The use of immunosuppressant agents in immunocompromised children with atopic eczema
Date First Published:
June 30, 2010
Last Updated:
July 6, 2010
Report by:
Anna James, Medical Student (University of Manchester)
Three-Part Question:
IN [immunocompromised children with atopic eczema] DO [steroid or immunomodulatory treatments] CAUSE [further problems relating to immunosuppression]?
Clinical Scenario:
A five year old child presents to the Paediatric Emergency Department with a moderate exacerbation of atopic eczema. They have leukaemia and are likely to be immunocompromised.
Usually you would give a mid-potency hydrocortisone cream but know they are only recommended by NICE in non-immunocompromised patients. You wonder whether any complications such as herpetic infection are increased when using potentially immunosuppressing drugs in immunocompromised children.
Usually you would give a mid-potency hydrocortisone cream but know they are only recommended by NICE in non-immunocompromised patients. You wonder whether any complications such as herpetic infection are increased when using potentially immunosuppressing drugs in immunocompromised children.
Search Strategy:
Cochrane, OVID Medline <1950 to June Week 3 2010, EMBASE <1980 to 2010 Week 25, CINAHL.
Search Details:
Cochrane: 'atopic dermatitis' OR 'eczema'
OVID Medline/EMBASE/CINAHL: (exp dermatitis,atopic OR exp eczema) AND (exp immunosuppression OR exp immunologic deficiency syndromes OR exp immunocompromised host OR immunodeficient$.mp.) LIMIT to child < 18 yrs AND human AND english language.
OVID Medline/EMBASE/CINAHL: (exp dermatitis,atopic OR exp eczema) AND (exp immunosuppression OR exp immunologic deficiency syndromes OR exp immunocompromised host OR immunodeficient$.mp.) LIMIT to child < 18 yrs AND human AND english language.
Outcome:
Cochrane: 37 results found. O relevant.
OVID Medline: 135 found. 0 relevant.
EMBASE: 0 found.
CINAHL: 0 found.
OVID Medline: 135 found. 0 relevant.
EMBASE: 0 found.
CINAHL: 0 found.
Author Commentary:
The NICE guidelines (2007) currently only support the treatment of atopic dermatitis with immunosuppressing drugs such as steroids and calceurin inhibitors in those who are non-immunocompromised. There is no reference to immunocompromised patients in the National Association of Dermatologists' guidelines (2009). I have been unable to identify any evidence relating to the safety and side effects of immunosuppressing agents in children with atopic dermatitis, who are known to be immunocompromised. A senior informaticist re-ran this search using all possible synonyms and found no results.
Bottom Line:
There is currently no evidence to support or contraindicate the use of steroid or immunomodulatory therapy in immunocompromised children with atopic dermatitis.