Four common emollients — lotions, creams, gels, and ointments — are equally effective in treating childhood eczema, a randomized trial in the United Kingdom found.
“Our findings challenge the previous consensus that ointments are more effective, require less frequent application, and have fewer adverse effects than other emollient types, especially for more severe eczema,” the researchers reported in The Lancet Child & Adolescent Health.
Overall satisfaction and intention to continue treatment was highest for families who used lotions and gels, according to the researchers, and “users need to be able to choose from a range of emollient types to suit their needs and preferences.”
Daily use of emollients along with topical anti-inflammatory agents such as corticosteroids is widely recommended for eczema, which affects about 13% of children in the United States.
Previous research showed emollients can reduce flare-ups of eczema but did not establish that one product works better than another, according to a Cochrane review published in 2017.
For the new study, researchers at the University of Bristol, Bristol, England, and their colleagues randomly assigned 550 children aged 6 months to 12 years with mild or worse eczema to use one of four types of emollients for 16 weeks. Each child’s general practitioner selected a specific medication from local formularies.
The median age of the children in the study was 4 years, 255 (46%) were girls, and 473 (86%) were White. The mean Patient-Orientated Eczema Measure (POEM) score was 9.3, which indicates moderate disease.
Changes in disease severity reported by parents were similar among the treatment groups, according to the researchers. Over 16 weeks, mean POEM scores improved by 1.9 for those using lotion, 1.7 for cream, 2.2 for gel, and 2.5 for ointment. Also, scores on the Eczema Area Severity Index collected by blinded evaluators at 16 weeks did not vary among the groups.
Nor were there differences in adverse events, which were reported in 205 participants (37%). Worsening of eczema, redness, and itching or inflammation were most common. Stinging was half as common in ointment users as other groups, the researchers reported.
With more than 100 emollients on the market in the United Kingdom, the researchers said comparing these products by type rather than performing head-to-head comparisons rendered the findings more generalizable.
“A trial and error approach to prescribing is common, which can lead to underuse, waste, and frustration for families,” they wrote.
Heidi Kong, MD, MHSc, a senior investigator and chief of the Cutaneous Microbiome and Inflammation Section at the National Institute of Arthritis and Musculoskeletal and Skin Diseases, said the findings may be relevant in the United States, where similar emollients are available.
But the study’s racial homogeneity could limit its applicability to the United States, said Kong and Robert Sidbury, MD, MPH, a professor of pediatrics at the University of Washington, Seattle, and chief of dermatology at Seattle Children’s Hospital. Neither Kong nor Sidbury was involved in the new study.
Another limitation is that fewer study participants had severe disease, which can make a patient more susceptible to stinging or other discomfort, Kong told Medscape Medical News.
Still, Kong said the findings shift the focus to “the very important concept of considering individual patient and parent preferences on emollient type when making recommendations. If a type of emollient is preferable to a patient, they are more likely to use it.”
Although ointments can be messy, uncomfortable, and promote inflamed hair follicles, clinicians and parents have promoted them “because common sense suggests they work better” due to being thicker and longer lasting, Sidbury told Medscape. “This study suggests common sense may not be so sensible in this case,” he added.
The study was funded by the National Institute for Health and Care Research, a United Kingdom government agency.
One researcher in the Best Emollients for Eczema study is a consultant on an educational grant funded by Pfizer that is unrelated to the trial. Twenty other researchers involved with the study declared no competing interests. Sidbury is a speaker for Beiersdorf, which makes emollients. Kong reported no relevant financial relationships.
Lancet Child & Adolescent Health. Published Aug. 1, 2022. Full Text.
Mary Chris Jaklevic is a healthcare journalist in the Midwest.
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