The best moisturiser for children with eczema is the one they prefer and will use regularly, a study has revealed.
UK researchers found no difference between the four different types of emollients – lotions, creams, gels, and ointments – for childhood eczema in terms of symptoms, eczema signs, quality of life, and impact on the family.?
The results of the trial were published in The Lancet Child & Adolescent Health, andhave been welcomed by Australian dermatologists.
Perth dermatologist, Dr Kurt Gebauer, said it was an excellent study.
“It pretty much confirms what I’ve been saying to people forever,” he said.
“Moisturisers are very much poo-pooed. Patients just don’t understand how important it is for them to get out of a shower, cut down the soap, cut down the washers, cut down all that sort of stuff and just stop drying out their skin.”
In the study, led by the universities of Bristol, Nottingham and Southampton, 550 children with eczema aged under 12 years were randomised to use one of the four types of emollients as their main moisturiser for 16 weeks.
Parents completed diaries about their child’s eczema for a year, and some were interviewed to gain an in-depth understanding of how they used the moisturisers and what they thought of them. All children also had an independent examination of their skin.
Used alongside other eczema treatments, there was no difference in effectiveness of the four types of moisturisers used in the study.
Skin reactions such as itching or redness were common with all moisturiser types. Awareness of the different types of moisturisers was low, and users had different preferences based on how they looked and felt. For example, some people liked lotions that quickly soaked in whereas others preferred the “barrier” provided by ointments.
Study lead and GP, Professor Matthew Ridd, from the University of Bristol, said the trial was a world first and was long overdue.
“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,” he said.
“For example, ointments are often suggested for more severe eczema, yet they were found to be no better.”
Professor Hywel Williams, consultant dermatologist and co-researcher at the University of Nottingham, said that along with anti-inflammatory treatments such as topical corticosteroids, emollients were integral to the treatment and management of childhood eczema.
“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 to help them choose which one is mostly likely to work for them,” he said.
“At last we have evidence that supports the saying, ‘The best moisturisers are the ones the patient will use.’”
ACT dermatologist Dr Diana Rubel said it was a well-planned study that focused on mild eczema patients.
“We usually recommend thicker emollients because they are less likely to sting – this study did confirm that stinging was more likely with the lotions and gels than ointments,” she said.
“But ointments in this study were more associated with falls, because they are very greasy and slippery!
“An important point is that it is OK to let families choose which emollient they prefer, and that ultimately it doesn’t matter too much whether they are lotions, gels, creams or ointments.”
Dr Rubel said the key message for Australian GPs was to encourage emollient use, any that the patient would tolerate and comply best with.
“It is ok to switch around and try a few. If stinging occurs, then best to switch to an ointment,” she said.
Dr Gebauer said the study was timely for GPs, given the fact that winter put patients at more risk of dry skin and eczema flare-ups.
“They would all be seeing people coming in itching and scratching at the moment,” he said. “And the first thing to do with someone who has a non-specific itch is to moisturise and get them back in two weeks for a review, because for most it is just dry skin.
Melbourne dermatologist Dr Celeste Wong agreed, saying winter was always worse for eczema patients. She said the study had her thinking about her own preference for recommending some emollients over others.
“My preferred choice has always been cream or ointment over lotion, but this will probably make me a little bit more open to lotions and gels,” she said.