Tuesday, July 5, 2022

The best moisturiser for children with eczema is the one that they like to use

Which moisturiser is the best for children with eczema?

There are four main emollient types: lotions, creams, gels, and ointments. Yet, no clear evidence of which is best. A new study set out to find the best moisturiser by comparing their clinical effectiveness and safety.

The Universities of Bristol, Nottingham, and Southampton study, enrolled 550 children with eczema under 12 years. The children were given four types of moisturiser (lotion, cream, gel, or ointment) as their main moisturiser for 16 weeks.

For a year, parents kept diaries regarding their child’s eczema, and some were interviewed to learn more about how they used the moisturisers and what they thought of them. All of the children had their skin examined independently.

The four types of moisturiser used in the study had no difference in effectiveness when used in conjunction with other eczema treatments. Itching and redness were common skin reactions with all moisturiser kinds. Users expressed diverse preferences based on how the moisturisers looked and felt and minimal awareness of the many types of moisturiser. Some people favored the “barrier” provided by ointments, while others preferred the fast absorption of lotions.

In simple words, no one type of moisturizer is better than another.

Professor Matthew Ridd, a GP and study lead from the Centre for Academic Primary Care at the University of Bristol, said: “A study of this type has been long overdue. It has not been in the interest of the manufacturers to directly compare types of moisturiser in the way we have done in this trial. Our findings challenge conventions about how often moisturisers need to be applied, which types are less likely to cause problems, and which patients should be recommended certain types. For example, ointments are often suggested for more severe eczema, yet they were no better.”

Hayley, the mother of Abriarna who took part in the trial, said: “The trial helped us find an emollient we had never used before, which has helped keep Abriarna’s skin in good condition for the longest time. Her eczema often requires a different emollient for various purposes, for example, Abriarna has a regular day-to-day moisturizer, which we found thorough the trial. She then has an emollient for days when her eczema is agitated and then an emollient to wash in and use after handwashing.”

Tiffany Barrett, pharmacist, co-researcher, added: “NHS prescribing of moisturisers is determined by locally agreed formularies. These formularies are based on both cost and perceived effectiveness. What this study does is emphasize the importance of having the four main types of moisturisers available on formularies for children with eczema so that the right product can be used at the right time.”

Professor Hywel Williams, consultant dermatologist, and co-researcher at the University of Nottingham, explained: “Along with anti-inflammatory treatments such as topical corticosteroids, emollients are a vital part of treatment for childhood eczema, preventing flares and helping to soothe the skin and improving the quality of life for children and their carers.”

“Our study shows that one size does not fit all and points to the need for doctors to make parents aware of the different emollient types and help them choose which one is most likely to work for them. At last, we have evidence that supports the saying, ‘The best moisturisers are the ones the patient will use.”

Professor Nick Levell, NIHR National Specialty Lead for Dermatology, said“Around one in five children get eczema. Scratching and sleep loss affect school performance and exhaust children and their parents. This study confirms that parent and patient preference is important in choosing a moisturiser to treat eczema. Some people prefer ointments, but others like gels, creams, or lotions. No one option is best. As reactions to moisturisers are common, it is important that the NHS provides a wide choice to help parents find something that soothes and calms their child’s fiery skin.”

Journal Reference:

  1. Prof Matthew J Ridd et al. Effectiveness and safety of lotion, cream, gel, and ointment emollients for childhood eczema: a pragmatic, randomised, phase 4, superiority trial. DOI: 10.1016/S2352-4642(22)00146-8
  2. Eileen Sutton, Alison RG Shaw et al. How parents and children evaluate emollients for childhood eczema: a qualitative study. DOI: 10.3399/BJGP.2021.0630
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