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Keep prescribing bath emollients, GPs urged

By Emma Wilkinson

GPs have been urged to continue prescribing bath emollients for patients with eczema, despite a damning review of their effectiveness.

The Drug and Therapeutics Bulletin warned such products were of ‘questionable value' and cost the NHS £16m a year.

It said there was no evidence of their effectiveness and there had not been any comparative studies with other bath products, or with the use of creams after washing.

But the group representing dermatology GPSIs argued that they were an established therapy and that alternatives such as soap aggravate eczema.

Bath emollients are often recommended by healthcare professionals and in guidelines from organisations such as the British Association of Dermatologists.

The DTB called for a proper evaluation of bath emollients given the considerable cost to the NHS and said there was no consensus among experts that they were effective in addition to topical creams.

‘We believe that, in the absence of such evidence, treatment strategies in which patients successfully apply emol- lients to the skin without ever using bath emollients are entirely reasonable,' the DTB concluded.

But Dr Tom Poyner, vice-chair of the Primary Care Dermatology Society and a GP in Stockton-on-Tees, Teesside, said GPs should keep using them.

‘There isn't the evidence that they work but there is no evidence they don't – established therapies that have been used for many years will not have evidence and it's difficult to single out one part of a regimen.

‘What would you do if you don't use them? You would need to use soap, which makes eczema worse.'

He said the cost to the NHS was related to the high prevalence of eczema but agreed a Health Technology Assessment on emollients would be helpful for GPs.

‘But for the present their use is good practice – carry on prescribing, carry on using.'

Atopic Eczema Atopic eczema Best use of emollients

Best use of emollients

• Emollients should be applied as liberally and frequently as possible – ideally three to four times a day
• They are best applied when the skin is moist but can and should be applied at other times as well
• Continual treatment with complete emollient therapy (combinations of cream, ointment, bath oil and emollient soap substitute) will help provide maximal effect
• Emollients should be prescribed in large quantities – 600g/week for an adult and 250g/week for a child

Source: Primary Care Dermatology Society 2006 guidelines

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