Abstract and Introduction
Background Complementary and alternative interventions are becoming increasingly utilized as adjuncts to conventional treatment of atopic dermatitis (AD). While the number of studies continues to grow, the vastness of the subject coupled with the relatively poor quality and small size of the studies limit their usefulness to clinicians.
Purpose Our aim was to comprehensively review randomized controlled trials (RCTs) of complementary and alternative therapies for AD.
Methods Searches were performed on PubMed, the Cochrane Central Register of Controlled Trials, EMBASE, and the Global Resource for EczemA Trial (GREAT) databases, focusing on RCTs of alternative or complementary AD therapies, with a sample size of ≥10, through March 2015 and limited to the English language. A total of 70 manuscripts met the inclusion criteria and were included in the final analysis.
Results There is at least some level I evidence to support the use of acupuncture and acupressure, stress-reducing techniques such as hypnosis, massage, and biofeedback, balneotherapy, herbal preparations (with many important caveats), certain botanical oils, oral evening primrose oil, vitamin D supplementation, and topical vitamin B12. Many other therapies either have sufficient data to suggest that they are ineffective, or simply do not have enough evidence to formulate a verdict.
Conclusions Careful review of the literature reveals several promising therapies in this domain; such findings may help direct further research that is necessary to bolster clinical recommendations for alternative or complementary treatments of AD.
Atopic dermatitis (AD) represents a chronic, relapsing, itchy, inflammatory skin condition that poses significant therapeutic challenges and has no known cure. One of the most common inflammatory skin diseases, AD has a prevalence exceeding 10 % of children in some populations. Despite tremendous gains in understanding its pathogenesis and treatment, navigating the line between risks and benefits of conventional therapies such as topical corticosteroids, antibiotics, and systemic immunosuppressants remains fraught with difficulty. Many patients seek alternative and complementary therapies, perhaps more so when diseases are incurable or when standard treatments have undesirable side effects, making AD a prime candidate for such exploration. Indeed, multiple studies converge on the conclusion that more than half of patients with AD utilize alternative medicine.[2–4]
Alternative medicine can be difficult to define, as it encompasses a wide range of unconventional therapies, from snake oil sold on the Internet to ancient and complex healing systems. Generally speaking, it consists of treatments that have not been sufficiently tested to make conclusions about efficacy, as well as those that have accrued enough evidence to dismiss them completely. In theory, any treatment that garners enough high-quality evidence will cease being alternative and graduate into the conventional canon. Herein we review the literature in order to make evidence-based conclusions about many of the most common alternative and complementary treatments for AD. In doing so, we hope to elucidate promising therapies that may be overlooked, and highlight those that are not beneficial so that time and money will not be wasted in fruitless pursuits. Moreover, by compiling a large number of studies, we hope to centralize these results in an accessible document to better inform clinicians and researchers.
Am J Clin Dermatol. 2016;17(6):557-581. © 2016 Adis Springer International Publishing AG