Published: 24 May 2022
The Best Emollients for Eczema trial has found that no one type of moisturiser is better than another. This study, the first in the world to directly compare different types of moisturisers, highlights the importance of patient education and choice when deciding which moisturisers to use for children with eczema. The results from the NIHR funded study are published in The Lancet Child & Adolescent Health and British Journal of General Practice.
Moisturisers (also called emollients) are recommended for the one in five children who have eczema (also known as atopic eczema/dermatitis), which causes dry and itchy skin. Over 100 different moisturisers are prescribed in the NHS, costing over £100 million a year. Lack of research in this area means NHS guidelines vary widely in what is recommended, which leads to confusion and waste.
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 four types of moisturiser (lotion, cream, gel or ointment) 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 moisturiser used in the study. Skin reactions such as itching or redness were common with all moisturiser types. Awareness of the different types of moisturiser was low, and users had different preferences based on how the moisturisers look and feel. For example, some people liked how lotions quickly soaked in whereas others preferred the “barrier” provided by ointments.
Professor Matthew Ridd, a GP and study lead from 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 found to be no better.”
Professor Nick Levell, NIHR National Specialty Lead for Dermatology, said: "Around one in five children get eczema and the scratching and sleep loss affects school performance and exhausts children and their parents. This study confirms that parent and patient preference is very 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."
The study was funded by the NIHR Health Technology Assessment (HTA) Programme, while recruitment to the study was supported by the NIHR Clinical Research Network.
Find out more about the study on the NIHR Funding & Awards website.