Cardona Ivan D, Kempe Erin E, Lary Christine, Ginder Julia H, Jain Neal
Department of Pediatrics, Maine Medical Center Research Institute, Portland, Maine.
Colorado Allergy and Asthma Centers, Fort Collins, Colo.
J Allergy Clin Immunol Pract. 2020 Mar;8(3):1014-1021. doi: 10.1016/j.jaip.2019.10.042. Epub 2019 Nov 13.
Studies evaluating bathing frequency in pediatric atopic dermatitis (AD) are limited. Parents of children with AD often receive conflicting information, leading to frustration and confusion.
To evaluate efficacy of twice-daily soaking baths, followed by immediate application of an occlusive moisturizer (ie, soak-and-seal [SS]), versus twice-weekly SS baths, in the acute management of pediatric AD.
We conducted a randomized, single-blind, crossover-controlled trial comparing frequent versus infrequent SS baths, in children 6 months to 11 years of age with moderate-to-severe AD. Children were randomized 1:1 into 2 groups: group 1 underwent twice-weekly SS baths, for 10 minutes or less, over 2 weeks ("dry method" [DM]) followed by twice-daily SS baths, for 15 to 20 minutes, over 2 weeks ("wet method" [WM]). Group 2 did the inverse. Patients received the same moisturizer, cleanser, and low-potency topical corticosteroid (TCS). Primary outcome was AD severity evaluated using the SCORing Atopic Dermatitis (SCORAD) index. Caregiver assessment of AD severity (Atopic Dermatitis Quickscore [ADQ]), quality of life, Staphylococcal aureus colonization, skin hydration, moisturizer, and TCS usage were assessed.
Of the 63 children screened, 42 fulfilled inclusion criteria and were randomized. Forty (95%) completed the study. WM decreased SCORAD by 21.2 compared with DM (95% confidence interval [CI], 14.9-27.6; P < .0001). Secondary analysis showed a greater than 30% SCORAD improvement for WM versus DM (McNemar's χ = 8.83, df = 1, P = .0030). SCORAD correlated with ADQ (r = 0.66), and ADQ also showed significant improvement with WM decreasing ADQ by 5.8 (95% CI, 1.8-9.7). No other secondary endpoints showed significance.
As an acute treatment intervention, WM is superior to DM at improving disease severity in moderate-to-severe pediatric AD.
评估小儿特应性皮炎（AD）洗澡频率的研究有限。AD患儿的家长常常收到相互矛盾的信息，这导致他们感到沮丧和困惑。
评估每日两次浸泡浴，随后立即涂抹封闭性保湿剂（即浸泡 - 封包[SS]），与每周两次SS浴相比，在小儿AD急性治疗中的疗效。
我们进行了一项随机、单盲、交叉对照试验，比较6个月至11岁中重度AD患儿频繁与不频繁的SS浴。患儿按1:1随机分为2组：第1组在2周内每周进行两次SS浴，每次10分钟或更短时间（“干法”[DM]），随后在2周内每日进行两次SS浴，每次15至20分钟（“湿法”[WM]）。第2组顺序相反。患者使用相同的保湿剂、清洁剂和低效外用糖皮质激素（TCS）。主要结局是使用特应性皮炎评分（SCORAD）指数评估AD严重程度。评估了护理人员对AD严重程度的评估（特应性皮炎快速评分[ADQ]）、生活质量、金黄色葡萄球菌定植、皮肤水合作用、保湿剂和TCS的使用情况。
在63名筛查的儿童中，42名符合纳入标准并被随机分组。40名（95%）完成了研究。与DM相比，WM使SCORAD降低了21.2（95%置信区间[CI]，14.9 - 27.6；P <.0001）。二次分析显示，与DM相比，WM的SCORAD改善超过30%（McNemar's χ = 8.83，自由度 = 1，P =.0030）。SCORAD与ADQ相关（r = 0.66），并且ADQ也有显著改善，WM使ADQ降低了5.8（95% CI，1.8 - 9.7）。没有其他次要终点显示出显著性。
作为一种急性治疗干预措施，在改善中重度小儿AD的疾病严重程度方面，WM优于DM。
