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For the management of childhood eczema, all four emollient types (lotions, creams, gels and ointments) are equally effective.
In a clinical trial, the four types of emollients (lotions, creams, gels and ointments) exhibited comparable efficiency in relieving pediatric eczema. Investigators aimed to determine the acceptability and efficiency of lotions, creams, gels, and ointments, shedding light on the 'trial and error' approach often used in prescribing these emollients for children battling eczema.
The trial (Best Emollients for Eczema clinical trial [BEE RCT]), a four-group, parallel, individually randomized clinical study, involved 550 pediatrics aged between 6 months and 12 years with at least mild-severity eczema. Patient-Oriented Eczema Measure scores over 16 weeks was the key endpoint ascertained. On the other hand, Patient-Oriented Eczema Measure scores over 52 weeks, Eczema Area Severity Index score at 16 weeks, quality of life (Atopic Dermatitis Quality of Life, five-level version scores, Child Health Utility-9 Dimensions, and EuroQol-5 Dimensions), Dermatitis Family Impact and satisfaction levels at 16 weeks were the secondary endpoints ascertained.
Overall, 550 pediatrics were randomly assigned to different treatment groups: lotion (131 analyzed out of 137 allocated), cream (137/140), gel (130/135), or ointment (126/138). At the outset, 86.0% of participants were of white ethnicity, and 46.4% were women. The median age, with an interquartile range of 2 to 8 years, was 4 years, and the median Patient-Oriented Eczema Measure score was 9.3 (with a standard deviation of 5.5).
No discernible difference was noted in mean Patient-Oriented Eczema Measure scores across emollient types during the initial 16 weeks (global p = 0.765). The adjusted Patient-Oriented Eczema Measure pairwise differences were as follows: cream-lotion 0.42 (95% confidence interval [CI] -0.48 to 1.32), gel-lotion 0.17 (95% CI -0.75 to 1.09), ointment-lotion -0.01 (95% CI -0.93 to 0.91), gel-cream -0.25 (95% CI -1.15 to 0.65), ointment-cream -0.43 (95% CI -1.34 to 0.48), and ointment-gel -0.18 (95% CI -1.11 to 0.75).
Investigators did not observe any effect modification based on parent expectations, age, illness intensity, or UK diagnostic criteria application. Regarding secondary endpoints, there were no profound differences between study arms. The median weekly usage of the assigned emollient, non-assigned emollient, and topical corticosteroids was comparable across all the groups.
Overall, volunteers expressed the highest satisfaction with gels and lotions. No profound disparities were witnessed in the occurrence of adverse reactions, and there were no noteworthy adverse events. In the nested qualitative assessment involving 25 pediatrics and 44 parents, opinions on creams and ointments acceptability varied, although challenges were noted across all types. The authors indicated a potential inclination towards prioritizing efficiency over acceptability. Parents illustrated a preference for pumps and bottles over tubs and reported an enhanced comprehension of, and adherence to, emollient use as a result of their participation in the trial.
The study concluded that the four emollient types demonstrated equal effectiveness in treating childhood eczema. However, satisfaction levels varied among users, with different parents and children expressing preferences for different emollient types. This highlights the importance of providing users with the option to select from a diverse range of emollient types to find the one that best suits their needs.
Looking ahead, future research must concentrate on enhancing support for shared decision-making regarding various emollient types. Additionally, there is a need for evaluations of other emollients, including those that are paraffin-based, non-paraffin, and considered 'novel.' This research direction aims to further refine the understanding of emollient effectiveness and preferences, contributing to more personalized and effective eczema management strategies.
Health Technology Assessment
Comparison of lotions, creams, gels and ointments for the treatment of childhood eczema: the BEE RCT
Matthew J Ridd et al.
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