Which emollients are effective and acceptable for eczema in children?

Ridd, Matthew J; Roberts, Amanda; Grindlay, D. J. C.; Williams, Hywel C

doi:10.1136/bmj.l5882

Cited by 15 publications

(19 citation statements)

References 17 publications

(18 reference statements)

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“…Our study tested an intervention that was acceptable to parents and the use of emollients in the study is likely to closely reflect how emollients are recommended and used in the community. 28 Selection, detection, performance, and attrition biases are unlikely to explain the absence of a preventive effect. Eczema was measured using validated criteria, applied by trained researchers masked to the treatment intervention 1 year after use of the emollient had ceased.…”

Section: Discussionmentioning

confidence: 99%

Daily emollient during infancy for prevention of eczema: the BEEP randomised controlled trial

et al. 2020

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Background Skin barrier dysfunction precedes eczema development. We tested whether daily use of emollient in the first year could prevent eczema in high-risk children.Methods We did a multicentre, pragmatic, parallel-group, randomised controlled trial in 12 hospitals and four primary care sites across the UK. Families were approached via antenatal or postnatal services for recruitment of term infants (at least 37 weeks' gestation) at high risk of developing eczema (ie, at least one first-degree relative with parentreported eczema, allergic rhinitis, or asthma, diagnosed by a doctor). Term newborns with a family history of atopic disease were randomly assigned (1:1) to application of emollient daily (either Diprobase cream or DoubleBase gel) for the first year plus standard skin-care advice (emollient group) or standard skin-care advice only (control group). The randomisation schedule was created using computer-generated code (stratified by recruiting centre and number of first-degree relatives with atopic disease) and participants were assigned to groups using an internet-based randomisation system. The primary outcome was eczema at age 2 years (defined by UK working party criteria) with analysis as randomised regardless of adherence to allocation for participants with outcome data collected, and adjusting for stratification variables. This trial is registered with ISRCTN, ISRCTN21528841. Data collection for longterm follow-up is ongoing, but the trial is closed to recruitment. Findings 1394 newborns were randomly assigned to study groups between Nov 19, 2014, and Nov 18, 2016; 693 were assigned to the emollient group and 701 to the control group. Adherence in the emollient group was 88% (466 of 532) at 3 months, 82% (427 of 519) at 6 months, and 74% (375 of 506) at 12 months in those with complete questionnaire data. At age 2 years, eczema was present in 139 (23%) of 598 infants with outcome data collected in the emollient group and 150 (25%) of 612 infants in the control group (adjusted relative risk 0•95 [95% CI 0•78 to 1•16], p=0•61; adjusted risk difference -1•2% [-5•9 to 3•6]). Other eczema definitions supported the results of the primary analysis. Mean number of skin infections per child in year 1 was 0•23 (SD 0•68) in the emollient group versus 0•15 (0•46) in the control group; adjusted incidence rate ratio 1•55 (95% CI 1•15 to 2•09).Interpretation We found no evidence that daily emollient during the first year of life prevents eczema in high-risk children and some evidence to suggest an increased risk of skin infections. Our study shows that families with eczema, asthma, or allergic rhinitis should not use daily emollients to try and prevent eczema in their newborn.

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Section: Discussionmentioning

confidence: 99%

Daily emollient during infancy for prevention of eczema: the BEEP randomised controlled trial

et al. 2020

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“…Ridd et al . further highlighted the evidence gap on emollient use in AE by examining emollient efficacy and acceptability in paediatric AE 8 . This study supplemented a previous Cochrane review published in 2017 by an updated search and concluded that the evidence on whether some emollients were superior to others was inconclusive as most of the studies were of poor quality.…”

Section: Topical Therapiesmentioning

confidence: 72%

What’s new in atopic eczema? An analysis of systematic reviews published in 2019. Part 2: treatment

et al. 2021

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Summary This review forms part of a series of annual evidence updates on atopic eczema (AE), and provides a summary of key findings from systematic reviews (SRs) published or indexed in 2019 related to AE treatment. Several SRs assessed the efficacy of topical corticosteroids (TCS), topical calcineurin inhibitors, topical phosphodiesterase‐4 inhibitors and topical Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathway inhibitors. However, there is a lack of good‐quality trials comparing topical treatment agents with TCS, which remain the standard of care for patients with AE. Most of the included trials lack meaningful comparisons as they used vehicle as a comparator. There is also lack of harmonization of outcome measures for AE across studies. Large, well‐designed RCTs are needed to further determine whether any specific emollients offer superior benefit. There is evidence highlighting limited benefit of oral H1 antihistamines as ‘add‐on’ therapy to topical treatment of eczema. Mycophenolate mofetil may have a role in patients with refractory AE. Among biologic therapies, most of the efficacy data relate to dupilumab. Furthermore, there is growing evidence for the efficacy and safety of systemic JAK/STAT pathway inhibitors, but the existing data are of low quality.

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“…No consensus exists for the optimal time interval between the application of TCS and moisturisers, or which is to be applied first 17. The “best moisturiser” is the one that the patient prefers, works best for the patient, and is affordable 18…”

Section: How Are Moisturisers Being Applied?mentioning

confidence: 99%

Atopic dermatitis in children: when topical steroid treatment “does not work”

Chong

2021

BMJ

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Which emollients are effective and acceptable for eczema in children?

Cited by 15 publications

References 17 publications

Daily emollient during infancy for prevention of eczema: the BEEP randomised controlled trial

Daily emollient during infancy for prevention of eczema: the BEEP randomised controlled trial

What’s new in atopic eczema? An analysis of systematic reviews published in 2019. Part 2: treatment

Atopic dermatitis in children: when topical steroid treatment “does not work”

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