Eczema is a common chronic skin disease that affects many people worldwide, and they will often turn to creams to help. In a new Cochrane Review from February 2017, Zbys Fedorowicz from Cochrane Bahrain and colleagues have brought together the relevant evidence from nearly 80 trials and we asked him to describe their findings.
John: Hello, I'm John Hilton, editor of the Cochrane Editorial unit. Eczema is a common chronic skin disease that affects many people worldwide, and they will often turn to creams to help. In a new Cochrane Review from February 2017, Zbys Fedorowicz from Cochrane Bahrain and colleagues have brought together the relevant evidence from nearly 80 trials and we asked him to describe their findings.
Zbys: People with eczema suffer from dry skin, red patches and intense itch. It can lead to feelings of unattractiveness, shame, discomfort, emotional stress, and low self-esteem. Nightly itch can also cause lack of sleep, making it difficult for the sufferer to concentrate at school or at work. All in all, eczema can have a considerable negative impact on quality of life and it’s important to find effective treatments.
The dry and itchy skin caused by eczema makes it common sense to use a moisturiser and they are widely prescribed for eczema and considered a cornerstone of its treatment. However, we need to know if moisturisers really are beneficial and safe, and whether one moisturiser might be preferable to another. Applying moisturisers is time consuming, they may stick to clothes and bed linen and can leave traces on everything they touch. Some might irritate or sting, and some ingredients might lead to allergic reactions. There are many reasons, therefore, to investigate the advantages and disadvantages of moisturisers, especially if their use will be a lifelong requirement for someone with eczema; and we hope that our Cochrane Review will help people make decisions about using them.
The review covers a variety of moisturisers, with 77 trials involving more than six and a half thousand participants. The quality of the evidence varied from very low to high, but was most often low to moderate. The age of the participants ranged from 4 months to 84 years, and the severity of their eczema was mostly mild to moderate. Most of the studies directly compared two moisturisers, which provides information on which of the two is more effective but does not tell us if a moisturiser is actually beneficial by itself.
Moving to our findings: most moisturisers reduced the severity of the eczema, but the extent of this reduction wasn’t usually considered important enough for people with eczema. When compared to not using a moisturiser, moisturisers reduced the number of flares and prolonged the time to flare, which are both clinically important outcomes. Furthermore, when moisturisers were used, less topical corticosteroids were needed to reach similar improvements in eczema compared to when no moisturisers were applied. Most studies did not provide adequate information on adverse events but, where they did, the moisturisers appeared to be safe with generally no more reporting of adverse events. However, the urea-containing and oat-containing creams led to slightly more complaints of stinging and smarting.
Nevertheless, many things remain unclear. We didn’t find reliable evidence that any moisturiser is convincingly better than any other, and the importance of using patient reported outcomes was underestimated in the majority of the studies, with very few assessing satisfaction with the moisturiser. It’s also unclear which moisturiser is most suitable and preferred for acute and for chronic eczema.
In summary, decisions about the use and choice of moisturiser should be based on the available evidence, whilst taking into account the experiences and preferences of the person with eczema.
John: If you would like to read more about the overall findings of the review and the details of the large number of included studies, you can find its full report online. Just go to Cochrane Library dot com and run a simple search for ‘moisturisers for eczema’.