***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Objective To explore the efficacy and safety of fluticasone propionate , cream and ointment , applied twice weekly in addition to maintenance treatment with emollients , in reducing the risk of relapse of  chronic recurrent atopic dermatitis .  Design R and omised , double blind , parallel group study of 20 weeks ' duration . Setting Dermatology outpatient clinics ( 6 countries , 39 centres ) . Participants Adult ( aged 12 - 65 ) patients with moderate to severe atopic dermatitis who were experiencing a flare . Methods Participants applied fluticasone propionate ( 0.05 % cream or 0.005 % ointment ; once or twice daily ) regularly for four weeks to stabilise their condition . The patients whose disease was brought under control then continued into a 16 week maintenance phase , applying emollient on a daily basis with a bath oil as needed and either the same formulation of fluticasone propionate or its placebo base ( emollient alone ) twice weekly to the areas that were usually affected . Main outcome measure Time to relapse of atopic dermatitis during maintenance phase . Results 376 patients entered the stabilisation phase , and 295 continued into the maintenance phase . After 16 weeks in the maintenance phase , the disease remained under control in 133 patients ( 87 using fluticasone propionate twice weekly , 46 using emollient alone ) , 135 ( 40 fluticasone propionate , 95 emollient ) had experienced a relapse , and 27 had discontinued . Median time to relapse was six weeks for emollient alone compared with more than 16 weeks for additional fluticasone propionate . Patients who applied fluticasone propionate cream twice weekly were 5.8 times less likely ( 95 % confidence interval 3.1 to 10.8 , P < 0.001 ) and patients using fluticasone propionate ointment 1.9 times less likely ( 1.2 to 3.2 , P=0.010 ) to have a relapse than patients applying emollient alone . The groups showed no differences in adverse events . Conclusion After atopic dermatitis had been stabilised the addition of fluticasone propionate twice weekly to maintenance treatment with emollients significantly reduced the risk of relapse BACKGROUND Intermittent dosing of a topical calcineurin inhibitor for preventing atopic dermatitis ( AD ) disease relapse in patients with stabilized AD has not been evaluated . OBJECTIVE We sought to evaluate the long-term efficacy and safety of 3-times-weekly use of tacrolimus ointment in preventing AD disease relapse . METHODS Adult and pediatric patients with moderate to severe AD who were clear of disease after up to 16 weeks of treatment with tacrolimus ointment were r and omized in a double-blind fashion to 3-times-weekly treatment with either tacrolimus ointment ( 0.03 % or 0.1 % ) or vehicle for 40 weeks . The primary end point was the number of flare-free treatment days . RESULTS A total of 125 patients were r and omized to tacrolimus  and 72 patients to vehicle .  The mean number of flare-free treatment days was 177 for tacrolimus and 134 for vehicle ( P = .003 ) . Median time to first relapse was 169 days for tacrolimus and 43 for vehicle ( P = .037 ) . LIMITATIONS Generalizability to all patients seen in clinic may be limited because only patients who responded to tacrolimus ointment in the stabilization phase were r and omized into the maintenance phase of the trial . CONCLUSIONS Maintenance therapy with tacrolimus ointment was associated with significantly more flare-free days compared with vehicle , and a significantly longer time until first disease relapse Tacrolimus ointment is a nonsteroidal topical immunomodulator that was formulated specifically for the treatment of atopic dermatitis . A total of 255 children , 2 to 15 years of age , with moderate to severe atopic dermatitis applied 0.1 % tacrolimus ointment twice daily for up to 12 months to assess long-term safety and efficacy . Patients on average were treated with tacrolimus ointment for 279 days or 87 % of study days . Substantial improvements in the signs and symptoms of atopic dermatitis , percent body surface area affected , and the patient 's or parent 's assessment of pruritus were observed during the first week of treatment and were maintained throughout the study . Transient skin burning and itching were the most common drug application site adverse events . Occurrence of these symptoms decreased after the first few days of treatment . There was no increased incidence of infections or other significant adverse events . Effectiveness of tacrolimus was maintained with prolonged daily use . Tacrolimus ointment ( 0.1 % ) is safe and effective for long-term treatment of atopic dermatitis in children BACKGROUND Little is known about the prevalence of atopic eczema outside Northern Europe . OBJECTIVES We sought to describe the magnitude and variation in the prevalence of atopic eczema symptoms throughout the world . METHODS A cross-sectional question naire survey was conducted on r and om sample s of schoolchildren aged 6 to 7 years and 13 to 14 years from centers in 56 countries throughout the world . Those children with a positive response to being question ed about the presence of an itchy relapsing skin rash in the last 12 months that had affected their skin creases were considered to have atopic eczema . Children whose atopic eczema symptoms result ed in sleep disturbance for 1 or more nights per week were considered to have severe atopic eczema . RESULTS Complete data was available for 256,410 children aged 6 to 7 years in 90 centers and 458,623 children aged 13 to 14 years in 153 centers . The prevalence range for symptoms of atopic eczema was from less than 2 % in Iran to over 16 % in Japan and Sweden in the 6 to 7 year age range and less than 1 % in Albania to over 17 % in Nigeria for the 13 to 14 year age range . Higher prevalences of atopic eczema symptoms were reported in Australasia and Northern Europe , and lower prevalences were reported in Eastern and Central Europe and Asia . Similar patterns were seen for symptoms of severe atopic eczema . CONCLUSIONS Atopic eczema is a common health problem for children and adolescents throughout the world . Symptoms of atopic eczema exhibit wide variations in prevalence both within and between countries inhabited by similar ethnic groups , suggesting that environmental factors may be critical in determining disease expression . Studies that include objective skin examinations are required to confirm these findings BACKGROUND For long-term management of atopic eczema , the use of skin care creams is recommended , but effectiveness of this treatment is not well established . OBJECTIVE The objective of this study was to yield data on the skin care properties of a cream with a unique lamellar matrix containing N-palmitoylethanolamine ( PEA ) and to assess quality -of-life variables in patients with mild to moderate atopic eczema . SETTING In this multinational , multicentre , observational , non-controlled , prospect i ve cohort study , patients between 2 and 70 years of age were enrolled . All patients were supplied with the study product sufficient for treatment over the entire study period . Outcome was followed in periods between 3 and 7 days and 4 and 6 weeks after study start . Data were gathered from doctor reports and patient self- assessment s via patient question naires . RESULTS Data from 2456 patients entered the data base . The mean examination intervals were 6 days for the 3- to 7-day period and 38 days for the 4- to 6-week period . At study end , intensities of erythema , pruritus , excoriation , scaling , lichenification and dryness were significantly reduced with a combined score reduction of 58.6 % in the entire population ( 57.7 % in adults > 12 years and 60.5 % in children < /= 12 years ) according to doctors ' reports . Patients reported a reduction of pruritus on visual analogue scales from 4.9 + /- 2.6 to 2.7 + /- 2.4 6 days after treatment start and a further reduction to 2.0 + /- 2.3 at study end ( P < 0.001 each ) . Likewise , sleep quality improved significantly during the study period . Earlier-used topical corticosteroids were omitted by 56 % of all patients ( 53.4 % in adults and 62.5 % in children ) at study end , and the average weekly application rate decreased by 62 % from 7.9 + /- 6.0 to 3.0 + /- 5.1 ( P < 0.001 ) . The tolerance was assessed as very good or good in 92 % of cases by both patients and doctors . CONCLUSION This study showed substantial relief of objective and subjective symptoms of atopic eczema after regular skin care with the study cream . The patient-related effectiveness ( decline of pruritus and loss of sleep ) indicated a gain in quality of life in these patients . The reduced use of topical corticosteroids is important in view of safety and pharmacoeconomic implication s in the treatment of atopic eczema Patients with atopic skin show a defective barrier function both in rough and in clinical ly normal skin , with an increasing risk of developing contact dermatitis . Moisturizing creams are often used in the treatment of dry skin . The purpose of this study was to investigate the influence of treatment with a urea‐containing moisturizer on the barrier properties of atopic skin . Fifteen patients with atopic dermatitis treated one of their forearms twice daily for 20 days with a moisturizing cream .  Skin capacitance and transepidermal water loss ( TEWL ) were measured at the start of the study and after 10 and 20 days . On day 21 the skin was exposed to sodium lauryl sulphate ( SLS ) and on day 22 the irritant reaction was measured non‐invasively . Skin capacitance was significantly increased by the treatment , indicating increased skin hydration . The water barrier function , as reflected by TEWL values , tended to improve ( P = 0.07 ) , and the skin susceptibility to SLS was significantly reduced , as measured by TEWL and superficial skin blood flow ( P < 0.05 ) . Thus , it seems that certain moisturizers could improve skin barrier function in atopics and reduce skin susceptibility to irritants . The mechanism and the clinical relevance need further investigation Moisturizers are used daily by many people to alleviate symptoms of clinical ly and subjectively dry skin . Recent studies suggest that certain ingredients in creams may accelerate the recovery of a disrupted barrier and decrease the skin susceptibility to irritant stimuli . In the present single‐blind study , a moisturizing cream was tested for its influence both on barrier recovery in surfuctant‐damaged skin and on the susceptibility of normal skin to exposure to the irritant sodium lauryl sulphate ( SLS ) . Parameters measured were transepidermal water loss ( TEWL ) and skin corneometer values , indicating degree of hydration . Treatment of surfactant‐damaged skin with the test cream for 14 days promoted barrier recovery , as observed as a decrease in TEWL . Skin corneometer values also normalized more rapidly during the treatment . In normal skin , use or the test cream significantly reduced TFWL after 14 days of treatment , and irritant reactions to SLS were , significantly decreased . Skin corneometer values increased after only 1 application and remained elevated after 14 days . In conclusion , the accelerated rate of recovery of surfactant‐damaged skin and the lower degree of SLS‐induced irritation in normal skin treated with the test cream may be of clinical relevance in attempts to reduce contact dermatitis due to irritant stimuli BACKGROUND MAS063DP cream has received marketing authorization in the US and the European Union for symptom relief of atopic dermatitis ( eczema ) and contact dermatitis . DESIGN A multicenter , r and omized , vehicle-controlled , phase IV study was completed in the US . METHODS 218 patients aged 18 to 84 years joined this 50-day study . Patients self-administered MAS063DP cream ( N=145 ) or vehicle cream ( N=73 ) 3 times per day to affected areas and those areas prone to be affected . The primary endpoint for efficacy was the change in EASI at Day 22 of treatment , comparing the 2 treatment groups . Secondary outcomes included EASI scores at other time points , IGA , pruritus ( 100 mm VAS ) , % BSA , and the need for rescue medication . RESULTS MAS063DP was statistically ( p<.0001 ) more effective than vehicle in all outcomes at all time points . The incidence of rash was 2.1 % in the MAS063DP group versus 5.5 % in the vehicle group . Only 2 patients discontinued MAS063DP due to an adverse event . CONCLUSION MAS063DP cream was confirmed to be a safe and effective treatment for mild to moderate atopic dermatitis in adults The effectiveness of an emollient as an adjunct to topical corticosteroid therapy for the treatment of mild to moderate atopic dermatitis was studied for 3 weeks in 25 children 3 to 15 years of age in comparison with corticosteroid therapy alone . The adjunctive regimen of a once-daily application each of hydrocortisone 2.5 % cream and of a water-in-oil cream was equivalent in efficacy to the comparative regimen of twice-daily applications of hydrocortis 
    Output:
    
Topical calcineurin inhibitors provide targeted anti-inflammatory activity without the local or systemic side-effects seen with topical corticosteroids .