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CE systematic overview

Topical treatments for seborrhoeic dermatitis of the scalp – need for more evidence

3 Sep, 15 | by BMJ Clinical Evidence

Diphoorn, JanoukBy Janouk Diphoorn and Luigi Naldi

Seborrhoeic dermatitis is one of the most common skin conditions. It occurs in 3 to 10% of the population. The scalp is one of the areas most frequently involved. For people with seborrhoeic dermatitis of the scalp it can be very distressing since there is itching and visible scaling, which can cause social embarrassment.

As the condition tends to relapse after treatment, it is important to consider maintenance treatment after clearance. Nowadays the most used treatment in clinical practice is ketoconazole, which is thought to inhibit the Malessezia furfur yeasts considered to play a role in the development of this condition. For the acute phase corticosteroids are often added to inhibit the inflammatory reaction.

In general there is limited evidence available on the treatment of seborrhoeic dermatitis of the scalp with topical agents. This is unfortunate as it is such a common condition. Only ketoconazole and ciclopirox were studied in multiple RCT’s that met the inclusion criteria for our recent BMJ Clinical Evidence systematic overview. For other topical treatments such as bifonazole, selenium sulfide, tar shampoo and corticosteroids the evidence was much sparser. more…

Otitis Externa – evidence for treatments

2 Jul, 15 | by BMJ Clinical Evidence

By Daniel Hajioff and Samuel MacKeith

Daniel Hajioff – cropped image

Samuel MacKeith image

 

Otitis externa is an infective and inflammatory condition of the skin of the ear canal that is thought to affect up to 10% of people at some stage: it is frequently encountered in both primary and secondary care. It may be associated with eczema, swimming, humidity, hearing aids, and trauma. It may be mild and short-lived, but may also be more severe with significant pain and may persist for weeks or months or recur following initial treatment. more…

Fetal cell or stem cell derived treatment for Parkinson´s disease

4 Jun, 15 | by BMJ Clinical Evidence

by Arnar Astradsson and Tipu Z. Aziz

Arnar Astradsson pictureTipu Aziz.crop

Parkinson’s disease (PD) is a neurodegenerative disorder characterized by the selective loss of nigrostriatal dopaminergic neurons which results in the cardinal symptoms of tremor, rigidity, bradykinesia and postural instability. The mainstay of therapy has been pharmacological substitution of dopamine using levodopa. However, after years of pharmacological therapy eventually the benefits may wear off and side effects such as dyskinesias may develop. Deep brain stimulation of the pallidum or subthalamic nucleus is also being used, which effectively controls the motor symptoms of Parkinson’s disease. As an alternative to pharmacological therapy or electrostimulation, cell-based therapies that reconstruct the nigrostriatal pathways have been developed with the transplantation of fetal ventral midbrain neurons into the striatum of PD patients. more…

Cognitive Behavioral Therapy for Insomnia

28 May, 15 | by BMJ Clinical Evidence

by Cathy A. Alessi and Michael V. VitielloCathy Alessi imageMVV cropped

Cognitive-behavioral therapy for insomnia (CBT-I) has been consistently demonstrated to be efficacious in a wide variety of settings and patient populations including older adults. This efficacy has been demonstrated in both patients with uncomplicated insomnia and in those whose insomnia is comorbid with a variety of medical and psychiatric conditions, more…

A gap in the evidence – What is the role of surgery in the patient with severe (secondary) Raynaud’s phenomenon?

21 May, 15 | by BMJ Clinical Evidence

by Ariane Herrick and Lindsay Muir

Herrick

Lindsay_Muir_crop

 

People with Raynaud’s phenomenon secondary to an underlying disease or condition (the best researched one being systemic sclerosis) can progress to irreversible tissue injury with ulceration and/or critical ischaemia and gangrene. Although there has been increasing interest in recent years in identifying new drug therapies for severe Raynaud’s phenomenon with randomised controlled trials (RCTs) of, for example, phosphodiesterase inhibitors and endothelin receptor antagonists, the recent BMJ Clinical Evidence overview identified no RCTs of any of the surgical procedures that  have been advocated for advanced peripheral vascular disease. more…

Trigeminal neuralgia – gaps in evidence

14 May, 15 | by BMJ Clinical Evidence

by Joanna M. Zakrzewska and Mark E. Linskey

Trigem imageTrigeminal neuralgia is a rare condition that causes excruciating intermittent short-lasting, usually unilateral facial pain especially provoked by light touch.
Although the criteria for diagnosis appear to be clear cut, there have been no case control studies to validate them, and there is no cohort data on progression of the disorder. This is especially important as—while the disorder is generally progressive over time—in more than 50% of cases this progression is interspersed with unpredictable remissions that can last 6 months or longer. more…

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