The best moisturiser for eczema is the one that patients prefer

By Rebecca Jenkins
No one type of moisturiser is better than another for childhood eczema, a UK study has found.

Research directly comparing the effectiveness and acceptability of emollients, often known as moisturisers, as a leave-on treatment for eczema was scarce, researchers wrote in The Lancet Child & Adolescent Health, but the consensus had tended to favour greasier emollients as more effective.

To address the knowledge gap, the researchers designed a pragmatic, individually randomised, parallel group, phase 4 superiority trial of four types of emollient (lotions, creams, gels and ointments) which recruited participants from 77 general practices in England.

The Best Emollients for Eczema (BEE) trial randomised 550 children with eczema aged 6 months to 12 years to use a lotion, cream, gel or ointment as their only leave-on emollient for 16 weeks. After 16 weeks, patients could continue to use their allocated emollient or switch to an alternative for weeks 16 to 52.

There was no difference between the four emollients for the primary outcome of parent-reported eczema severity over 16 weeks, as captured by a seven-item questionnaire of eczema symptoms over the previous week.

‘The result remained unchanged following multiple imputation, sensitivity, and subgroup analysis,’ the researchers wrote.

They also found no difference between the groups on a range of secondary outcomes, including the impact of eczema on the family at 16 and 52 weeks and eczema signs that were measured every four weeks from 16 to 52 weeks.

Adverse events occurred in 37% of participants, who mostly reported localised skin reactions such as itching and dryness, but the overall number of adverse events did not differ significantly between the treatment groups.

‘Based on the available evidence, patients should be able to choose emollients from a range of lotions, creams, gels, and ointments. Therefore, all emollient formularies must include at least one of each type,’ the researchers wrote.

‘Decision making should be shared,’ they added. ‘Better informed and involved patients should mean they find a suitable emollient more easily and quickly, thereby improving treatment use and disease control.’

The researchers also conducted a nested qualitative study, published in the British Journal of General Practice, where interviews with a sample of parents and children from the BEE trial emphasised how the acceptability of the same product varied between users.

Welcoming the research, Associate Professor David Orchard, Consultant Dermatologist at Melbourne’s Royal Children’s Hospital, agreed with the authors that patients should be supported to find the best emollient for them.

‘Performance (that is, moisturising) is also only one aspect. How user-friendly and whether the cream stings on application are very important factors. A cream that is applied is going to always be better than one that is not,’ Professor Orchard told Medicine Today.

Prescribers should also keep in mind that moisturisers are not a direct therapy for eczema, but a therapy for one of many triggers for eczema, being skin dryness, he added. 

‘Some individuals have extremely dry skin and prefer (and need) thicker preparations, whereas for others without as naturally dry skin, these same ointments will be considered sticky and occlusive,’ he said.
Lancet Child Adolesc Health 2022; https://doi.org/10.1016/S2352-4642(22)00146-8.
Br J Gen Pract 2022; https://doi.org/10.3399/BJGP.2021.0630.