Halometasone and fusidic acid optimal for infected eczema

By Helen Albert, Senior medwireNews Reporter

Results from a randomized, open-label phase III trial suggest that a combination cream of halometasone and fusidic acid reduces symptoms of eczema to a similar degree to a betamethasone and neomycin sulphate cream, but is more effective at treating infected lesions.

Combination treatment with a cream containing a steroid and an antibacterial agent is commonly recommended for treatment of infected eczema, with various options available on the market, but it is less clear which creams produce the best results.

As reported in the Indian Journal of Dermatology, Mariam Philip (SMCSI Medical College, Trivandrum, Kerala, India) and colleagues recruited 152 patients with infected eczema to compare the efficacy of a halometasone 0.05% and fusidic acid 2% cream (group A) with a betamethasone 0.12% and neomycin sulfate 0.5% cream (group B).

Depending on the severity of the lesions and infection, the patients were treated twice a day for 20-30 days. In total, 62 group A and 65 group B patients completed the study.

There was a significant reduction in the Eczema Area and Severity Index, the Investigator's global assessment scale for severity of eczema, and severity of pruritus from baseline in both groups, but no significant between-group difference for these measures.

The most common cause of the infected lesions was Staphylococcus aureus infection (over 80% of the cohort). Following treatment completion, 83.87% of group A and 65.71% of group B had a negative culture for infection.

Five adverse events that were probably or definitely associated with the study cream were reported; three in group A (two hypopigmentation, one dissemination) and two in group B (one ulcer, one autosensitization). Two patients in group B and one in group A withdrew from the study due to drug-related adverse events.

"This was an open-labeled study; hence, we recommend comparative, double blind studies with other routinely used agents in eczema," concede the authors.

They say that the two treatment creams showed similar efficacy for improving symptoms of eczema and pruritus, although the halometasone and fusidic acid combination cream appeared to be more effective at reducing infection.

However, "as resistance to fusidic acid has been exhibited by S. aureus, judicial use of this preparation is advocated," they conclude.

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