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The effect of gamma-linolenic acid on clinical status, red cell fatty acid composition and membrane microviscosity in infants with atopic dermatitis

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Abstract

A double blind placebo-controlled study of two doses of gamma-linolenic acid, provided by evening primrose oil (EPO, Epogam, Searle, U.K.), in children with atopic dermatitis was performed: 1) to examine the effect of gamma-linolenic acid administration on the clinical status of children with atopic dermatitis and abnormalities of IgE-mediated immune responses compared to those without such IgE abnormalities; 2) to investigate the effect of gamma-linolenic acid on red cell fatty acid composition and 3) to assess whether treatment with gamma-linolenic acid induced changes in red cell membrane microviscosity. A significant improvement in the overall severity of the clinical condition was seen in children treated with gamma-linolenic acid, independent of whether the children had manifestations of IgE-mediated allergy. Furthermore, gamma-linolenic acid treatment increased the percentage content of n-6 fatty acids in erythrocyte cell membrane; this increase was more marked in the membranes of children treated with high doses of EPO. In the high dose group a significant increase in dihomogamma-linolenic acid (DGLA) occurred. This may be of particular relevance because of the potential importance of DGLA as a precursor of antiinflammatory prostanoids. Red cell membrane microviscosity did not change in any group after treatment with EPO, even in high doses, despite a significant increase in the proportion of long chain polyunsaturated fatty acids.
... Overall risk of bias was low in four of the included RCTs [22][23][24][25] and unclear in 16 studies. [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] Bias arising from the randomization process was low in 25 of the included RCTs, [22][23][24][25][26]29,32,33,37,38,40,[42][43][44][45][46][47][48][49][50][51][52][53][54][55] whereas the other 26 RCTs had some concerns. In 7 of the included studies, 27,29,30,32,40,52,56 bias due to deviations from intended interventions had some concerns and 22 RCTs had low risk. ...
... In 7 of the included studies, 27,29,30,32,40,52,56 bias due to deviations from intended interventions had some concerns and 22 RCTs had low risk. [22][23][24][25][26]28,31,[33][34][35][36][37][38][39]41,43,47,51,[57][58][59][60] Two RCTs had some concerns due to missing outcome data, 40,50 and 18 RCTs had high risk. [42][43][44][45][47][48][49][53][54][55][56][61][62][63][64][65][66][67] Bias in measurement of the outcome was unclear in one study 50 and high in 13 of the included studies. ...
... A total of 19 studies on systemic therapy with EPO 24,25,32,[34][35][36][37][38][39][40][49][50][51][52][53]56,[64][65][66] were found. Of these, 13 were included in a meta-analysis. ...
Article
Herbal medicine is widely used for dermatological diseases, particularly atopic dermatitis. This study aims to systematically review existing literature on the efficacy of both topical and systemic herbal interventions for atopic dermatitis across various age groups. Conducting a comprehensive search on MEDLINE/PubMed, Scopus, and the Cochrane Central Register of Controlled Trials (Central) until April 12, 2023, only randomized controlled trials (RCTs) were included. The review is reported following the PRISMA guidelines and was conducted in accordance to Cochrane recommendations. Two authors independently extracted details, including demographics, medication, control/placebo groups, outcomes, adverse events, and results, with quality assessment using the Cochrane risk of bias tool 2.0. A meta-analysis, utilizing the random-effects model, was conducted, and publication bias was assessed through funnel plot inspection. The quality of evidence adhered to GRADE working group recommendations. The primary focus was evaluating atopic dermatitis or pruritus severity. The review encompassed 51 RCTs (3763 participants). Of these, 31 RCTs explored 19 distinct herbs and five complex remedies, whereas 20 RCTs (1088 participants) specifically investigated evening primrose oil (EPO). Herbs such as sunflower, licorice, figs, coconut, EPO, indigo naturalis, licorice, mauve, St. John's wort, and a combination of aloe vera and olive oil were found to have evidence of efficacy in the local treatment of atopic dermatitis. A meta-analysis on systemic used EPO, involving 13 RCTs, found no significant difference in atopic dermatitis severity compared with placebo (SMD: 0.14; 95% CI [-0.45; 0.73], 13 RCTs). In conclusion, this review provides a nuanced perspective on herbal substance efficacy for atopic dermatitis. While the EPO meta-analysis failed to show a discernible benefit beyond placebo, individual herbal preparations showed promising results in RCTs included in this review. Nevertheless, larger, methodologically rigorous studies are essential to establish evidence for herbal remedies in atopic dermatitis treatment.
... We located five RCTs of oral borage oil supplementation, [246][247][248][249][250] four RCTs of fish oil supplementation, [251][252][253][254] four RCTs of topical evening primrose oil, [232][233][234]241 two of which repeated the same study, 233,234 and ten published RCTs of oral evening primrose oil [235][236][237][238][239][240][242][243][244][245] (including one study published twice 242,245 ) for the treatment of atopic eczema, and these are described in Tables 20-29, respectively. ...
... The two largest 240,243 and best-reported studies did not show any evidence of benefit for evening primrose oil in atopic eczema. The remaining moderate-sized (between 50 and 100 patients) studies show conflicting results, 235,237,238,245 ranging from no hint of improvement 235 to a definite modest 10-20% benefit for some outcome measures when compared with placebo. The three small studies all suggest a benefit to evening primrose oil. ...
Article
Zusammenfassung Hintergrund/Ziel Phytotherapie wird zunehmend zur Behandlung dermatologischer Erkrankungen, insbesondere der atopischen Dermatitis (AD), eingesetzt. Ziel dieser systematischen Übersichtsarbeit war es, die Wirksamkeit topischer und systemischer pflanzlicher Interventionen bei Kindern und Jugendlichen mit AD zu bewerten. Methoden Eine systematische Literaturrecherche in Medline/PubMed, Scopus und dem Cochrane Central Register of Controlled Trials (Central) bis zum 12. April 2023 identifizierte randomisierte kontrollierte Studien (RCTs). Die Übersichtsarbeit folgte den PRISMA-Richtlinien, und die Qualität der Studien wurde mithilfe des Cochrane Risk of Bias Tools 2.0 sowie den GRADE-Kriterien bewertet. Eine Metaanalyse wurde unter Verwendung des Random-Effects-Modells durchgeführt. Ergebnisse Insgesamt wurden 25 RCTs mit 2091 Teilnehmern eingeschlossen. Verschiedene pflanzliche Präparate, wie Sonnenblumenöl, Feige, Eibisch und Kokosnussöl, zeigten in einzelnen Studien eine vielversprechende Wirksamkeit. Eine Metaanalyse von 5 RCTs zu systemischem Nachtkerzenöl zeigte jedoch keinen signifikanten Unterschied im Vergleich zu Placebo. Schlussfolgerung Die Ergebnisse deuten darauf hin, dass einige pflanzliche Präparate eine potenzielle Wirksamkeit bei AD aufweisen. Dennoch sind größere, methodisch robuste Studien notwendig, um klare Empfehlungen zur Anwendung pflanzlicher Therapien bei AD im Kindes- und Jugendalter aussprechen zu können.
Book
Whether you initiate alternative therapies for children, or simply need to respond when asked for information or advice, it's crucial to have the most current, evidence-based information so that you can safely and effectively integrate CAM therapies with conventional treatment. This innovative and reliable reference is the ideal resource to have at hand. With its focus on integrating conventional medicine with the best complementary therapies for children, it familiarizes you with the scientific evidence and rationales for various CAM therapies, and clearly describes how to use them, in conjunction with conventional medicine. You'll find the information you need to distinguish among those therapies with good evidence, those that are safe but not yet proven to be effective, and those contraindicated for certain conditions. Covers a wide range of complementary and alternative therapies, focusing on those most often utilized with children: mind-body approaches (hypnosis, mind/body, probiotics, spirituality); manual therapies (chiropractic, massage, osteopathy, psychological); lifestyle approaches (nutrition, Qigong); alternative systems (homeopathy, naturopathy); energy medicine (acupuncture, aromatherapy, herbal, laser, magnets); and biological agents (Chinese and Western herbs and probiotics). 57 of the most common pediatric conditions are comprehensively discussed, first with a focus on conventional diagnostic and treatment information, then with authoritative information on the most effective and evidence-based CAM therapies available for treatment of the condition. Presents an integrative approach, combining conventional and alternative therapies. Helps you answer questions relevant to today's patients, such as giving echinacea for a cold, the use of acupuncture to treat ADHD, and which alternative therapies may be used to avoid side effects of conventional medication.
Article
Atopic eczema (AE) is a common chronic inflammatory skin condition. Whilst many AE treatment options are available, the evidence to support their efficacy varies in depth and quality. In 2000, an NIHR HTA systematic review identified and evaluated existing randomised controlled trials (RCTs) of AE treatments. To ensure continuing utility, the NIHR commissioned an update to the review. Here, we present an overview of the updated report and key findings. Systematic reviews and RCTs of AE treatments that included participants with AE (criteria based or diagnosed) were identified using: MEDLINE, EMBASE, CENTRAL, LILACS, AMED, CINAHL and Cochrane Skin Group Specialised Register (searched to August 31st 2013 (RCTs) and 31st December 2015 (systematic reviews)). Outcome measures included: symptoms, AE severity, quality-of-life, and adverse effects. Study quality was assessed using the Cochrane Collaboration risk of bias tool. Of the 287 new RCTs identified, only 22 (8%) were judged to be low risk of bias. When combined with RCTs from the previous review (n= 254), we found ‘reasonable evidence of benefit’ for corticosteroids, calcineurin inhibitors, Atopiclair™, ciclosporin, azathioprine, ultraviolet light and education programmes. Interventions with reasonable evidence of ‘no benefit’ included some dietary interventions, ion exchange water softeners, multiple daily applications of topical corticosteroids and antibiotic-containing corticosteroids for non-infected AE. Many common treatments lack evidence of efficacy and warrant further evaluation. The evidence base for AE is still hampered by poor trial design and reporting. The trials included in this review were used to establish the Global Resource of Eczema Trials (GREAT) Database. This article is protected by copyright. All rights reserved.
Article
Background: Complementary and alternative interventions are becoming increasingly utilized as adjuncts to conventional treatment of atopic dermatitis (AD). While the number of studies continues to grow, the vastness of the subject coupled with the relatively poor quality and small size of the studies limit their usefulness to clinicians. Purpose: Our aim was to comprehensively review randomized controlled trials (RCTs) of complementary and alternative therapies for AD. Methods: Searches were performed on PubMed, the Cochrane Central Register of Controlled Trials, EMBASE, and the Global Resource for EczemA Trial (GREAT) databases, focusing on RCTs of alternative or complementary AD therapies, with a sample size of ≥10, through March 2015 and limited to the English language. A total of 70 manuscripts met the inclusion criteria and were included in the final analysis. Results: There is at least some level I evidence to support the use of acupuncture and acupressure, stress-reducing techniques such as hypnosis, massage, and biofeedback, balneotherapy, herbal preparations (with many important caveats), certain botanical oils, oral evening primrose oil, vitamin D supplementation, and topical vitamin B12. Many other therapies either have sufficient data to suggest that they are ineffective, or simply do not have enough evidence to formulate a verdict. Conclusions: Careful review of the literature reveals several promising therapies in this domain; such findings may help direct further research that is necessary to bolster clinical recommendations for alternative or complementary treatments of AD.
Chapter
Species of the genus Oenothera L. (Onagra Miller) from the family Onagraceae are characteristic of America, the homeland of species acclimated in Europe (Szafer and Pawłowski 1959; Raven 1968). The American flora has the most numerous representatives; plants of these species can be found in natural localities (Rickett 1970, 1971), or they are grown as decorative plants with white, pink to reddish purple, or mostly bright yellow flowers (Bailey 1950; Encke 1960). A few species are also found in Russia (Shishkin and Bobrow 1949; Grossgejm 1962). At present, the genus Oenothera is believed to be distributed throughout the world with the exception of Antarctica (Rostański 1992).
Chapter
The knowledge of intraepidermal lipid metabolism of keratinocytes and the respective lipometabolic disorders is of fundamental importance for understanding the role of fatty acids in inflammatory skin diseases.
Chapter
In 1929 and 1930, Burr and Burr reported the development of a scaly dermatitis in rats fed diets free of unsaturated fats [1,2]. Studies in several animal species and also in humans have now shown that a dietary deficiency of the n-6 essential fatty acid (EFA), linoleic acid, but not of the n-3 EFA, alpha-linolenic acid, leads to a range of skin abnormalities [3-6]. An inflammatory type of reaction is characteristic, with dryness, then scaling, then a breakdown of the skin surface with redness and weeping. At the same time epidermal cells proliferate more rapidly [7] and the skin becomes highly permeable to water leading to serious water loss across the skin surface [8-10].
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