Emollients and moisturisers for eczema

Background Eczema is a chronic skin disease characterised by dry skin, intense itching, inflammatory skin lesions, and has a considerable impact on quality of life. Moisturisation is an integral part of treatment, but it is unclear if moisturisers are effective. Objectives To assess the effects of moisturisers for eczema. Search methods We searched the following databases to December 2015: Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, LILACS, and GREAT. We searched five trials registers and checked references of included and excluded studies for further relevant trials. Selection criteria Randomised controlled trials in people with eczema. Data collection and analysis We used standard Cochrane methodological procedures. Main results We included 77 studies (mean duration: 6.7 weeks; 6603 participants, mean age: 18.6 years). Thirty‐six studies were at high risk of bias, 34 at unclear risk, and seven at low risk. Twenty‐four studies assessed our primary outcome of participant‐assessed disease severity, 13 assessed satisfaction, and 41 assessed adverse events. Secondary outcomes included investigator‐assessed disease severity (addressed in 65 studies), skin barrier function (29), flare prevention (16), quality of life (10), and corticosteroid use (eight). Adverse events reporting was limited (smarting, stinging, pruritus, erythema, folliculitis). Six studies evaluated moisturiser versus no moisturiser. Participant‐assessed disease severity and satisfaction were not assessed. Moisturiser use yielded lower SCORing Atopic Dermatitis (SCORAD) scores than no moisturiser (3 studies, 276 participants; mean difference (MD) ‐2.42, 95% confidence interval (CI) ‐4.55 to ‐0.28), but the minimal important difference (MID) was unmet. Moisturiser use resulted in fewer flares (2 studies, 87 participants; RR 0.40, 95% CI 0.23 to 0.70), prolonged time to flare (median: 180 versus 30 days), and reduced use of topical corticosteroids (2 studies, 222 participants; MD ‐9.30 g, 95% CI ‐15.3 to ‐3.27). There was no clear difference in adverse events (1 study, 173 participants; risk ratio (RR) 15.34, 95% CI 0.90 to 261.64). Evidence for these outcomes was low quality. With Atopiclair, 174/232 participants reported improvement in disease severity versus 27/158 using vehicle (3 studies; RR 4.51, 95% CI 2.19 to 9.29). Atopiclair decreased itching (4 studies, 396 participants; MD ‐2.65, 95% CI ‐4.21 to ‐1.09) and achieved more frequent satisfaction (2 studies, 248 particip