***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: Summary .— Eighty‐four out‐ patients with either ichthyosis vulgaris or X‐linked ichthyosis were treated with 4 topical applications ( only cream , B.P. ; salicylic acid ointment , B.P. ; a urea cream ; and Boots E.45 cream ) in a doubleblind control trial . At the end of the 2‐week treatment period the response was assessed by soliciting the patient 's opinion and by personal assessment of the clinicians in charge . The patient 's assessment did not reveal any statistically significant difference between the groups , but on the assessment of the clinicians , the urea cream ( Calmurid ) was statistically significantly better in controlling the ichthyosis than the other 3 preparations The object of this study was to compare the protective action of a new barrier cream ( Excipial Protect ® , Spirig Pharma AG , Egerkingen , Switzerl and ) to its vehicle in the context of h and irritation of apprentice hairdressers caused by repeated shampooing and exposure to hair‐care products . This was a double‐blind cross‐over comparing Excipial Protect ® ( containing aluminium chlorohydrate 5 % as active ingredient ) against its vehicle alone . The efficacy of the creams was evaluated taking into account : ( 1 ) clinical scores by research ers , ( 2 ) biometric measurements , ( 3 ) subjective opinions of the subjects . An analysis of variance was performed considering order of application , degree of atopy , and reported number of shampoos . We observed very little difference in efficacy between the protective cream and its vehicle . The presence , however , of aluminium chlorhydrate in the protective cream was shown to have a positive effect against work‐related irritation . The cosmetic qualities of the creams seemed , to the participants , to be as important as their real protective and hydrating properties , an important factor in compliance issues Lactate 12 % lotion was significantly more effective than both its vehicle and a petrolatum-based cream in the treatment of ichthyosis . The treatment regimen was twice-daily application for 4 weeks with evaluations weekly during the treatment period and for 2 weeks after treatment was stopped . Vulgaris , lamellar , sex-linked , Netherton 's , and epidermolytic hyperkeratotic forms of ichthyosis were significantly improved by treatment with lactate 12 % lotion . This new therapeutic modality exp and s the scope and extent of ichthyotic conditions that may now be successfully treated BACKGROUND Limited information documents the prevention and treatment benefits of a h and care regimen using moisturizer in a controlled manner for employees in typical manufacturing situations . OBJECTIVE The objective was to assess the effectiveness of a comprehensive skin care program including skin conditioning lotion in multiple manufacturing environments where employees are at high risk for skin disease . METHODS A r and omized trial test design with multiple measures , including skin bioengineering measurement techniques , visual grading , and self- assessment question naires , was used to broadly characterize skin condition . RESULTS Comparison of the change in the skin condition of workers using the full h and care regimen with moisturizer versus a control group using a regimen without moisturizer  demonstrated significant ( p < .05 ) improvements in multiple measures after 1 to 2 weeks . Corneometer readings consistently showed significant improvement for employees using moisturizer , regardless of their work location . CONCLUSION Improved skin condition result ed from the regular use of an effective skin conditioning h and moisturizer as part of a skin care regimen in work environments in which workers were prone to experiencing occupational irritant contact dermatitis BACKGROUND Reports on controlled trials on the efficacy and tolerability of sulfonated shale oils in atopic eczema are not available so far . The aim of this study was to investigate whether topically applied , specially prepared pale sulfonated shale oil ( PSSO ) cream is capable of improving symptoms/signs of mild to moderate atopic eczema in children more efficaciously than a corresponding vehicle cream . PATIENTS AND METHODS A total of 99 children suffering from mild to moderate atopic eczema were enrolled in this multicentre , r and omized , vehicle-controlled study . Verum or vehicle cream was applied to the affected skin area three times a day over 4 weeks . As the primary outcome parameter served the reduction of the total score after 4 weeks of treatment , compared with the initial examination . Secondary outcome parameters were addressed as well . Tolerability was judged by investigators and patients /parents , and adverse events were documented . RESULTS After 4 weeks of treatment , the total score declined from 13.4 ± 3.7 to 4.5 ± 7.4 score points in the verum group and from 13.0 ± 3.1 to 11.7 ± 8.6 score points in the vehicle group ( P < 0.0001 ) . The superiority of verum regarding total score was already apparent after a treatment period of 1 week ( reduction by 5.6 ± 4.3 vs. 1.3 ± 5.9 score points ; P < 0.0001 ) . Tolerability was found superior at the end of the treatment in the verum when compared with the control group -- both by investigators ( P < 0.0001 ) and patients /parents ( P = 0.0051 ) . CONCLUSION Pale sulfonated shale oil cream 4 % is capable to treat mild to moderate atopic eczema in children more efficaciously than vehicle and is well tolerated . PSSO thus represents a valuable addition to our therapeutic armamentarium . PSSO should be considered in particular when valid alternatives for topical glucocorticoids are sought for Background : Patients with atopic dermatitis show a defective barrier function . In atopic skin , ceramide is significantly decreased and the secretion of lamellar bodies is also impaired . To mimic lamellar bodies , we prepared lipid granules composed of ceramide , fatty acids and cholesterol . Because these lipid granules contain multiple lamellar structures , it is expected that they will have superior affinity to skin ; hence , they should have a good moisturizing effect . This study was performed to evaluate the effects of moisturizer containing lipid granules on atopic dermatitis . Methods : Patients with mild atopic dermatitis ( n = 30 , aged 5–19 years ) were recruited and instructed to apply a moisturizer containing physiologic lipid granules for 4 weeks . The SCORing Atopic Dermatitis ( SCORAD ) score and general symptoms were evaluated . In addition , transepidermal water loss ( TEWL ) and stratum corneum ( SC ) hydration were also measured . Results : Twenty-nine patients completed the study .  The SCORAD value decreased dramatically after 4 weeks of moisturizer application ( p = 0.000 ) . The general symptoms of atopic dermatitis were also greatly improved . At baseline , most patients reported their symptoms as mild and moderate , but after 4 weeks 20 of the patients ( 69 % ) had no symptoms . The TEWL was not changed , but the SC hydration increased significantly ( p = 0.000 ) . No significant adverse effects were observed . Conclusions : Moisturizer containing lipid granules effectively controlled atopic dermatitis Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Two over-the-counter products have been clinical ly tested for efficacy and tolerability in the treatment of atopic dermatitis . Study 1 evaluated a daily maintenance Body Cream ( Eucerin Eczema Relief Body Crème ) applied twice daily for 14 days , followed by treatment withdrawal for 5 days ( regression period ) in subjects with a history of atopic dermatitis . Study 2 evaluated an acute treatment ( Eucerin Eczema Relief Instant Therapy [ Instant Therapy ] ) for active atopic dermatitis lesions administered for 14 days . Skin barrier function , hydration , tolerability , and relief of symptoms were assessed at baseline , day 7 , and day 14 . Study 2 also measured itch relief and treatment impact on work , social activities , and sleep . Body Cream significantly improved skin hydration and barrier function ( P<.001 ) at 14 days , with improvements persisting through the 5-day regression phase . Itching was significantly improved in 93.8 % of subjects ( P<.001 ) . Instant Therapy treatment of atopic dermatitis lesions significantly improved skin hydration and barrier function , as well as symptoms of erythema , pruritus , excoriation , and lichenification , with rapid improvement of itch reported within minutes of the first treatment application . Instant Therapy significantly reduced itch intensity and frequency , and demonstrated beneficial improvements in subjects ' quality of life .  Body Cream and Instant Therapy were both safe and well tolerated BACKGROUND Atopic dermatitis ( AD ) is increasingly common , with a point prevalence of more than 30 % in some countries , and is characterized by visible skin lesions and intense itching . OBJECTIVE The International Study of Life with Atopic Eczema ( ISOLATE ) is the first large-scale study to assess the effect of AD on the lives of patients and society , how patients and caregivers manage the condition , and how well patients and caregivers currently believe that AD is controlled . METHODS Two thous and two patients ( > 13 years ) and caregivers of children ( 2 - 13 years ) with moderate-to-severe AD r and omly selected from 8 countries underwent  st and ardized telephone interviews using questions developed in collaboration with national eczema patient groups and physicians . RESULTS During each year , patients spend , on average , 1 of 3 days in flare . The majority of patients receive prescription topical corticosteroids to treat flares ; however , 49 % of respondents are concerned about using these agents . On average , patients and caregivers delay initiating treatment for 7 days after onset of a flare . Only 24 % of patients and caregivers feel confident they can manage AD flares adequately . Seventy-five percent of caregivers and patients feel that being able to effectively control AD would be the single most important improvement to their or their child 's quality of life . The avoidable secondary economic cost of AD is estimated at 2 billion Euro per year across the European Union . CONCLUSION ISOLATE highlights the need to improve patients ' control of AD to reduce the significant effect this condition has on the patient and society . CLINICAL IMPLICATION S ISOLATE shows that patients with AD are untreated for half the time they are in flare , and thus there is an urgent need for physicians to ensure that the patients are educated and confident in using medication as prescribed to gain disease control Atopic dermatitis ( AD ) affects adults and children and has a negative impact on quality of life . The present multicentre r and omized double-blind controlled trial showed a barrier-improving cream ( 5 % urea ) to be superior to a reference cream in preventing eczema relapse in patients with AD ( hazard ratio 0.634 , p = 0.011 ) . The risk of eczema relapse was reduced by 37 % ( 95 % confidence interval ( 95 % CI ) 10 - 55 % ) . Median time to relapse in the test cream group and in the reference cream group was 22 days and 15 days , respectively ( p = 0.013 ) . At 6 months 26 % of the patients in the test cream group were still eczema free , compared with 10 % in the reference cream group . Thus , the barrier-improving cream significantly prolonged the eczema-free time compared with the reference cream and decreased the risk of eczema relapse . The test cream was well tolerated in patients with AD H and eczema influences the quality of life . Management strategies include the use of moisturizers . In the present study the time to relapse of eczema during treatment with a barrier-strengthening moisturizer ( 5 % urea ) was compared with no treatment ( no medical or non-medicated preparations ) in 53 r and omized patients with successfully treated h and eczema . The median time to relapse was 20 days in the moisturizer group compared with 2 days in the no treatment group ( p = 0.04 ) . Eczema relapsed in 90 % of the patients within 26 weeks . No difference in severity was noted between the groups at relapse . Dermatology Life Quality Index ( DLQI ) increased significantly in both groups ; from 4.7 to 7.1 in the moisturizer group and from 4.1 to 7.8 in the no treatment group ( p < 0.01 ) at the time of relapse . Hence , the application of moisturizers seems to prolong the disease-free interval in patients with controlled h and eczema . Whether the data is applic-able to moisturizers without barrier-strengthening properties remains to be eluci date Background : Atopic dermatitis ( AD ) skin is dry and readily colonized by Staphylococcus aureus ( SA ) . Coconut and olive oils are traditionally used to moisturize and treat skin infections . Objective : To compare virgin coconut oil ( VCO ) and virgin olive oil ( VOO ) in moisturizing dryness and removing SA from colonized AD skin . Methods : This was a double‐blind controlled trial in two outpatient dermatology clinics with adult AD patients who were diagnosed by history , pattern , evolution , and skin lesions and who were r and omized to apply VCO or VOO twice daily at two noninfected sites . SA cultures , photography , and objective ‐SCORAD severity index ( O‐SSI ) scoring were done at baseline and after 4 weeks . Results : Twenty‐six subjects each received VCO or VOO . Of those on VCO , 20 were positive for SA colonies at baseline versus 12 on VOO . Post intervention , only 1 ( 
    Output:
    
Direct comparisons between individual moisturizers are still scarce , but the clinical effect appears to be much more well-documented for urea and glycerin than , for example , propylene glycol , lactate , ceramide , and aluminum chlorohydrate .
Conclusions The clinical effect of moisturizers is well-documented .
Urea-based preparations may be preferable as a first-line treatment , but there is an unmet need for well-powered comparisons between individual moisturizers