Emollient bath additives provide no benefit over standard care for eczema in children and more effective treatments should be invested in, a study has found.
The research found that children who used emollient bath additives in addition to other standard treatments for eczema did not benefit more than children who did not use additives, suggesting that prescribers should stop focussing on bath additives in the treatment of eczema.
The study, carried out by researchers in the UK, looked at just under 500 children with eczema aged between one and eleven. The children were assigned to receive either standard care, including leave-on emollients but no bath additives, for 12 months or standard care with regular bath additives.
Eczema control was measured weekly for the first 16 weeks of the study using the patient oriented eczema measure (POEM). The baseline POEM score for children who used bath additives was 9.5 and in children who did not use them it was 10.1 This fell to 7.5 and 8.4 respectively at 16 weeks, representing no significant difference in eczema control between the two groups.
There was also no significant difference in levels of control or quality of life between the groups at the one year mark.
The researchers suggest that the findings could help inform prescribing policies for eczema.
They said in the paper: ‘These findings are timely for clinicians and prescribing advisers, as prescribing guidelines vary widely in their advice on the use of bath additives, and pressure on budgets has led to formularies becoming increasingly restrictive.
‘Reviews have estimated that bath additives might contribute to up to one third of the costs of eczema in the United Kingdom. Our findings provide evidence that can contribute to effective prescribing in this area, where there is currently little research evidence to guide decision making.’
Writing in a linked editorial, Dr Carsten Flohr, consultant dermatologist at the St John’s Institute of Dermatology at Guy’s & St Thomas’ NHS Foundation Trust, commented: ‘There is still some room for further work, but it is heartening to see that an important evidence gap has been closed. Both the NHS and families of children with eczema can now better invest in more effective treatments for this common and distressing condition.’
BMJ 2018; available online 2nd May
