The Inside Edge

Few treatments for alopecia areata have been evaluated properly in randomised trials. A Cochrane review that included 17 trials with a total of 540 participants found no significant benefit in terms of hair growth for any of the interventions studied compared with placebo. These included topical and oral corticosteroids, topical ciclosporin, photodynamic therapy and topical minoxidil. The authors found no randomised controlled trials on the use of diphencyprone, dinitrochlorobenzene, intralesional corticosteroids or dithranol, despite these being commonly used to treat alopecia. They say most trials have been reported poorly and are small, making clinical benefits inconclusive.
Delamere FM, Sladden MM, Dobbins HM, Leonardi-Bee J. Cochrane Database Syst Rev 2008; 2: CD004413

Cochrane reviewers have also attempted to assess the effects of systemic antibiotics and topical antibiotics and antiseptics on the healing of venous ulcers. Twenty-two trials were included. The authors found no evidence to support routine use of systemic antibiotics to promote venous leg ulcer healing. However, a general lack of reliable evidence meant that they could not recommend discontinuation of any systemic antibiotics in the studies reviewed. There was some evidence to support use of a topical preparation, cadexomer iodine, but further research is needed before definitive conclusions can be made about the effectiveness of other topical preparations.
O'Meara S, Al-Kurdi D, Ovington LG. Cochrane Database Syst Rev 2008; 2: CD003557

A herbal preparation used in Chinese medicine may benefit eczema patients by targeting eczema-related inflammatory mediators. Researchers at the Chinese University in Hong Kong investigated the effects of a concoction of five herbal ingredients. In vitro testing showed that the mixture reduced expression of four proteins and cytokines thought to have inflammatory effects linked with eczema. This was confirmed in a study of 28 children with atopic dermatitis, treated with the mixture for three months. Mean plasma concentrations of two inflammatory mediators were measured and found to be significantly lower at study completion compared with baseline.
Leung TF, Wong KY, Wong CK et al. Br J Dermatol 2008; 158: 1216-23

Health promotion campaigns aimed at reducing sun exposure and melanoma rates can pay dividends, a study suggests. Researchers compared trends in melanoma incidence in Queensland, Australia, with those in the west of Scotland between 1982 and 2001. They found that rates of melanoma in younger people in Queensland were stabilising, which might be expected if prevention campaigns were effective. In contrast, melanoma incidence continued to rise rapidly in all age groups in Scotland and among older people in Queensland.
Whiteman DC, Bray CA, Siskind V et al. Eur J Cancer Prev 2008; 17: 243-50

High levels of Staphylococcus aureus in the home may contribute to the severity and persistence of atopic dermatitis, a US study suggests. Participants with mild (18), moderate (14), severe (15) and no atopic dermatitis (15) collected dust from their bed, bedroom floor and vacuum cleaner bag. Those with severe disease had significantly more Staph aureus DNA in their bed dust than other participants. The same was true for the floor and vacuum cleaner dust. In addition, Eczema Area and Severity Index scores correlated with Staph aureus DNA from the bed and floor, but not vacuum cleaner bags.
Leung AD, Schiltz AM, Hall CF, Liu AH. Clin Exp Allergy 2008; 38: 789-93.

Finnish folk medicine may be the key to treating pressure ulcers. A traditional salve made from Norwegian spruce tree resin and unsalted butter was compared with a control treatment (sodium carboxymethylcellulose hydrocolloid polymer) among 22 patients with a total of 29 severe pressure ulcers (grade II-IV). Over the six-month treatment period, all ulcers were healed in 12 out of 13 patients treated with the salve, compared with four out of nine controls.
Sipponen A, Jokinen JJ, Sipponen P et al. Br J Dermatol 2008; 158: 1055-62

- Email suggestions to The Editor, MIMS Dermatology editor at paula.hensler@haymarket.com.


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