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Complementary and alternative medicine for treatment of atopic eczema in children under 14 years old: a systematic review and meta-analysis of randomized controlled trials.

  • 2018-09-26
  • BMC complementary and alternative medicine 18(1)
    • Chun-Li Lu
    • Xue-Han Liu
    • Trine Stub
    • Agnete E Kristoffersen
    • Shi-Bing Liang
    • Xiao Wang
    • Xue Bai
    • Arne Johan Norheim
    • Frauke Musial
    • Terje Alræk.
    • Vinjar Fonnebo
    • Jian-Ping Liu

Study Design

Type
Meta-Analysis
Sample size
n = 2,233
Population
2233 children under 14 years old with atopic eczema
Methods
Systematic review and meta-analysis of randomized controlled trials on CAM therapies (probiotics, diet, biofilm, borage oil, swimming) alone or combined with conventional medicine; searched 12 databases from inception to May 2018
Duration
8 weeks to 3 years

Background

Due to limitations of conventional medicine for atopic eczema (AE), complementary and alternative medicine (CAM) is widely used as an alternative, maintaining, or simultaneous treatment for AE. We aimed to evaluate the beneficial and harmful effects of CAM for children with AE under 14 years old.

Methods

We searched for randomized trials on CAM in 12 Chinese and English databases from their inception to May 2018. We included children (< 14 years) diagnosed with AE, who received CAM therapy alone or combined with conventional medicine. We extracted data, and used the Cochrane "Risk of bias" tool to assess methodological quality. Effect was presented as relative risk (RR) or mean difference (MD) with 95% confidence interval (CI) using RevMan 5.3.

Results

Twenty-four randomized controlled trials involving 2233 children with AE were included. Methodological quality was of unclear or high risk of bias in general. The trials tested 5 different types of CAM therapies, including probiotics, diet, biofilm, borage oil, and swimming. Compared to placebo, probiotics showed improved effect for the SCORAD index (MD 9.01, 95% CI 7.12-10.90; n = 5). For symptoms and signs such as itching, skin lesions, CAM combined with usual care was more effective for symptom relief ≥95% (RR 1.47, 95% CI 1.30-1.68; n = 8), and for ≥50% symptoms improvement (RR 1.34, 1.25-1.45; n = 9) compared to usual care. There was no statistic significant difference between CAM and usual care on ≥95% improvement or ≥ 50% improvement of symptoms. However, swimming, diet and biofilm showed improvement of clinical symptoms compared with usual care. At follow-up of 8 weeks to 3 years, CAM alone or combined with usual care showed lower relapse rate (RR 0.38, 0.28-0.51, n = 2; RR 0.31, 0.24-0.40, n = 7; respectively) compared to usual care. Twelve out of 24 trials reported no occurrence of severe adverse events.

Conclusions

Low evidence demonstrates that some CAM modalities may improve symptoms of childhood AE and reduce relapse rate. Safety remains unclear due to insufficient reporting. Further well-designed randomized trials are needed to confirm the potential beneficial effect and to establish safety use.

Research Insights

  • Borage Seed→Improved Clinical Symptoms

    There was no statistic significant difference between CAM and usual care on ≥95% improvement or ≥50% improvement of symptoms.

    Effect
    Neutral
    Effect size
    Small

Adverse Events Reported

  • Borage Seed→Overall tolerability

    Safety remains unclear due to insufficient reporting.

    Finding
    Reported
  • Borage Seed→serious adverse events

    Twelve out of 24 trials reported no occurrence of severe adverse events.

    Finding
    Reported
    Severity
    Serious adverse event
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