| Background:The incidence of eczema/AD is very complex. It may be caused by a variety of internal and external factors, which led to the occurrence of eczema/AD by triggering the body’s type Ⅰ rapid hypersensitivity or type Ⅳ delayed hypersensitivity. A variety of skin lesions and severe itching are typical clinical manifestations. Previous studies have found that bacteria, especially Staphylococcus aureus colonization or infection is associated with the onset of eczema/AD. Now we consider Staphylococcus aureus, and eczema/AD may have the following interactions:1.due to abnormal natural immunity, skin barrier dysfunction, low body surface antigen peptide levels, and so on, Bacterial colonization in the epidermis of eczema patients easily.2. Staphylococcus aureus can induce eczema/AD, Staphylococcus aureus can produce or secrete toxin, enzymes, bacteria capsule, peptidoglycan and so on,which can be used as conventional allergens or superantigen (SAg). Skin antigen presenting cells (APC) can recognize and present SAgs, activity T cell, resulting in the occurrence of type Ⅳ allergy, or allergens can stimulate the Langerhans cells (LCs) then cause, Th2can stimulate Plasma cells produce IgE,LCs also can cause differentiation of Th0to Th1, cause Th1/Th2unbalance, and AD,3. Staphylococcus aureus can aggravate eczema, SAg eliminate Treg cells suppress immune function and aggravate eczema immune response, can also increase the expression of IL-31, increased patient itching, and ultimately increase the patient’s condition.4. Staphylococcus aureus can reduce susceptibility to glucocorticoids in patients. According to those studies, people try to using antibiotics for eczema/AD, but made a different conclusion. there is doubt whether and how long to use topical antibiotics for eczema without evidence of infections. Mupirocin is topical antibiotic, which is safe, effective and less allergenic. In the past it often used in the treatment of eczema with secondary infection, Mupirocin has a good antibacterial, bactericidal effect to Staphylococcus aureus. In this study, a meta-analysis of previous research clear the application of mupirocin in treatment of eczema with no evidence of infections.Method:Using key words "eczema" or "atopic dermatitis" or’"atopic eczema" and "mupirocin" or "Pseudomonic Acid A" or "Bactroban" or "BRL4910A" retrieve pubmed and Cochrane Library databases and related foreign literature, the use of keywords " eczema " or " atopic dermatitis " and " Bactroban " or " mupirocin " retrieve Wanfang data resources, Chinese academic Journal Full-text database (CNKI), Chinese Scientific Journals Full-text Database (VIP) and the relevant Chinese literature. Inclusion criteria:1.the literature content is to assess the impact of topical mupirocin combined with glucocorticoids for treating eczema;2the study is a randomized controlled trial;3, treatment observation time Ow,1w,2w,4w, and SCORAD/EASI is scoring;4,the literature to provide accurate data, to calculate the value of95%CI and OR. Statistical Analysis Review Manager5.2software. The heterogeneity between each test is judged according to12, I2<50%means no significant heterogeneity, then through fixed effects model while I2>50%means significant heterogeneity among included trials, then through the random effects model. Using OR and95%CI evaluate therapy of the mupirocin combined with topical corticosteroids for treating eczema. Using Jadad assesses the quality of the literature and using the funnel plot assesses the publication bias.Results:After rigorous screening, this study included14literatures, including four high-quality literature which Jadad score is greater than or equal to4points, and the remaining literature are low quality which score less than4points,. Literature contains a total of1893patients, while960people in treated group,933people in the control group. according to the treatment time, add the appropriate research into meta-analysis together. Treatment groups, mupirocin combined with topical corticosteroids compared to control group only topical corticosteroid therapy:the first week of treatment, the overall OR=3.58,95%CI [1.61,7.96]; two weeks of treatment, the overall OR=3.20,95%CI [2.37,4.32]; the second week of treatment, the overall OR=1.11,95%CI [0.44,2.79]; treatment over four weeks, OR=1.38,95%CI [0.84,2.26].The funnel plot shows no publication bias.Conclusions:Topical corticosteroids are still the first choice for topical treatment of eczema, topical antibiotic is also the important treatment for eczema with no evidence of infection, combined topical antibiotics such as mupirocin with topical corticosteroids. can significantly improve the efficacy.1in eczema treatment, the earlier combined with topical antibiotic, the better curative effect patients get,;2.from the beginning of treatment to the first week, using topical antibiotic combined with topical corticosteroids can significantly improve the therapeutic effect. After two weeks, topical antibiotic combined with topical corticosteroids is still better than only topical corticosteroids, Over four weeks, there is no significant difference between the therapy group and control group;3. We suggest early treatment of eczema can use topical antibiotic combined with topical corticosteroids, one week is the suitable therapy time, if necessary, it can extended to another week,after two weeks,the application of topical antibiotic has no significant meaning. |
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