Documenti di Didattica
Documenti di Professioni
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i
Prepared by:
Reviewed by:
Dr Junainah Sabirin
Senior Principal Assistant Director
Health Technology Assessment Section (MaHTAS)
Medical Development Division
Ministry of Health Malaysia
External reviewers:
DISCLOSURE
The author of this report has no competing interest in this subject and the
preparation of this report is totally funded by the Ministry of Health, Malaysia.
ii
EXECUTIVE SUMMARY
Background
Chronic skin diseases are common among the general population. Many factors
may contribute to the cause, development and burden of chronic skin diseases,
such as genetic, immunologic, environmental and psychological factors.
Objective/ aim
The objective of this systematic review was to assess the effectiveness, safety
and cost/ cost-effectiveness of homeopathy for eczema, psoriasis, and
seborrheic dermatitis.
A total of 66 titles were identified through the Ovid interface and PubMed. Seven
relevant articles were included in this review: one systematic review, two
randomised controlled trials, one non-randomised interventional study, two pre
and post intervention studies and one case report. However, there are several
limitations whereby some of the included studies have small sample size. The
homeopathic and conventional treatments in some studies were not specified.
iii
Apart from that, some of the studies retrieved were observational studies, which
are considered to have higher risk of bias.
a. Effectiveness
Eczema:
There was limited fair level of retrievable evidence to suggest that
there was no significant difference between homeopathic therapy and
conventional therapy. However, some of the included studies have
small sample size. The pre and post intervention study by Donsky H
and Clarke D in 2007 which showed improvement in eczema with a
topical homeopathic therapy, Reliva, when compared with before
treatment, may suggest a role for homeopathic therapy. The mean
Eczema Area Severity Index (EASI) scores in the patients decreased
significantly by 75%, 91% and 97% after four, eight and 12 weeks of
treatment, respectively.
Psoriasis:
There was very limited fair level of retrievable evidence that showed
homeopathic treatment was effective in treating and improving the
quality of life of psoriasis patients. However, in a randomised
controlled trial specific to a homeopathic therapy, the area of skin
applied with the homeopathic treatment and the placebo was small
(4.0 cm x4.0 cm).
Seborrheic dermatitis:
There was very limited fair level of retrievable evidence to suggest that
a low-dose oral homeopathic formulation improved seborrheic
dermatitis (one study). There was a significant difference in the mean
percentage change in the Seborrhea Area and Severity Index (SASI)
between the active group (38.54 42.13) and the placebo group (-
10.82 66.16, P= 0.0302). On a similar note, the improvement in SASI
in the placebo group was also significant after the crossover to the
active medication group (41.64 39.45) at week 20 as compared to
before crossover (-16.40 50.12, P= 0.0035).
b. Safety
iv
c. Cost/ Cost effectiveness
Methods
Electronic databases were searched through the Ovid interface: Ovid MEDLINE
In-process and other Non-indexed citations and Ovid MEDLINE 1946 to
present, EBM Reviews - Cochrane Central Register of Controlled Trials
February 2016, EBM Reviews - Cochrane Database of Systematic Reviews -
2005 to April 7 2016, EBM Reviews Database of Abstracts of Reviews of
Effects 1st Quarter 2016, EBM Reviews - Health Technology Assessment 1st
Quarter 2016, EBM Reviews NHS Economic Evaluation Database 1st Quarter
2016, Embase 1988 to 2016 week 15. Searches were also run in PubMed.
Google was used to search for additional web-based materials and information.
Additional articles were identified from reviewing the references of retrieved
articles.
v
HOMEOPATHY FOR ECZEMA, PSORIASIS, AND
SEBORRHOEIC DERMATITIS
1. BACKGROUND
1
Traditional and Complementary Medicine (TCM) Act 2013 had been
gazetted in 2013 in which homeopathy is recognised as one of the TCM
modalities in Malaysia. The claims made for the clinical effects of
homeopathy including for skin diseases are controversial and there are
discrepancies between outcomes of different studies. Thus, this
systematic review was requested by Senior Principal Assistant Director of
the Traditional and Complementary Division, mainly to look at the
effectiveness and safety of homeopathic treatment for three of the
common skin diseases in Malaysia namely eczema, psoriasis, and
seborrhea or more popularly known as seborrheic dermatitis.
2. OBJECTIVE / AIM
3. TECHNICAL FEATURES
The law of infinitesimals defines the rule that the appropriate drug has to
be given in high dilutions, and that the higher the dilution, the greater the
effect, whereby an agent becomes more powerful the more it is diluted.8,10
Earlier, it was believed that high dilutions of homeopathy medicines
virtually do not contain even a single molecule of the original starting
substance. However, recent studies show that homeopathy dilutions do
contain nanoparticles of starting substance in all potencies.11
2
Most of the conditions treated by homeopathic practitioners are chronic or
recurrent. Initially, a very detailed history is taken from the patient, a
clinical examination is performed, and all signs and symptoms are
recorded. Attention is paid to alternating or unusual symptoms and
information is sought on the conditions providing relief or aggravation of
symptoms, such as weather or activity. The symptoms are then matched
to remedies using either a homeopathic repertory or pattern
recognition.12
4. METHODS
4.1 Searching
4.2 Selection
A reviewer screened the titles and abstracts against the inclusion and
exclusion criteria and then evaluated the selected full text articles for final
article selection.
3
The inclusion and exclusion criteria were:
Inclusion criteria
Problems Patients with eczema, psoriasis, or seborrheic dermatitis
Exclusion criteria
Study design Studies conducted in animals/ laboratory studies and narrative
reviews
A total of 66 titles were identified through the Ovid interface and PubMed:
45 for eczema, 17 for psoriasis and four for seborrheic dermatitis. Seven
relevant articles were included in this review: one systematic review, two
randomised controlled trials, one non-randomised interventional study, two
pre and post intervention studies and one case report.
4
5.1 EFFECTIVENESS
5.1.1 Eczema
5
(P=0.741). The study also looked at the Children Dermatology Life Quality
Index (CDLQI) as a measure of the participating childrens quality of life.
Similarly, the CDQLI showed no significant difference: mean for
homeopathy group was 2.2, 95% CI: 1.4, 3.4 versus conventional 1.8,
95% CI: 1.2, 2.8 (P=0.627).14, level II-2
5.1.2 Psoriasis
In 2009, Witt CM, Ludtke R and Willich SN carried out a pre and post
intervention study in Germany to evaluate details and effects of
homeopathic treatment in patients with psoriasis on usual medical care.
Eighty two adult primary care patients were followed up for two years. The
study looked into the mean scores for severity of the psoriasis diagnosis,
severity of all other diagnoses at baseline (physician assessment),
severity of all complaints (patient assessment) using numeric rating scale
(NRS; 0 =no complaints, 10 =maximum severity) and quality of life (QoL)
scores. Other diagnoses at baseline included migraine, allergic rhinitis,
psoriatic arthropathy, hypertension, chronic sinusitis, allergy and
dermatitis. The mean NRS showed that the strongest improvement in all
6
diagnoses (including psoriasis) and medical complaints was seen in the
first three months; this continued during the full observation period. By the
end of study period, all changes since baseline in severity of diagnoses
and complaints were of large effect size (Cohens d 1.02-2.09 [Cohens d:
>0.8 large, >0.5 medium, >0.2 small]). The health-related QoL improved
similarly but with smaller effect size; physical component score: Cohens d
0.26, mental component score: Cohens d 0.49. Reductions in the use of
conventional medicines and health care services were observed as well.
Use of conventional medicines was reduced by five percent while use for
health care services was reduced between 7 to 46%.16, level II-2
7
for the first 10 weeks, there was a significant improvement in the primary
study outcome which was the disease state as depicted by mean
percentage change in the Seborrhea Area and Severity Index (SASI)
between the active group (38.54 42.13) and the placebo group (-10.82
66.16, P= 0.0302). On a similar note, the improvement in disease state in
the placebo group was also significant after the crossover to the active
medication group (41.64 39.45) at week 20 as compared to before
crossover (-16.40 50.12, P= 0.0035).17, level II-1
5.2 SAFETY
In the study by Roll S et al. it was reported that two patients in the
homeopathy group (5.3%) and five in the conventional group (8.2%)
reported adverse events (P= 0.704). The adverse events that occurred
included pruritus, burning sensation, reddening, dry /flaky skin, burns,
herpes zoster and allergic reaction, with one child in the conventional
group needing hospitalisation due to worsening of the atopic eczema with
additional streptococcal infection.14, level II-2
8
versus 0.24). The most frequent adverse events were stomach upset,
stomach pain and nausea. These adverse events were considered mild
and infrequent. As for laboratory parameters (standard serum chemistry
profile, complete blood count, and urinalysis), small but statistically
significant shifts from baseline occurred for some parameters in the active-
treatment, placebo-treatment-before-crossover and placebo-after-
crossover-to-active groups. However they remained well within the normal
lab references and were not considered to be causally related to the study
medication.18, level II-1
5.4 LIMITATIONS
6. CONCLUSION
6.1 Effectiveness
Eczema:
There was limited fair level of retrievable evidence to suggest that
there was no significant difference between homeopathic therapy
9
and conventional therapy. However, one pre and post intervention
study showed improvement in eczema with Reliva, a topical
homeopathic therapy, when compared with before treatment.
Psoriasis:
There was very limited fair level of retrievable evidence that
showed homeopathic treatment was effective in treating and
improving the quality of life of psoriasis patients.
Seborrheic dermatitis:
There was very limited fair level of retrievable evidence to suggest
that a low-dose oral homeopathic formulation improved seborrheic
dermatitis (one study).
6.2 Safety
10
7. REFERENCES
2. Hay RJ, Johns NE, Williams HC et al. The Global Burden of Skin Disease
in 2010: an analysis of the prevalence and impact of skin conditions. J
Invest Dermatol. 2014;134:1527-1534
12. OMeara S, Wilson P, Bridle C et al. Homoeopathy. Qual Saf Heath Care.
2002;11:189-194
11
13. Ernst E. Homeopathy for eczema: a systematic review of controlled
clinical trials. Br J Dermatol. 2012;166:1170-1172
18. Smith SA, Baker AE, Williams JH. Effective treatment of seborrheic
dermatitis using a low dose, oral homeopathic medication consisting of
potassium bromide, sodium bromide, nickel sulphate, and sodium chloride
in a double-blind, placebo controlled study. Altern Med Rev. 2002;7(1):59-
67
12
8. APPENDIX
1 ECZEMA/ (9854)
2 eczema*.tw. (15476)
3 (eczematous adj1 dermatiti*).tw. (303)
4 1 or 2 or 3 (19328)
5 PSORIASIS/ (28859)
6 psorias?s.tw. (29645)
7 (pustulosis adj1 ((palmoplantaris or palmaris et plantaris or palms) and
soles)).tw. (10)
8 (pustular psoriasis of palm* and sole*).tw. (4)
9 5 or 6 or 7 or 8 (37011)
10 DERMATITIS, SEBORRHEIC/ (2445)
11 seborrh?ea.tw. (603)
12 (seborrh?e* adj1 dermatiti*).tw. (1387)
13 10 or 11 or 12 (3313)
14 HOMEOPATHY/ (4328)
15 hom?eopath*.tw. (4454)
16 14 or 15 (5835)
17 4 and 16 (45)
18 9 and 16 (17)
19 13 and 16 (4)
13
OTHER DATABASES
EBM Reviews - Cochrane Central
Register of Controlled Trials
EBM Reviews - Cochrane
Database of Systematic Reviews
EBM Reviews - Health Same MeSH, keywords, limits used as
Technology Assessment per MEDLINE search
EBM Reviews Database of
Abstracts of Reviews of Effects
EBM Reviews NHS Economic
Evaluation Database
EMBASE
PubMed
14
8.2 Appendix 2
II-3 Evidence obtained from multiple time series with or without the
intervention. Dramatic results in uncontrolled experiments (such as the
results of the introduction of penicillin treatment in the 1940s) could also
be regarded as this type of evidence.
15
Appendix 3
Evidence Table: Effectiveness
Question: How effective is homeopathic treatment compared with conventional treatment for eczema?
1. Ernst E. Systematic review I 3 controlled trials: Homeopathy i. Conventional NA All studies had methodological
Homeopathy for 1 randomised, 2 of any type treatment limitations.
eczema: a Objective: to summarise and non randomised ii. Placebo
systematic critically evaluate the The two non-randomised trials
review of evidence from controlled i. Keil et al. suggest therapeutic equivalence
controlled clinical trials testing the - comparative between homeopathy and
clinical trials. Br efficacy of homeopathy as a cohort study conventional therapy. The studies
J Dermatol. treatment for eczema -118 children with lacked sufficient detail about
2012;166:1170- eczema treatments administered and both
1172 Methods: Electronic were open to selection and other
searches were conducted in ii. Witt et al. biases.
Medline, Embase and the - comparative
Cochrane Library. No cohort study The RCT shows a marginal
restrictions on time or -135 children with superiority of placebo over
language. Hand search for atopic eczema homeopathy. Only 14 of 24 patients
further relevant studies from completed the study.
departmental files, other iii. Siebenwirth et
systematic reviews and al.
bibliographies of the - RCT
retrieved studies were also - 24 patients with Authors conclusion: The available
done. Limit to human study. eczema trial data do not demonstrate
The methodological quality homeopathic remedies to be
of included trials was efficacious as a treatment of
estimated using the Jadad eczema
score.
16
Evidence Table: Effective
Question: How effective is homeopathic treatment compared with conventional treatment for eczema?
2. Roll S, Non-randomised II-2 135 children Homeopathic Conventional 36 months Main outcome was SCORAD
Reinhold T, interventional study - - 48 therapy therapy (SCORing Atopic Dermatitis) at 36
Pach D et al. homeopathy, 87 months. Further outcomes were
Comparative Objective: to describe conventional quality of life, conventional medicine
effectiveness of the effectiveness and consumption, safety and disease-
homeopathic the costs involved in the Inclusion related costs at 6, 12 and 36 months
vs. long-term follow-up after criteria: after baseline.
conventional 36 months. - children 1-
therapy in 14yrs with SCORAD showed no significant
usual care of Children were recruited atopic eczema differences between groups: mean for
atopic eczema from January 2005 to - disease homeopathy group 13.68 2.91, 95%
in children: June 2006. Data was duration of at CI 7.88 to 9.48 vs conventional group
long-term collected until October least 6months 14.90 2.25, 95% CI 10.41 to 19.05
medical and 2009, allowing a total - fulfilled 3 of 4 (P=0.741).
economic observation period of Williams
outcomes. 36months per patient. criteria, Childrens QoL CDLQI (Children
PLoS One. Study was multi-centre - Three-Item- Dermatology Life Quality Index) also
2013;8(1):e549 in Berlin, Germany. The Score (TIS) showed no significant difference:
73 children and their between 2 to 7. mean for homeopathy grp 2.2, 95%
parents were recruited CI 1.4 to 3.4 vs conventional 1.8, 95%
at either homeopathic or Exclusion CI 1.2 to 2.8 (P=0.627).
conventional doctors criteria:
practices and had - other dermal Total costs were significantly higher in
already made their own disease, severe the homeopathic group (217 Euro,
choice of therapy. Thus, medical or 95% CI 154.1 to 279.9), compared to
the parents preference psychological conventional group (99.9 Euro, 95%
towards treatment disease CI 53.7 to 146.1), P=0.005).
generated the groups to - oral or iv
be compared. corticosteroids
Homeopathic doctors during last
were recruited by the 3months before
organisation of study entry
homeopathic doctors in -psychotherapy,
Berlin. Doctors for allergy
conventional treatment desensitisation
17
Evidence Table: Effective
Question: How effective is homeopathic treatment compared with conventional treatment for eczema?
18
Evidence Table: Effectiveness
Question: How effective is homeopathic treatment compared with conventional treatment for eczema?
3. Donsky H, Pre and post intervention II-2 - 42 patients Reliva cream - Patients were Main outcome was improvement in
Clarke D. enrolled, from (homeopathic assessed at EASI scores.
Reliva, a Objective: to assess the which 12 product baseline (day
Mahonia efficacy and safety of patients containing 0) and at 4, 8 EASI scores in per-protocol group:
Aquifolium Relieva, a topical cream, in dropped out. Psorberine, a and 12 weeks Time Mean (SD) Median
extract for adult patients with atopic Thus, 30 proprietary after initiation point (range)
the treatment dermatitis (AD). patients extract from of treatment. 0 2.01 (1.54) 1.50 (0.5-5.6)
of adult completed the Mahonia 4 wks 0.50 (0.84) 0.20 (0-4.0)
patients with Patients were recruited study (n=30). aquifolium 8 wks 0.16 (0.43) 0.0 (0-2.0)
atopic from clinical private 10% cream 12 wks 0.06 (0.18) 0.0 (0-0.8)
dermatitis. practices, the local college formulated in
Am J Ther. student population, local Inclusion an emulsion
The mean EASI scores decreased
2007;14:442- newspaper advertisements criteria: cream base)
by 75%, 91% and 97% after 4, 8
446 and by word of mouth. - Patients 18 - for topical
and 12 weeks of treatment,
Eligibility was assessed 80 years old administration
respectively (all P<0.05).
through telephone pre- with atopic
screening. Patients who dermatitis on
Subject Reported Evaluation of
passed were invited to 10% or less of
Treatment at 12-weeks showed
participate in the study. their body and
93% of patients rated the
in good overall
effectiveness of treatment as
Participation began with an health
better or much better, 83.4%
initial visit (day 0), which
rated itching as better or much
included completion of Exclusion
better and 93.3% rated the
consent forms, a screening criteria:
appearance of rash as better or
health questionnaire, and a - Patients using
much better. No patient indicated
physical examination. topical AD
a score of much worse and only 1
Patients were provided with medications in
person (3.3%) indicated worse for
Relieva and instructed on the past 2wks;
5 out of the 7 questions.
the application of a thin systemic (oral,
layer of it 3x per day to intravenous,
infected areas on the skin. intramuscular,
intradermal)
Patients selected to medications
participate in the study for AD in the
were provided with past 28 days;
19
Evidence Table: Effectiveness
Question: How effective is homeopathic treatment compared with conventional treatment for eczema?
20
Evidence Table: Effectiveness
Question: How effective is homeopathic treatment compared with conventional treatment for psoriasis?
21
Evidence Table: Effectiveness
Question: How effective is homeopathic treatment compared with conventional treatment for psoriasis?
22
Evidence Table: Effectiveness
Question: How effective is homeopathic treatment compared with conventional treatment for psoriasis?
23
Evidence Table: Effectiveness
Question: How effective is homeopathic treatment compared with conventional treatment for psoriasis?
24
Evidence Table: Effectiveness
Question: How effective is homeopathic treatment compared with conventional treatment for seborrheic dermatitis?
6. Smith SA, Randomised controlled-trial II-1 41 patients A liquid Placebo 10 +10 weeks Primary outcome: the percent
Baker AE, - 21 males, 20 homeopathic consisting of improvement in Seborrhea Area and
Williams JH. Objective: to evaluate the females medication vehicle only Severity Index (SASI); the SASI rates
Effective therapeutic potential of a - 20 randomised consisting of both the degree of involvement and
treatment of low-dose oral administration into placebo potassium severity for seborrheic dermatitis and
seborrheic of potassium bromide, group, 21 into bromide, dandruff on the head as a single number
dermatitis sodium bromide, nickel active group sodium on a scale of 1 to 48.
using a low sulphate, and sodium bromide, nickel
dose, oral chloride in a homeopathic Inclusion criteria: sulphate and Other outcomes: safety- which included
homeopathic formulation. Patients with sodium a satisfactory exam at each 5-week visit
medication typical chloride in a and satisfactory laboratory results as
consisting of Patients were recruited from seborrheic vehicle of compared to baseline at weeks 10 and
potassium the dermatology practice of dermatitis or purified water 20, and adverse events.
bromide, Steven A. Smith and by dandruff with a and 20% ethyl
sodium local advertisement in minimum of 20% alcohol. Percentage change in SASI between
bromide, Tulsa, Oklahama. The affected scalp placebo and active treatment:
nickel active and placebo groups surface area, a wk placebo active
sulphate, and were assigned coded minimum of 20% Mean SD Mean SD P
sodium names by the study monitor affected face value
chloride in a and randomised in blocks of surface area, or 5 8.43 68.99 35.18 35.48 0.191
5
double-blind, four. The study investigator a minimum of 10 - 66.16 38.54 42.13 0.030
placebo was given a list of the 20% combined 10.82 2
controlled randomised, coded dose affected scalp
study. Altern groups. and surface Percentage change in SASI in placebo
Med Rev. area. Once group before and after crossover:
2002;7(1):59- For the first 10 weeks the admitted to the wk placebo active
67 blinded patients took the study, patients Mean SD Mean SD P
assigned study medication were required to value
and were evaluated at 0, 5 discontinue all 5 11.20 60.84 21.21 79.70 0.660
and 10 weeks. At the end of concomitant vs 6
15
10 weeks all patients, seborrhea 10 - 50.12 41.64 39.45 0.003
crossed over to the active medications for 2 vs 16.40 5
medication for an additional weeks before 20
10-week open study. beginning and
The patients self- throughout the
25
Evidence Table: Effectiveness
Question: How effective is homeopathic treatment compared with conventional treatment for seborrheic dermatitis?
26
Evidence Table: Safety
Question: How safe is homeopathic treatment compared with conventional treatment?
27
Evidence Table: Safety
Question: How effective is homeopathic treatment compared with conventional treatment for eczema?
2. Roll S, Non-randomised II-2 135 children Homeopathic Conventional 36 months 2 patients in the homeopathy group
Reinhold T, interventional study - - 48 therapy therapy (5.3%) and 5 patients in the
Pach D et al. homeopathy, 87 conventional group (8.2%) reported
Comparative Objective: to describe conventional adverse events (p=0.704). Adverse
effectiveness of the effectiveness and events that occurred included
homeopathic the costs involved in the Inclusion pruritus, burning sensation,
vs. long-term follow-up after criteria: reddening, dry/ flaky skin, burns,
conventional 36 months. - children 1- herpes zoster and allergic reaction,
therapy in 14yrs with with 1 child in the conventional group
usual care of Children were recruited atopic eczema needing hospitalisation due to
atopic eczema from January 2005 to - disease worsening of the atopic eczema with
in children: June 2006. Data was duration of at additional streptococcal infection.
long-term collected until October least 6months
medical and 2009, allowing a total - fulfilled 3 of 4
economic observation period of Williams
outcomes. 36months per patient. criteria,
PLoS One. Study was multi-centre - Three-Item-
2013;8(1):e549 in Berlin, Germany. The Score (TIS)
73 children and their between 2 to 7.
parents were recruited
at either homeopathic or Exclusion
conventional doctors criteria:
practices and had - other dermal
already made their own disease, severe
choice of therapy. Thus, medical or
the parents preference psychological
towards treatment disease
generated the groups to - oral or iv
be compared. corticosteroids
Homeopathic doctors during last
were recruited by the 3months before
organisation of study entry
homeopathic doctors in -psychotherapy,
Berlin. Doctors for allergy
conventional treatment desensitisation
28
Evidence Table: Safety
Question: How effective is homeopathic treatment compared with conventional treatment for eczema?
(paediatricians or or additional
dermatologists) were complementary
chosen from address therapy during
lists or via last 3 months
recommendation. before study
entry 135
After conventional case children
taking, screening and - - 48
recruitment, patients homeopathy, 87
were enrolled into the conventional
study. The baseline
data for the main
outcome measure,
SCORAD were
assessed by 2
specifically trained staff
members who were
blinded to treatment
assignment. Other
baseline data were
obtained with
questionnaires. Each
patient was assigned to
only one rater for the
whole study period.
After the rating, the
homeopathic case,
taking and the following
treatment or the
conventional treatment
began. Follow-up data
were obtained also by
ratings and
questionnaires.
29
Evidence Table: Safety
Question: How effective is homeopathic treatment compared with conventional treatment for eczema?
3. Donsky H, Pre and post intervention II-2 - 42 patients Reliva cream Patients were 3 patients reported itching and/ or
Clarke D. enrolled, from (homeopathic assessed at burning when using the cream and
Reliva, a Objective: to assess the which 12 product baseline (day dropped out of the study at weeks
Mahonia efficacy and safety of patients containing 0) and at 4, 8 1.5, 2, and 5.
Aquifolium Relieva, a topical cream, in dropped out. Psorberine, a and 12 weeks
extract for adult patients with atopic Thus, 30 proprietary after initiation
the treatment dermatitis (AD). patients extract from of treatment.
of adult completed the Mahonia
patients with Patients were recruited study (n=30). aquifolium
atopic from clinical private 10% cream
dermatitis. practices, the local college formulated in
Am J Ther. student population, local Inclusion an emulsion
2007;14:442- newspaper advertisements criteria: cream base)
446 and by word of mouth. - Patients 18 - for topical
Eligibility was assessed 80 years old administration
through telephone pre- with atopic
screening. Patients who dermatitis on
passed were invited to 10% or less of
participate in the study. their body and
in good overall
Participation began with an health
initial visit (day 0), which
included completion of Exclusion
consent forms, a screening criteria:
health questionnaire, and a - Patients using
physical examination. topical AD
Patients were provided with medications in
Relieva and instructed on the past 2wks;
the application of a thin systemic (oral,
layer of it 3x per day to intravenous,
infected areas on the skin. intramuscular,
intradermal)
Patients selected to medications
participate in the study for AD in the
were provided with past 28 days;
30
Evidence Table: Safety
Question: How effective is homeopathic treatment compared with conventional treatment for eczema?
31
Evidence Table: Safety
Question: How effective is homeopathic treatment compared with conventional treatment for psoriasis?
32
Evidence Table: Safety
Question: How effective is homeopathic treatment compared with conventional treatment for psoriasis?
33
Evidence Table: Safety
Question: How effective is homeopathic treatment compared with conventional treatment for seborrheic dermatitis?
5. Smith SA, Randomised controlled-trial II-1 41 patients A liquid Placebo 10 +10 weeks There was no significant difference
Baker AE, - 21 males, 20 homeopathic consisting of (p=0.7999) between the frequency of
Williams JH. Objective: to evaluate the females medication vehicle only adverse events for the active group as
Effective therapeutic potential of a - 20 randomised consisting of compared to the placebo group. The
treatment of low-dose oral administration into placebo potassium most frequent adverse events were
seborrheic of potassium bromide, group, 21 into bromide, stomach upset, stomach pain and
dermatitis sodium bromide, nickel active group sodium nausea. These adverse events were mild
using a low sulphate, and sodium bromide, nickel and infrequent.
dose, oral chloride in a homeopathic Inclusion criteria: sulphate and
homeopathic formulation. Patients with sodium Changes in lab parameters over time
medication typical chloride in a were evaluated for the active-treatment,
consisting of Patients were recruited from seborrheic vehicle of placebo treatment before crossover and
potassium the dermatology practice of dermatitis or purified water placebo after crossover to active groups.
bromide, Steven A. Smith and by dandruff with a and 20% ethyl Small but statistically significant shifts
sodium local advertisement in minimum of 20% alcohol. from baseline occurred for some
bromide, Tulsa, Oklahama. The affected scalp parameters in the groups. However they
nickel active and placebo groups surface area, a remained well within the normal lab
sulphate, and were assigned coded minimum of 20% references and were not considered to
sodium names by the study monitor affected face be causally related to the study
chloride in a and randomised in blocks of surface area, or medication.
double-blind, four. The study investigator a minimum of
placebo was given a list of the 20% combined
controlled randomised, coded dose affected scalp
study. Altern groups. and surface
Med Rev. area. Once
2002;7(1):59- For the first 10 weeks the admitted to the
67 blinded patients took the study, patients
assigned study medication were required to
and were evaluated at 0, 5 discontinue all
and 10 weeks. At the end of concomitant
10 weeks all patients, seborrhea
crossed over to the active medications for 2
medication for an additional weeks before
10-week open study. beginning and
The patients self- throughout the
34
Evidence Table: Safety
Question: How effective is homeopathic treatment compared with conventional treatment for seborrheic dermatitis?
35