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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.

Search Strategy

Cochrane, OVID Medline <1950 to June Week 3 2010, EMBASE <1980 to 2010 Week 25, CINAHL.
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.

Search Outcome

Cochrane: 37 results found. O relevant.
OVID Medline: 135 found. 0 relevant.
EMBASE: 0 found.
CINAHL: 0 found.

Comment(s)

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.

Clinical Bottom Line

There is currently no evidence to support or contraindicate the use of steroid or immunomodulatory therapy in immunocompromised children with atopic dermatitis.