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Effects of antihistamines on eczema

Apfelbacher CJ, van Zuuren EJ, Fedorowicz Z, Jupiter A, Matterne U, Weisshaar E
Published Online: 
31 May 2013

Eczema is a common chronic disease. Itch is the most important symptom, and eczema is often accompanied by dry skin. Skin lesions include rash, redness, swelling of the skin, crusts, oozing, and sometimes also bleeding as a consequence of persistent scratching. Although the disease can resolve during childhood, it might also recur in or persist into adult life. The cause of eczema is considered to be a combination of genetic and environmental factors. Moisturisers, topical corticosteroids, and topical immunomodulators are the mainstay during treatment of eczema, while more severe cases might need UV light therapy or systemic immunosuppressants. Itch is very difficult to treat and leads to scratching, which leads to more inflammation of the skin, and often people with eczema end up in a vicious circle of itching and scratching. The role of histamine in itching associated with eczema is not fully elucidated, but oral H1 antihistamines have been used for many years in the treatment of eczema. These might have been used largely for their sedative action, with highly sedative antihistamines, e.g. chlorpheniramine and hydroxyzine. However, oral H1 antihistamines are widely used in the treatment of allergic disorders, such as urticaria, allergic rhinitis, and allergic conjunctivitis, but their efficacy in alleviating itch and eczema remains unclear. This systematic review sought evidence for the effects and safety of the use of oral antihistamines for eczema, to guide their use in clinical practice.

No study matched our inclusion criteria. There is currently no evidence to support the efficacy or safety of the use of oral H1 antihistamines alone in the treatment of eczema. This does not mean that such antihistamines could not be useful as an add-on therapy to the main treatments including topical steroids, which will be the topic of a further review.

This record should be cited as: 
Apfelbacher CJ, van Zuuren EJ, Fedorowicz Z, Jupiter A, Matterne U, Weisshaar E. Oral H1 antihistamines as monotherapy for eczema. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD007770. DOI: 10.1002/14651858.CD007770.pub2
Assessed as up to date: 
20 August 2012