Emollients and moisturizers for eczema: abridged Cochrane systematic review includingGRADEassessments

Abstract

Eczema is a chronic inflammatory skin disorder with considerable impact on quality of life. Emollients or moisturizers are widely recommended, but are these effective and safe? We searched for randomized controlled trials (RCTs) in the Cochrane Skin Group Specialised Skin Register, CENTRAL in The Cochrane Library, MEDLINE, Embase, LILACS, the GREAT database and five trial registers to December 2015. We included 77 RCTs with 6603 participants. Seven studies (9%) were at low risk of bias, 34 (44%) had unclear risk and 36 (47%) were at high risk. The quality of the evidence was mainly low or moderate for the prespecified outcomes. The most important comparison, 'moisturizer vs. no moisturizer', showed improved Scoring Atopic Dermatitis values in the moisturizer group compared with no moisturizer [mean difference -2·42, 95% confidence interval (CI) -4·55 to -0·28], but did not meet the minimal important difference of 8·7. Fewer flares were seen (risk ratio 0·40, 95% CI 0·23-0·70) and the rate of flares was reduced (hazard ratio 3·74, 95% CI 1·86-7·50). The groups applying moisturizer used less topical corticosteroids over 6-8 weeks (mean difference -9·30 g, 95% CI 15·3 to -3·27). Glycyrrhetinic acid-, urea- and glycerol-containing creams worked better than their controls (vehicle, placebo or no moisturizer) according to both participants and physicians. More flares were reported with moisturizer alone than when combined with twice-weekly fluticasone propionate (risk ratio 2·17, 95% CI 1·55-3·11). Adding moisturizers to topical anti-inflammatory treatment was more effective than anti-inflammatory treatment alone and resulted in fewer flares.

Methotrexate for severe nummular eczema in children: Efficacy and tolerability in a retrospective study of 28 patients

“…Calcineurin inhibitors are also of limited benefit. Emollients are ineffective, because most patients do not have dry or atopic skin, and are poorly tolerated . Most patients with NE have chronic pruritus and poor quality of life.…”

Topical urea in skincare: A review

“…Of note, combination therapy with urea was found to be more effective than treatment with hydrocortisone or betamethasone-17-valerate alone (Pan et al, 2013). A recent Cochrane review confirmed that, in AD, treatment with moisturizers and topical corticosteroids is more effective than treatment with topical corticosteroids alone (Van Zuuren, Fedorowicz, & Arents, 2017). A systematic review confirmed the positive effect of moisturizers in AD but alerted to the need for better-designed studies that allow direct comparisons between moisturizing agents (Lindh & Bradley, 2015).…”

Atopic Dermatitis: Collegium Internationale Allergologicum (CIA) Update 2019

“…Based on a Cochrane review and vast clinical experience, the application of moisturizers leads to an improvement in AD severity, increases the effect of anti-inflammatory therapies, reduces the number of flares, and decreases the use of TCS [137]. Would it be possible to prevent AD by restoring the skin barrier?…”