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NIHR Signal Adding emollients to the bath unlikely to help children with eczema
Adding emollients to children’s bath water does not significantly improve their eczema. Prescriptions should focus on emollients applied directly to the skin or used as a soap substitute. Using emollients to lock in moisture is the standard treatment for childhood eczema. These can be applied in a number of ways, but there is uncertainty surrounding their use as a bath additive. This NIHR-funded year-long trial included 482 children, mostly with mild eczema. It found there was little cha...
NIHR Signal Biological therapies for psoriasis do not increase serious infection risk
People with psoriasis who take an immune-modulating treatment are no more likely to get serious infections than people taking standard therapies. There are fears that these biological therapies raise the risk of serious infections and this has discouraged their use. They are recommended by NICE for moderate to severe psoriasis. Previous studies have reached conflicting conclusions, making it hard to advise on the true risk. This study used a large database of people with psoriasis from the UK ...
NIHR Signal Terbinafine is probably first choice oral drug for fungal toenail infection
The oral antifungal drug terbinafine appears to be slightly better than alternative ‘azole’ drugs for treating fungal toenail infection. Fifty-eight percent of people had a normal nail appearance after a treatment course compared with 47% taking ‘azoles’. Both drug classes were more effective than placebo and had similar side effects. Current guidelines recommend terbinafine or itraconazole as first-choice treatments, but consider terbinafine more effective. However, sys...
NIHR Signal Long-term antibiotics likely to reduce risk of recurrent cellulitis
Antibiotics may reduce the risk of leg cellulitis by about two thirds, in adults who have had at least two previous episodes, but only while they take the antibiotics. There is limited evidence measuring the efficacy of other forms of prevention. A review of five studies showed that the risk of developing repeated cellulitis was reduced in participants who were taking long-term (more than six months) penicillin or erythromycin, compared with a control group. Once the antibiotic course had finis...
NIHR Signal Heel casts do not improve heel ulcers in diabetes
Fibreglass casts moulded to the heel did not improve heel ulcers in people with diabetes when added to usual ulcer care. Ulcers healed within six months in 44% of people using casts compared with 37% without which was not a statistically significant difference. Foot ulcers are a common complication of diabetes, and heel ulcers are particularly difficult to treat. Based on the success of casts for treating ulcers elsewhere on the foot this trial was designed to test the effect and cost-effective...
NIHR Signal Molluscum contagiosum is best left to clear by itself
Molluscum contagiosum, the viral skin infection, is best left alone to heal by itself rather than being treated with medication, destructive treatments or creams. When comparing imiquimod (a skin cream that activates the immune system) with nothing, about 40% of people were clinically clear by 6 months in either group. Treatment increased the chance of severe adverse events such as irritation and scarring fourfold. The majority of other treatment comparisons were from studies judged by the auth...
NIHR Signal Silk clothing for children does not reduce objective measures of eczema severity
Six months of wearing special silk clothing had no effect on objective measures of child eczema severity, infection rates or medication use. Children and carers reported some small improvements in eczema severity on two scales but their awareness of the clothing worn by their child may have slightly influenced their judgment. Overall quality of life did not significantly improve. Specialist silk clothing is currently available on NHS prescription, but prior to this trial there was limited evide...
NIHR Signal Doxycycline may be a safer first option for treating a blistering skin condition
Doxycycline (an established antibiotic) may be a safer first option than the standard steroid treatment for people with the autoimmune skin condition bullous pemphigoid. The condition causes severe, itchy blistering. This NIHR-funded study showed that people started on doxycycline were 19% less likely to have severe, life-threatening or fatal events during the next 12 months than those who started a steroid (prednisolone). Blister control was considered acceptable for both treatments (74% treat...
NIHR Signal Moisturisers improve eczema symptoms and lessen the need for corticosteroids
Moisturisers help reduce eczema symptoms compared to no treatment, but to a minor extent. They do lengthen the time between each flare, and reduce the number of flares. Importantly they reduce the amount of corticosteroid creams required. Moisturisers seem well tolerated, though there is little data on patient satisfaction. This Cochrane review of 77 trials does not provide information on which moisturiser might be preferred for different parts of the body or different disease severity. Neverth...
NIHR Signal Young children from deprived areas are more at risk of serious burns and scalds
Five in every 1,000 children under four are injured by burns and scalds each year in England, although these injuries are becoming less common. Serious injuries needing hospital treatment happen more often to children from deprived areas than wealthy areas. The study looked at general practice data from 1998 to 2013. It showed a steady decline in children having burns and scalds over the 15 year period, and the gap between least- and most-deprived areas has narrowed. However, children from the ...
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