Is topical antimycotic treatment useful as adjuvant therapy for flexural atopic dermatitis: randomized, double-blind, controlled trial using one side of the elbow or knee as a control.
BACKGROUND
Certain factors are known to cause exacerbation of atopic dermatitis (AD), e.g. soap, detergent, dry skin, staphylococcal colonization, and herpes infection. Other factors are suspected, but not yet proven, e.g. yeasts belonging to the Malassezia genus. It is known that antimycotics may be beneficial in a small subset of adult patients with dermatitis affecting the head and neck region; however, it is not known whether AD patients, many of whom also have head and neck involvement, may also find antimycotics useful. A previous study has demonstrated no treatment difference in adult AD patients; however, the measurement method was criticized and 1% hydrocortisone cream may have too weak an effect in adult patients. Therefore, we designed this randomized, double-blind, controlled trial to examine this question. Younger AD patients were recruited and different methods of measuring outcomes were used.


OBJECTIVE
To evaluate the usefulness of topical antimycotic treatment as adjuvant therapy for flexural AD. Methods This was a randomized, double-blind, controlled trial in AD patients using one side of the elbow or knee as a control. There were three independent outcomes: (i) to compare the ability to relieve symptoms; (ii) to compare the ability to improve clinical signs; and (iii) to compare the ability to provide lasting clinical effects.


RESULTS
All three outcomes showed unequivocally that the addition of antimycotic did not provide extra benefit to the standard treatment.


CONCLUSIONS
The addition of antimycotic does not seem to provide extra benefit to AD patients, and the beneficial effect of this medication seems to be restricted to a small subset of adult patients with dermatitis affecting the head and neck region.
Wong
Alson W K
AW
School of Public Health, The Chinese University of Hong Kong. awkwong@hk.super.net
Hon
Ellis Kam-Lun
EK
Zee
Benny
B
D000287:Administration, Topical; D000293:Adolescent; D000935:Antifungal Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003876:Dermatitis, Atopic / Q000188:drug therapy*; D004311:Double-Blind Method; D004338:Drug Combinations; D004550:Elbow; D005148:Facial Dermatoses / Q000188:drug therapy; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use*; D007717:Knee; D008297:Male; D008825:Miconazole / Q000627:therapeutic use*; D012536:Scalp Dermatoses / Q000188:drug therapy; D016896:Treatment Outcome
D000935:Antifungal Agents; D004338:Drug Combinations; C024105:Daktacort; D008825:Miconazole; D006854:Hydrocortisone