically useful effect, providing dermatologists and patients with an opportunity to disinvest in such treatment rituals.

• Some treatments currently in use (for example oral azathrioprine) have not been tested within RCTs at all, making primary research in these areas an urgent research priority.

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