New treatment approach may help patients with eczema

For patients with eczema, applying fluticasone propionate cream twice a week, alongside daily emollient treatment, significantly reduces the risk of relapse, say researchers in this week’s BMJ.

The study involved 376 patients with moderate to severe eczema from 39 dermatology clinics in six countries. All patients were experiencing a ’flare’ of their condition.

Patients applied fluticasone propionate (cream or ointment; once or twice daily) for four weeks to stabilise their condition. A total of 295 patients whose eczema was brought under control then entered a maintenance phase, applying fluticasone propionate or a placebo (emollient alone) twice weekly for up to 16 weeks. All patients continued to apply emollient on a daily basis with a bath oil as needed.

After 16 weeks in the maintenance phase, the disease remained under control in 133 patients (87 using fluticasone propionate and 46 using emollient alone). Average time to relapse was six weeks for emollient alone compared with more than 16 weeks for fluticasone propionate.

Patients who applied fluticasone propionate cream were six times less likely to have a relapse than patients applying emollient alone. The groups showed no differences in adverse events.

Surprisingly, this course of treatment also addresses concerns about long term exposure to steroids because, by producing longer remission periods, it should reduce the need for intensive treatment, as is often required to control flares, say the authors.

Whether or not this maintenance strategy can be applied to other topical corticosteroids of lower potency remains to be established, they conclude.

Contact: Emma Dickinson, edickinson@bmj.com

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