The effect of water hardness on atopic eczema, skin barrier function: A systematic review, meta‐analysis

作者：Zarif K. Jabbar‐Lopez, Chuin Ying Ung, Helen Alexander, Nikeeta Gurung, Joanne R Chalmers, Simon G. Danby, Michael J. Cork, Janet L. Peacock, Carsten Flohr · 发表于：Clinical & Experimental Allergy · 年份：2020 · DOI：10.1111/cea.13797 · 被引用次数：41 · 研究领域：Dermatology and Skin Diseases、Neonatal skin health care、Advancements in Transdermal Drug Delivery

BACKGROUND: Hard domestic water has been reported to worsen atopic eczema (AE) and may contribute to its development in early life. OBJECTIVE: ) on (a) the risk of developing AE, (b) the treatment of existing AE and (c) skin barrier function in human and animal studies. DESIGN , DATA SOURCES AND ELIGIBILITY CRITERIA: We systematically searched databases (MEDLINE, Embase, Cochrane CENTRAL, GREAT and Web of Science) from inception until 30/6/2020. Human and animal observational and experimental studies were included. The primary outcomes were risk of AE and skin barrier function. Studies were meta-analysed using a random effects model. Evidence certainty was evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. RESULTS: Sixteen studies were included. Pooled observational data from seven studies on 385,901 participants identified increased odds of AE in children exposed to harder versus softer water (odds ratio 1.28, 95% CI 1.09, 1.50; GRADE certainty: very low). Two mechanistic studies in humans reported higher deposition of the detergent sodium lauryl sulphate in those exposed to harder versus softer water. Two randomized controlled trials comparing water softeners with standard care did not show a significant difference in objective AE severity with softened water (standardized mean difference 0.06 standard deviations higher, 95% CI 0.16 lower to 0.27 higher; GRADE certainty: moderate). CONCLUSIONS & CLINICAL RELEVANCE: ) ar...