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Meta-Analysis
. 2012 Feb 15;2012(2):CD005205.
doi: 10.1002/14651858.CD005205.pub3.

Dietary supplements for established atopic eczema

Fiona J Bath-Hextall  1 , Claire Jenkinson, Rosemary Humphreys, Hywel C Williams
Affiliations
Meta-Analysis

Dietary supplements for established atopic eczema

Fiona J Bath-Hextall et al. Cochrane Database Syst Rev. .

Abstract

Background: Many people with atopic eczema are reluctant to use the most commonly recommended treatments because they fear the long-term health effects. As a result, many turn to dietary supplements as a possible treatment approach, often with the belief that some essential ingredient is 'missing' in their diet. Various supplements have been proposed, but it is unclear whether any of these interventions are effective.

Objectives: To evaluate dietary supplements for treating established atopic eczema/dermatitis.Evening primrose oil, borage oil, and probiotics are covered in other Cochrane reviews.

Search methods: We searched the following databases up to July 2010: the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE (from 2005), EMBASE (from 2007), PsycINFO (from 1806), AMED (from 1985), LILACS (from 1982), ISI Web of Science, GREAT (Global Resource of EczemA Trials) database, and reference lists of articles. We searched ongoing trials registers up to April 2011.

Selection criteria: Randomised controlled trials (RCTs) of dietary supplements for the treatment of those with established atopic eczema/dermatitis.

Data collection and analysis: Two authors independently screened the titles and abstracts, read the full text of the publications, extracted data, and assessed the risk of bias.

Main results: We included 11 studies with a total of 596 participants. Two studies assessed fish oil versus olive oil or corn oil placebo. The following were all looked at in single studies: oral zinc sulphate compared to placebo, selenium versus selenium plus vitamin E versus placebo, vitamin D versus placebo, vitamin D versus vitamin E versus vitamins D plus vitamin E together versus placebo, pyridoxine versus placebo, sea buckthorn seed oil versus sea buckthorn pulp oil versus placebo, hempseed oil versus placebo, sunflower oil (linoleic acid) versus fish oil versus placebo, and DHA versus control (saturated fatty acids of the same energy value). Two small studies on fish oil suggest a possible modest benefit, but many outcomes were explored. A convincingly positive result from a much larger study with a publicly-registered protocol is needed before clinical practice can be influenced.

Authors' conclusions: There is no convincing evidence of the benefit of dietary supplements in eczema, and they cannot be recommended for the public or for clinical practice at present. Whilst some may argue that at least supplements do not do any harm, high doses of vitamin D may give rise to serious medical problems, and the cost of long-term supplements may also mount up.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1
1
Methodological quality graph: Review authors' judgements about each methodological quality item presented as percentages across all included studies.
2
2
Methodological quality summary: Review authors' judgements about each methodological quality item for each included study.
1.1
1.1. Analysis
Comparison 1 Fish oil vs placebo, Outcome 1 Total symptom score rated by participants at end of treatment.
1.2
1.2. Analysis
Comparison 1 Fish oil vs placebo, Outcome 2 Erythema at end of treatment (physician).
1.3
1.3. Analysis
Comparison 1 Fish oil vs placebo, Outcome 3 Excoriation at end of treatment (physician).
1.4
1.4. Analysis
Comparison 1 Fish oil vs placebo, Outcome 4 Lichenification at end of treatment (physician).
1.5
1.5. Analysis
Comparison 1 Fish oil vs placebo, Outcome 5 Severity at end of treatment (physician).
1.6
1.6. Analysis
Comparison 1 Fish oil vs placebo, Outcome 6 Scale at end of treatment (physician).
1.7
1.7. Analysis
Comparison 1 Fish oil vs placebo, Outcome 7 Visibility at end of treatment (physician).
1.8
1.8. Analysis
Comparison 1 Fish oil vs placebo, Outcome 8 Area affected at end of treatment (physician).
1.9
1.9. Analysis
Comparison 1 Fish oil vs placebo, Outcome 9 Induration at end of treatment (physician).
1.10
1.10. Analysis
Comparison 1 Fish oil vs placebo, Outcome 10 Pruritus at end of treatment (physician).
1.11
1.11. Analysis
Comparison 1 Fish oil vs placebo, Outcome 11 Effect on daily living at end of treatment.
1.12
1.12. Analysis
Comparison 1 Fish oil vs placebo, Outcome 12 Itch evaluated by participants at end of study.
2.1
2.1. Analysis
Comparison 2 Zinc vs placebo, Outcome 1 Disease severity at 4 weeks.
2.2
2.2. Analysis
Comparison 2 Zinc vs placebo, Outcome 2 Disease severity at 8 weeks.
2.3
2.3. Analysis
Comparison 2 Zinc vs placebo, Outcome 3 Erythema at 4 weeks.
2.4
2.4. Analysis
Comparison 2 Zinc vs placebo, Outcome 4 Erythema at 8 weeks.
2.5
2.5. Analysis
Comparison 2 Zinc vs placebo, Outcome 5 Mean itch scores at 8 weeks (parental‐rated symptoms).
2.6
2.6. Analysis
Comparison 2 Zinc vs placebo, Outcome 6 Surface area of body affected by eczema at 4 weeks.
2.7
2.7. Analysis
Comparison 2 Zinc vs placebo, Outcome 7 Surface area of body affected by eczema at 8 weeks.
3.1
3.1. Analysis
Comparison 3 Vitamin D vs placebo, Outcome 1 SCORAD at end of treatment (60 days).
3.2
3.2. Analysis
Comparison 3 Vitamin D vs placebo, Outcome 2 Objective SCORAD at end of treatment (60 days).
3.3
3.3. Analysis
Comparison 3 Vitamin D vs placebo, Outcome 3 Erythema at end of treatment (60 days).
3.4
3.4. Analysis
Comparison 3 Vitamin D vs placebo, Outcome 4 Oedema after treatment (60 days).
3.5
3.5. Analysis
Comparison 3 Vitamin D vs placebo, Outcome 5 Oozing after treatment (60 days).
3.6
3.6. Analysis
Comparison 3 Vitamin D vs placebo, Outcome 6 Excoriation after treatment (60 days).
3.7
3.7. Analysis
Comparison 3 Vitamin D vs placebo, Outcome 7 Lichenification after treatment (60 days).
3.8
3.8. Analysis
Comparison 3 Vitamin D vs placebo, Outcome 8 Dryness after treatment (60 days).
3.9
3.9. Analysis
Comparison 3 Vitamin D vs placebo, Outcome 9 Pruritus after treatment (60 days).
3.10
3.10. Analysis
Comparison 3 Vitamin D vs placebo, Outcome 10 Numbers worse or same (IGA after 1 month).
3.11
3.11. Analysis
Comparison 3 Vitamin D vs placebo, Outcome 11 Mean topical steroid use at end of study.
4.1
4.1. Analysis
Comparison 4 Vitamin E vs placebo, Outcome 1 SCORAD at end of treatment (60 days).
4.2
4.2. Analysis
Comparison 4 Vitamin E vs placebo, Outcome 2 Objective SCORAD at end of treatment (60 days).
4.3
4.3. Analysis
Comparison 4 Vitamin E vs placebo, Outcome 3 Erythema at end of treatment (60 days).
4.4
4.4. Analysis
Comparison 4 Vitamin E vs placebo, Outcome 4 Oedema at end of treatment (60 days).
4.5
4.5. Analysis
Comparison 4 Vitamin E vs placebo, Outcome 5 Excoriation at end of treatment (60 days).
4.6
4.6. Analysis
Comparison 4 Vitamin E vs placebo, Outcome 6 Lichenification at end of treatment (60 days).
4.7
4.7. Analysis
Comparison 4 Vitamin E vs placebo, Outcome 7 Dryness after treatment (60 days).
4.8
4.8. Analysis
Comparison 4 Vitamin E vs placebo, Outcome 8 Pruritus.
4.9
4.9. Analysis
Comparison 4 Vitamin E vs placebo, Outcome 9 Mean topical steroid use at end of study.
5.1
5.1. Analysis
Comparison 5 Vitamin D plus vitamin E vs placebo, Outcome 1 SCORAD at end of treatment (60 days).
5.2
5.2. Analysis
Comparison 5 Vitamin D plus vitamin E vs placebo, Outcome 2 Objective SCORAD at end of treatment (60 days).
5.3
5.3. Analysis
Comparison 5 Vitamin D plus vitamin E vs placebo, Outcome 3 Erythema at end of treatment (60 days).
5.4
5.4. Analysis
Comparison 5 Vitamin D plus vitamin E vs placebo, Outcome 4 Oedema at end of treatment (60 days).
5.5
5.5. Analysis
Comparison 5 Vitamin D plus vitamin E vs placebo, Outcome 5 Excoriation at end of treatment (60 days).
5.6
5.6. Analysis
Comparison 5 Vitamin D plus vitamin E vs placebo, Outcome 6 Lichenification at end of treatment (60 days).
5.7
5.7. Analysis
Comparison 5 Vitamin D plus vitamin E vs placebo, Outcome 7 Dryness after treatment (60 days).
5.8
5.8. Analysis
Comparison 5 Vitamin D plus vitamin E vs placebo, Outcome 8 Pruritus.
5.9
5.9. Analysis
Comparison 5 Vitamin D plus vitamin E vs placebo, Outcome 9 Mean topical steroid use at end of study.
6.1
6.1. Analysis
Comparison 6 Pyridoxine hydrochloride vs placebo, Outcome 1 Eczema ‐ no better or worse as rated by parents.
7.1
7.1. Analysis
Comparison 7 Sea buckthorn seed oil vs placebo, Outcome 1 SCORAD at 4 weeks.
7.2
7.2. Analysis
Comparison 7 Sea buckthorn seed oil vs placebo, Outcome 2 SCORAD at 4 months.
8.1
8.1. Analysis
Comparison 8 Sea buckthorn pulp oil vs placebo, Outcome 1 SCORAD at 4 weeks.
8.2
8.2. Analysis
Comparison 8 Sea buckthorn pulp oil vs placebo, Outcome 2 SCORAD at 4 months.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD005205.pub2

References

References to studies included in this review

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References to studies excluded from this review

Czeizel 1994 {published data only}
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References to studies awaiting assessment

Bautista 2010 {published data only}
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References to ongoing studies

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