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. 2014 May 19;2014(5):CD009446. doi: 10.1002/14651858.CD009446.pub2

Warshaw 2007.

Methods Study type: individual RCT
Randomisation method: computer‐generated blocks of 4
Blinding: double‐blind
Intention‐to‐treat analysis used: Both ITT and PP analyses were used
Participants Inclusion criteria of the trial
  • Facial seborrhoeic dermatitis


Exclusion criteria of the trial
  • Pregnancy or nursing

  • Allergies to products

  • Acne vulgaris or rosacea

  • People with poorly controlled chronic conditions

  • Those with cancer, neurologic conditions, or HIV infection (or other immunosuppression)


Number of randomised participants: 96 in total (pimecrolimus N = 47, vehicle N = 49)
Number of dropouts: 2 (2%)
Sex: 85 males, 11 females
Mean age (range): pimecrolimus arm = 59.5 (27 to 84) years, placebo arm = 59.6 (20 to 88) years
Country: USA
Interventions Treatment
  • Pimecrolimus 1% cream, applied to the face twice daily for 4 weeks


Comparator/s
  • Placebo (vehicle), applied to the face twice daily for 4 weeks

Outcomes
  1. Erythema and scaling score (scale 0 to 3)

  2. Total target area score (sum of erythema and scaling score)

  3. IGA score (Investigator's Global Assessment score, scale 0 to 4)

  4. Adverse events

Notes
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk Quote: "The computer‐generated randomization assignment (blocks of 4) was only accessible to the research pharmacist during the study"
Allocation concealment (selection bias) Low risk Quote: "The computer‐generated randomization assignment (blocks of 4) was only accessible to the research pharmacist during the study"
Similarity of the study groups (selection bias) Unclear risk Quote: "At baseline, both groups had similar demographics...with the exception that a higher percentage of participants in the pimecrolimus group (38%) had previously used medication to treat their seborrhoeic dermatitis, compared with participants in the vehicle group (29%). In addition, participants in the vehicle group had milder disease at baseline compared with those in the pimecrolimus group with regard to mean scale target area score...and with regard to mean facial IGA"
Blinding of participants (performance bias) Low risk The study was double‐blind
Quote: "The two creams were packaged in identical tubes"
Blinding of care providers (performance bias) Low risk Quote: "double‐blind"
Blinded parties were not specified. Nevertheless, the research pharmacist was the only person that knew the participants' assignments
Blinding of outcome assessment (detection bias) 
 All outcomes Low risk Quote: "double‐blind"
Blinded parties were not specified. Nevertheless, the research pharmacist was the only person that knew the participants' assignments
Incomplete outcome data (attrition bias) 
 All outcomes Low risk The dropout rate was acceptable
Selective reporting (reporting bias) Low risk Prespecified outcomes were reported
Other bias Unclear risk Quote: "This investigator‐initiated study was supported by Novartis Pharmaceuticals Corporation" Novartis Pharmaceuticals Corporation employed at least 2 of the authors