***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 Background Rational health care decision‐making based on outcomes and economic evidence is essential to provide the best possible care for individual patients with atopic dermatitis ( AD ) Abstract Objective : To determine whether a three day burst of a potent corticosteroid is more effective than a mild preparation used for seven days in children with mild or moderate atopic eczema . Design : R and omised , double blind , parallel group study of 18 weeks ' duration . Setting : 13 general practice s and a teaching hospital in the Nottingham area . Participants : 174 children with mild or moderate atopic eczema recruited from general practice s and 33 from a hospital outpatient clinic . Interventions : 0.1 % betamethasone valerate applied for three days followed by the base ointment for four days versus 1 % hydrocortisone applied for seven days . Main outcome measures : Primary outcomes were total number of scratch-free days and number of relapses . Secondary outcomes were median duration of relapses , number of undisturbed nights , disease severity ( six area , six sign atopic dermatitis severity scale ) , scores on two quality of life measures ( children 's life quality index and dermatitis family impact question naire ) , and number of patients in whom treatment failed in each arm . Results : No differences were found between the two groups . This was consistent for all outcomes . The median number of scratch-free days was 118.0 for the mild group and 117.5 for the potent group ( difference 0.5 , 95 % confidence interval −2.0 to 4.0 , P=0.53 ) . The median number of relapses for both groups was 1.0 . Both groups showed clinical ly important improvements in disease severity and quality of life compared with baseline . Conclusion : A short burst of a potent topical corticosteroid is just as effective as prolonged use of a milder preparation for controlling mild or moderate atopic eczema in children . What is already known on this topic Topical corticosteroids have been used to control atopic eczema for 40 years No studies have compared short bursts of a potent preparation with prolonged use of a weak preparation for controlling mild or moderate disease What this study adds A short burst of a potent topical steroid is as effective and safe as prolonged use of a weak preparation for mild or moderate atopic eczema The type of preparation is i m material provided that the dosage is In this study several schedules of discontinuous application ( DA ) were tested , using various weak and strong topical corticosteroids ( CS ) . The purpose of this study was to measure the influence of corticosteroids on skin thickness by means of a mechanical method . In a first experiment , betamethasone 17,21-dipropionate ( Bet ) and fluprednidene 21-acetate ( Flu ) were applied to the skin of the volar side of the forearm at a rhythm of 1:1 ( 1 day CS , 1-day interval ) and 1:2 under occlusive dressing .  The investigation period was 8 weeks . For comparison , Bet and Flu were applied continuously ( CA ) for 3 weeks . Flu thinned the skin to a lesser extent than Bet . With DA the skin was thinned to the same extent as with CA . In a second experiment , hydrocortisone 17-butyrate , betamethasone 17-valerate , desoxymethasone and hydrocortisone were tested . Here the treatment regimen was 5:9 . The CS preparations were tested for 3 months on the volar side of the forearms under occlusive dressing .  Skin thinning occurred during the 5 days of CS action and , in the beginning , receded again in the CS-free interval . However , this regressive process became weaker each time . At the end of the experiment the skin thinning persisted . With the exception of hydrocortisone , all CS tested produced statistically significant skin thinning after DA . The results of the investigation presented here show that thinning of the skin must also be expected with discontinuous application of topical CS Different scoring systems have been developed to determine the severity of atopic dermatitis .  The SCORAD ( SCORing Atopic Dermatitis ) , one of the best vali date d systems , is suited for clinical trials , but is too complicated and time consuming for routine clinical use . The TIS score  ( Three Item Severity score ) , a simplified system , is based on the evaluation of erythema , oedema/papulation and excoriation on a scale from 0 to 3 . In order to determine the value of the TIS score we conducted a prospect i ve study in 126 children with mild to severe atopic dermatitis . Both the  TIS score and the SCORAD  were assessed by trained investigators . Interobserver agreement was investigated in 20 children by comparing the independently performed scores of three investigators . A positive correlation was found between the TIS score and the SCORAD ( Rank Spearman r(s)=0.86 ; p<0.0005 ) . The item which correlated best with the SCORAD was excoriation ( r(s)=0.72 ; p<0.0005 ) followed by oedema/papulations ( r(s)=0.66 ; p<0.0005 ) . Interobserver agreement which was calculated by Cohen 's kappa ( kappa ) was " excellent " for SCORAD ( kappa=0.82 ; p<0.001 ) and " fair " for TIS score ( kappa=0.58 ; p<0.01 ) . We conclude that the TIS score is a rough , though reliable and simple system for scoring  atopic dermatitis . It is particularly suitable in general practice , for routine clinical use and for screening purpose s in clinical trials . For research purpose s , the objective SCORAD offers a more detailed and comprehensive assessment This study was design ed to investigate a long‐term therapeutic strategy for the management of  recurring atopic dermatitis ( AD ) in adults using fluticasone propionate ( FP ) ointment ( CutivateTM ) whereby FP could help to prevent a relapse of AD once symptoms were under control . Adult patients with chronic , moderate to severe AD entered this multicentre study . All patients were initially treated with FP 0.005 % ( g/g ) ointment in two different regimens . Patients whose AD had been completely healed by these treatments then entered a long‐term treatment phase applying FP or placebo ointment once daily , two times per week for 16 weeks to ‘ known ’ healed lesions . By the end of the initial treatment period , mean SCORAD values had significantly ( P < 0.0005 ) improved from baseline . Patients who entered the maintenance phase and were treated with intermittent FP for up to 16 weeks , demonstrated its superior efficacy ( P = 0.018 ) over placebo , maintaining the improvements achieved after the initial treatment phase , reducing risk of relapse and delaying time to relapse ( P = 0.013 ) . No significant changes were detected in either treatment group in serum cortisol levels or in skin thickness measurements . Intermittent FP applied two times per week maintained a significant level of control , and delayed relapse of AD by comparison with placebo Background : Long‐term treatment for atopic dermatitis ( AD ) using low dose , intermittent , topical anti‐inflammatory agents may control acute disease and prevent relapses . This 12‐month , European , multicentre , r and omized study investigated whether the proactive use of 0.1 % tacrolimus ointment applied twice weekly can keep AD in remission and reduce the incidence of disease exacerbations ( DE ) Question : How effective and safe is the addition of twiceweekly fluticasone propionate cream or ointment to regular emollient therapy for reducing relapses in people with chronic relapsing atopic dermatitis ( AD ) ? Design : R and omized , double-blind , parallel-group study . Setting : Thirty-nine dermatology outpatient clinics in 6 European countries . Participants : PeoplewithAD , asdefinedbytheUKWorkingParty ’s refinementofHanifin and Rajka’sdiagnostic criteria , aged 12 to 65 years with moderate to severe disease who were experiencing a flare at study recruitment . Interventions : For the first 4-week phase of the study , all participants weregiven0.05%fluticasonepropionatecream or 0.005 % fluticasone propionate ointment to apply once or twice daily to stabilize their disease . Patients whose disease was brought under control were then entered into a 16-weekmaintenancephaseduringwhich timeemollients and bathoilswereusedasneeded . During themaintenance phase , patients werer and omizedto1of4groups : (1)0.05 % fluticasone propionate cream , ( 2 ) vehicle control for the cream , ( 3 ) 0.005 % fluticasone propionate ointment , or ( 4 ) vehicle control ointment . Each group was instructed toapplythecream/ointmenton2consecutivedayseachweek to areas usually affected by AD plus any new affected areas . Main Outcome Measures : Median time to relapse of AD during the 16-week maintenance phase . Severity was measured using a 3-item severity ( TIS ) score that sums the score on a scale of 0 ( absent ) to 3 ( severe ) for the 3 signs of erythema , edema/papulation , and excoriation at any site displaying a flare during the maintenance phase . A relapse was defined as a score of 4 or more and a remission as a score of 1 or less . Results : A total of 376 patients entered the initial 4-week stabilization phase during which time no significant differences in efficacy were shown between twice and once-daily application of topical fluticasone in cream or ointment form . There were 295 patients who continued into the maintenance phase ( 33 patients discontinued during the stabilization phase and 48 did not meet eligibility criteria for the maintenance phase ) . Median time to relapse was 6 weeks for emollients alone compared with more than 16 weeks for additional twiceweekly fluticasone ( P .001 for cream and P=.010 for ointment ) . After 16 weeks in the maintenance 
    Output:
    
Meta-regression indicated robustness of these findings .
Proactive anti-inflammatory therapy was generally well tolerated .
Vehicle-controlled trials indicate efficacy of proactive treatment with tacrolimus , fluticasone propionate and methylprednisolone aceponate to prevent AE flares .
Indirect evidence from vehicle-controlled trials suggests that twice weekly application of the potent topical corticosteroid fluticasone propionate may be more efficacious to prevent AE flares than tacrolimus ointment .