Original paperProspective observational study of 42 patients with atopic dermatitis treated with homeopathic medicines
Introduction
Atopic dermatitis (AD) is a chronic itching inflammatory skin disease with a predilection for the skin flexures, which usually develops during early childhood. It is associated to high seric IgE and a personal or family history of AD, hay fever and/or bronchial asthma. Despite what its name suggests, up to 60% of children with AD do not have demonstrable IgE-mediated sensitivity to allergens. Approximately 70% of cases of AD start in children under age 5 years; 10% of cases begin in adulthood.1 Direct morbidity affects patients in many ways: sleep disturbance associated with itch, ostracism by other children and parents, need of special clothing and bedding, avoidance of some activities such as swimming, and the need of frequent application of greasy ointments and visits to the doctor.2 Asthma develops in approximately 30% of children with AD and allergic rhinitis in 35%.1 AD usually predates the development of asthma and allergic rhinitis, and it has been suggested that AD can be an entry point for subsequent allergic disease. Asthma is frequently more severe in children with coexistent AD than in children without AD.3
Prevalence of AD has risen steadily in Western industrialized and developing countries in the last decades,3 and according to surveys, it is currently about 10–30% in children and 1–3% in adults. In Latin America the prevalence of AD in children ranges from 3.2 to 25.0% in different regions (average 11.3%), and in teenagers from 3.4 to 30.2% (average 10.6%). Severe AD is found in 1.4% of the former and 1.5% of the latter.4 About 60% of affected children are apparently clear or free from symptoms by adolescence.1 But early onset, severe disease in childhood and associated asthma/hay fever are predictors of worse prognosis.2 Prognosis in adults with AD is worse than in children.2, 5
Conventional treatment includes topical corticosteroids and calcineurin inhibitors, emollients, oral antihistamine drugs and immunosuppressant agents, with varying effectiveness and potential adverse effects.1, 2, 6
AD is frequently seen in homeopathic practice. It probably accounts for one third of consultations for dermatologic disorders.7 Homeopathic treatment is believed to be effective in this disorder as in eczema in general,8, 9, 10, 11, 12, 13 including severe cases.14 But conclusive research defining its real efficacy and best homeopathic therapeutic strategies is still insufficient. In a recent comparative cohort study of homeopathic versus conventional treatment of 118 children with eczema over 12 months, both groups improved similarly regarding perception of eczema symptoms and health-related quality of life.8 A more recent randomized controlled trial (RCT) comparing homeopathic treatment versus placebo reported negative results, but the sample was too small and the number of drop-outs too high to infer any firm conclusion.15
Although the lack of sufficient research assessing homeopathic treatment of AD might lead to a negative view of its possible effectiveness, the fact that about half of patients with this disorder resort to alternative treatments16, 17 may be an indirect indicator of their dissatisfaction with conventional approaches.
The aim of this study is to evaluate the effectiveness of homeopathic treatment of AD in a general homeopathic practice setting and the frequency of prescribed homeopathic medicines.
Section snippets
Protocol and forms
A specific protocol was designed for the purpose of this study, based on a modified version of Dantas’ protocol for evaluation of homeopathic treatment of AD.18 In addition to the usual clinical-homeopathic form, a specific one was filled by physicians and patients in every visit, these forms were filed separately. In order to conceal assessments made in previous visits, neither practitioners nor patients were able to see the previously completed forms.
Patients and setting
Every patient spontaneously attending the
Patients’ characteristics and severity of disease at baseline
Forty two patients fulfilling inclusion criteria, age ranging from 2 months to 66 years old (median 6 years old), were recruited between 4 June 2003 and 23 August 2005. Two of the homeopaths quit the study soon after it began.
Half of the cases had atopic comorbidities at entry, mainly asthma (40.5%), allergic rhinitis (31.0%), or both (26.2%), and 76.2% had taken various conventional treatments for DA in the previous 2 weeks. Thirty six percent of patients had a history of more than 5 years since
Discussion
Although an observational study is considered relatively low grade of evidence, it has the advantage of showing what happens in the routine medical setting. Moreover, some issues about the study model and the patients’ characteristics might heighten the value of this type of research. That could be the case of chronic diseases with little tendency to spontaneous remission, patients with longstanding disease, with moderate to severe presentation, dissatisfied with previous conventional
Conclusions
This study suggests that on the basis of a general medicine practice setting, homeopathic treatment could be regarded as an effective choice for patients with AD.
Funding source
Costs of the study were supported by the authors.
Conflict of interest statement
No conflict of interest is declared.
Acknowledgments
We thank Silvia Waisse for a critical review of the manuscript and Esteban Rosberg for text revision. We also thank the homeopathic physicians that collaborated with this research, Francisco X. Eizayaga, Pedro B. Scala and Perla Aizenberg.
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