Вопросы врачу Вадиму Асадулину

[Вадим Асадулин]

Дерматологические заболевания остаются самой неблагодарной темой моей врачебной практики.
Западная медицина может предложить только лечение гормональными препаратами внутрь и наружно, не задумываясь о тяжелых последствиях такого "лечения", которое дает только видимое, сиюминутное улучшение.
Что может предложить Традиционная Медицина с позиций современных требований к Доказательствам?
Материалы будут только на английском языке, страждущие найдут время и средства для перевода.
Edzard Ernst: The Desktop Guide to Complementary and Alternative Medicine, Second Edition. 2006. p. 56-61.

http://books.google.ru/books?id=HqZ5...czema.&f=false
Atopic eczema.
Synonyms/subcategories.
Atopic dermatitis, infantile eczema.
Definition.
Atopic eczema (atopic dermatitis) is an inflammatory skin disease characterised by an itchy erythematous poorly demarcated skin eruption with a predilection for skin creases.
CAM usage.
A survey of German eczema patients reported homeopathy, acupuncture, dietary therapy, autogenic training and relaxation as the most frequently used forms of CAM [1].
Clinical evidence.
Autogenic training.
An RCT (n = 113) compared autogenic training (once weekly for 12 weeks) with cognitive–behavioural therapy, a dermatological education programme and standard medical care [2]. Results at one year follow-up indicated that autogenic training was as effective as the psychotherapy and superior to the educational programme and usual care in terms of skin condition and use of topical steroids.
Diet.
Several RCTs [3-6] have investigated egg and cow’s milk exclusion diets, with two of them showing positive results, [3,6] including one on the effect of maternal antigen avoidance on breast-fed infants [6]. RCTs of prevention of eczema in high-risk infants by maternal antigen avoidance during pregnancy and lactation [7] have been systematically reviewed. Based on only three trials each, it was concluded that the risk of the child developing eczema was likely to be reduced by exclusion diets during lactation, but not during pregnancy.
A Cochrane review of five studies found no convincing evidence that feeding infants without clinical allergy/intolerance on an adapted soy milk formula instead of human milk would be of benefit in the prevention of atopic eczema [8].
Herbal medicine.
Three RCTs of borage (Borago officinalis) seed oil involving mostly adult patients have produced conflicting results (Table 2.9). [9–11]. A smaller crossover trial in children using gamma-linolenic acid from borage seeds reported a strong placebo response and no difference between the interventions [12] Collectively these data fail to demonstrate the effectiveness of borage oil.
Encouraging but not fully convincing were data also published for black seed (Nigella sativa) oil [13].
A meta-analysis of nine placebo-controlled trials of oil of evening primrose (Oenothera biennis) demonstrated a positive effect [14]. However, the results of subsequent RCTs do not tend to support this result (Table 2.10). [15–18].
Здесь должны быть интересные таблицы, которые я не сумел вставить, прошу умельцев мне помочь!
Table 2.9 Double-blind RCTs of borage oil for atopic eczema.
Table 2.10 Double-blind RCTs of evening primrose oil for atopic eczema.
A non-randomised trial (n = 161) of a topical preparation containing German chamomile (Matricaria recutita) suggested it may be as useful as hydrocortisone, but no statistical analysis was carried out [19]. A subsequent RCT reported slight superiority over hydrocortisone but little difference with placebo [20].
Topical preparations of liquorice (Glycyrrhiza glabra) [21] and St John’s wort (Hypericum perforatum) [22] have also generated encouraging findings which require independent replication.
A systematic review of the Chinese herbal mixture Zemaphyte, [23] included only two RCTs from the same researchers who reported positive results for a herbal combination in both adults and children. A subsequent independent crossover RCT of the same preparation found it to be no different from placebo [24]. A Cochrane review of these three RCTs and an open label study concluded that this approach ‘may be effective’ [25].
A mixture of Eleutherococcus, Achillea millefolium and Lamium album did not generate any benefit over placebo in a small (n = 49) RCT with a 2-week treatment period [26].
Hypnotherapy.
An RCT including children (n = 31) compared the effects of hypnotherapy (four sessions over 8 weeks) with biofeedback (skin conductance) and an attention control condition where children discussed their eczema and kept a symptom diary [27]. After 5 months the hypnotherapy and biofeedback groups had improved more than the control group on severity of eczema, but not area of coverage.
Supplements.
A substantial body of evidence from RCTs suggests that probiotics are effective in the prevention and treatment of atopic eczema in infants and children [28–33].
A double-blind RCT of supplementation with selenium (alone and combined with Vitamin E) found no difference in severity of eczema compared with placebo [34]. More recently, an open, uncontrolled study found levels reduced in children with atopic eczema and suggested that selenium-supplementation generated positive clinical effects [35].
Zinc has been investigated in a double-blind RCT with children [36]. It was not superior to placebo in any outcome measure.
Other therapies.
A small sham-controlled RCT of autologous blood therapy showed a mild but positive effect on a symptom score in adults with atopic eczema [37].
Таблицы вставить не удалось.
Table 2.11 Summary of clinical evidence for atopic eczema
Table 2.11 (Continued) Summary of clinical evidence for atopic eczema.
A crossover trial with eight children receiving either massage with essential oils (aromatherapy) or massage alone found no difference in clinical signs of atopic eczema [38].
Overall recommendation.
There is no convincing evidence for the effectiveness of any complementary therapy in treating or preventing eczema. The therapies with the most encouraging evidence are autogenic training, biofeedback, hypnotherapy, some dietary approaches, and some supplements. They are considered relatively risk-free and may be worth considering as an adjunctive to effective conventional treatments.
Библиографию выложу позднее, т. к. её обработка и поиски ссылок требуют много времени.
Принимается бескорыстная помощь в виде переводов.