April 15, 2012 ◆ Volume 85, Number 8
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American Family Physician 817
What complementary and alternative thera-
pies are effective in the treatment of atopic
Evening primrose oil may be effective for
the treatment of atopic dermatitis. (Strength
of Recommendation [SOR]: B, based on
one randomized controlled trial [RCT].)
Homeopathy may be as good as conventional
therapy for eczema. Probiotics (SOR: A,
based on a Cochrane review) and borage oil
(SOR: B, based on two RCTs) should not be
used in the treatment of atopic dermatitis.
Psychological and educational interventions
for children with atopic dermatitis and their
parents may decrease disease severity and
improve parental quality of life. (SOR: B,
based on a systematic review of five RCTs.)
EVENING PRIMROSE OIL
A small, low-quality RCT evaluating the use
of 2,000 to 6,000 mg of oral evening primrose
oil (8 percent gamma-linoleic acid) per day
in 65 children and adults with atopic derma-
titis found that evening primrose oil reduced
itching and intensity of symptoms compared
with placebo.1 The number needed to treat
was 1.6 (95% confidence interval, 1.3 to 2.6).
There was no intention-to-treat analysis. The
authors analyzed the results from the first 25
patients in each group (treatment and pla-
cebo) to report their results.
A 12-month, prospective, multicenter cohort
observational study compared classical
homeopathic treatment with unspecified
conventional treatment in 118 children one
to 16 years of age who had eczema.2 Homeo-
pathic treatment was defined as “a prescrip-
tion of a single remedy according to the
simile law” (let like be cured by like). Fifty-
four children received homeopathic treat-
ment, and 64 children received conventional
treatment. After one year, eczema symptoms
and disease-related quality of life as rated by
patients or parents improved in both groups
(P = .45).
A Cochrane review of 12 RCTs evaluating
the use of oral probiotics for the treatment
of atopic dermatitis in 785 children three
months to 13 years of age included a variety
of probiotic strains and used parent-, patient-,
and investigator-rated scales of eczema sever-
ity.3 There were no significant differences in
outcomes between the probiotic groups and
Two RCTs evaluating the use of oral borage
oil in the treatment of atopic dermatitis did
not show any improvement compared with
PSYCHOLOGICAL AND EDUCATIONAL
A Cochrane review analyzed five RCTs of
psychological or educational interventions, in
addition to conventional therapy, for atopic
eczema in children.6 The one study of a
psychological intervention used biofeedback
and hypnotherapy as relaxation techniques
versus discussion only in 44 patients with a
Complementary and Alternative Therapies for Atopic
SIMONE NORRIS, MD, and DAVID D. ORTIZ, MD, CHRISTUS Santa Rosa Family Medicine Residency Program,
San Antonio, Texas
ELAINE SULLO, MLS, MAEd, George Washington University Medical Center, Washington, District of Columbia
Clinical Inquiries provides
answers to questions
submitted by practicing
family physicians to the
Family Physicians Inquiries
Network (FPIN). Members
of the network select
questions based on their
relevance to family medi-
cine. Answers are drawn
from an approved set of
and undergo peer review.
The strength of recom-
mendations and the level
of evidence for individual
studies are rated using
criteria developed by the
Working Group (http://
The complete database of
and answers is copyrighted
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submitting questions or
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A collection of FPIN’s
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FPIN’s Clinical Inquiries
Downloaded from the American Family Physician Web site at www.aafp.org/afp. Copyright © 2012 American Academy of Family Physicians. For the private, noncommercial use of
mean age of 9.8 years. After three sessions over 20 weeks,
children in the intervention group had reduced skin
surface damage and lichenification (P = .042). However,
this study did not use an intention-to-treat analysis, and
13 of the 44 children were lost to follow-up. Three of the
four educational studies identified significant improve-
ments in disease severity in the intervention groups. The
fourth trial evaluated long-term outcomes and found a
statistically significant improvement (P < .01) in disease
severity and parental quality of life over 12 months in all
studied age groups (three months to 18 years). Heteroge-
neity in outcome measures and inadequate methodology
limited data synthesis in this review. The psychological
and educational interventions were delivered by nurses
or multidisciplinary teams.
Recommendations from Others
The American Academy of Dermatology’s guidelines
for treatment of atopic dermatitis state that although
probiotics may be of benefit in the treatment of atopic
dermatitis, the effectiveness, safety, and optimal dosage
and duration of therapy need to be established.7 This
recommendation was released before the publication
of the Cochrane review on probiotics for the treatment
of eczema. The guideline authors also reviewed studies
evaluating other complementary and alternative thera-
pies, and did not find evidence to support their use in the
treatment of atopic dermatitis.
Copyright Family Physicians Inquiries Network. Used with permission.
Address correspondence to Simone Norris, MD, at simone@ifmofsa.
com. Reprints are not available from the authors.
Author disclosure: No relevant financial affiliations to disclose.
1. Senapati S, Banerjee S, Gangopadhyay DN. Evening primrose oil is
effective in atopic dermatitis: a randomized placebo-controlled trial.
Indian J Dermatol Venereol Leprol. 2008;74(5):447-452.
2. Keil T, Witt CM, Roll S, et al. Homoeopathic versus conventional treat-
ment of children with eczema: a comparative cohort study. Complement
Ther Med. 2008;16(1):15-21.
3. Boyle RJ, Bath-Hextall FJ, Leonardi-Bee J, Murrell DF, Tang ML. Probiotics
for treating eczema. Cochrane Database Syst Rev. 2008;(4):CD006135.
4. Takwale A, Tan E, Agarwal S, et al. Efficacy and tolerability of borage oil
in adults and children with atopic eczema: randomized, double blind,
placebo controlled, parallel group trial. BMJ. 2003;327(7428):1385.
5. Henz BM, Jablonska S, van de Kerkhof PC, et al. Double-blind, mul-
ticentre analysis of the efficacy of borage oil in patients with atopic
eczema. Br J Dermatol. 1999;140(4):685-688.
6. Ersser SJ, Latter S, Sibley A, Satherley PA, Welbourne S. Psychological
and educational interventions for atopic eczema in children. Cochrane
Database Syst Rev. 2007;(3):CD004054.
7. Hanifin JM, Cooper KD, Ho VC, et al; American Academy of Dermatol-
ogy. Guidelines of care for atopic dermatitis. J Am Acad Dermatol.
Supported in part by a grant from the American Academy of
Family Physicians Foundation.
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