What’s the Right Moisturizer Format for Children with Eczema?

A trial exploring the best emollients for eczema has found that no one type of moisturizer—gel, cream, ointment or lotion— is better than another. According to researchers, the study—the first to directly compare different types of moisturizers— highlights the importance of patient education and choice when deciding which moisturizers to use for children with eczema. 

The results from the National Institute for Health and Care Research (NIHR)-funded study were published in The Lancet Child & Adolescent Health and British Journal of General Practice on May 24 (The article is titled: “Effectiveness and safety of lotion, cream, gel, and ointment emollients for childhood eczema: a pragmatic, randomized, phase 4, superiority trial.”)

In the study, led by the universities of Bristol, Nottingham and Southampton, 550 children with eczema aged under 12 years were randomized to use one of four types of moisturizer (lotion, cream, gel or ointment) as their main moisturizer 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 moisturizers and what they thought of them.  All children also had an independent examination of their skin.

Lotions, Ointments, Gels or Cream?

Used alongside other eczema treatments, there was no difference in effectiveness of the four types of moisturiser used in the study, according to the publication.  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.

“A study of this type has been long overdue,” said Professor Matthew Ridd, a GP and study lead from Centre for Academic Primary Care at the University of Bristol. ” 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 moisturizers 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.”

“The trial helped us find an emollient we had never used before, which has helped keep Abriarna’s skin in good condition for the longest time,” said Hayley, the mother a girl took part in the trial. “Her eczema often requires a different emollient for various purposes, for example, Abriarna has a regular day-to-day moisturiser, which we found through the trial.  She then has an emollient for days when her eczema is agitated and then an emollient to wash in as well as to use after handwashing.”

Tiffany Barrett, a pharmacist and co-researcher, noted that NHS’s prescribing of moisturizers is determined by locally agreed formularies.

“These formularies are based on both cost and perceived effectiveness. What this study does is emphasise the importance of having the four main types of moisturizers available on formularies for children with eczema, so that the right product can be used at the right time,” she said.

Along with anti-inflammatory treatments such as topical corticosteroids, emollients are a really key part of treatment for childhood eczema, preventing flares and helping to soothe the skin and improving the quality of life for children and their carers, noted Professor Hywel Williams, consultant dermatologist and co-researcher at the University of Nottingham.

“Our study shows that one size does not fit all, and points to the need for doctors to make parents aware of the different emollient types and to help them choose which one is mostly likely to work for them.  At last we have evidence that supports the saying, ‘The best moisturisers are the ones the patient will use,” said Prof. Williams.

Professor Nick Levell, NIHR National Specialty Lead for Dermatology, agreed. “This study confirms that parent and patient preference is very important in choosing a moisturizer to treat eczema. Some people prefer ointments, but others like gels, creams or lotions. No one option is best. As reactions to moisturizers 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.”

Further work is needed to determine if these findings apply to adolescents and adults with eczema, and people with other dry skin conditions, according to researchers.