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 m...
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| Veröffentlicht in: | Cochrane database of systematic reviews 2017-02, Vol.2020 (8), p.CD012119 |
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| creator | Zuuren, Esther J Zuuren, Esther J Fedorowicz, Zbys Christensen, Robin Lavrijsen, Adriana PM Arents, Bernd WM |
| description | 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 |
| doi_str_mv | 10.1002/14651858.CD012119.pub2 |
| format | Article |
| fullrecord | <record><control><sourceid>wiley_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6464068</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>CD012119.pub2</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4732-f2f6c8a969a9f1890c896dc67a4c1e9b695379595a3e4af9fef00dc71fafb2e03</originalsourceid><addsrcrecordid>eNqFkM1OwzAQhC0EoqXwClVO3FLWTuLYFyQI5UeqxAXOluPY1CiJK7sFlacnUWhVuHDalWbn291BaIphhgHIFU5phlnGZsUdYIIxn602JTlC416Ie-X4oB-hsxDeARLKSX6KRoRhShMOY3Q5b1xdW92uQyTbKmqcDeuNt0H7EBnnI62-dCPP0YmRddAXP3WCXu_nL8VjvHh-eCpuFrFK84TEhhiqmOSUS24w46AYp5WiuUwV1rykPEtynvFMJjqVhhttACqVYyNNSTQkE3Q9cLtvGl2p7i4va7HytpF-K5y04rfS2qV4cx-CpjQFyjoAHQDKuxC8NnsvBtEnJ3bJiV1yPZF0xunh5r1tF1U3cDsMfNpab4Vyaullq__h_tnyDbTtf5s</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Emollients and moisturisers for eczema</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Alma/SFX Local Collection</source><source>Cochrane Library</source><creator>Zuuren, Esther J ; Zuuren, Esther J ; Fedorowicz, Zbys ; Christensen, Robin ; Lavrijsen, Adriana PM ; Arents, Bernd WM</creator><creatorcontrib>Zuuren, Esther J ; Zuuren, Esther J ; Fedorowicz, Zbys ; Christensen, Robin ; Lavrijsen, Adriana PM ; Arents, Bernd WM</creatorcontrib><description>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 participants; RR 2.14, 95% CI 1.58 to 2.89), fewer flares (3 studies, 397 participants; RR 0.18, 95% CI 0.11 to 0.31), and lower Eczema Area and Severity Index (EASI) scores (4 studies, 426 participants; MD ‐4.0, 95% CI ‐5.42 to ‐2.57), but the MID was unmet. The number of participants reporting adverse events was not statistically different (4 studies, 430 participants; RR 1.03, 95% CI 0.79 to 1.33). Evidence for these outcomes was moderate quality.
Participants reported skin improvement more frequently with urea‐containing cream than placebo (1 study, 129 participants; RR 1.28, 95% CI 1.06 to 1.53; low‐quality evidence), with equal satisfaction between the two groups (1 study, 38 participants; low‐quality evidence). Urea‐containing cream improved dryness (investigator‐assessed) (1 study, 128 participants; RR 1.40, 95% CI 1.14 to 1.71; moderate‐quality evidence), and produced fewer flares (1 study, 44 participants; RR 0.47, 95% CI 0.24 to 0.92; low‐quality evidence), but caused more adverse events (1 study, 129 participants; RR 1.65, 95% CI 1.16 to 2.34; moderate‐quality evidence).
Three studies assessed glycerol‐containing moisturiser versus vehicle or placebo. More participants in the glycerol group noticed skin improvement (1 study, 134 participants; RR 1.22, 95% CI 1.01 to 1.48; moderate‐quality evidence), which also included improved investigator‐assessed SCORAD scores (1 study, 249 participants; MD ‐2.20, 95% CI ‐3.44 to ‐0.96; high‐quality evidence), but the MID was unmet. Participant satisfaction was not addressed. The number of adverse events reported was not statistically significant (2 studies, 385 participants; RR 0.90, 95% CI 0.68 to 1.19; moderate‐quality evidence).
Four studies investigated oat‐containing moisturisers versus no treatment or vehicle. No significant differences between groups were reported for participant‐assessed disease severity (1 study, 50 participants; RR 1.11, 95% CI 0.84 to 1.46; low‐quality evidence), satisfaction (1 study, 50 participants; RR 1.06, 95% CI 0.74 to 1.52; very low‐quality evidence), or investigator‐assessed disease severity (3 studies, 272 participants; standardised mean difference (SMD) ‐0.23, 95% CI ‐0.66 to 0.21; low‐quality evidence). In the oat group, there were fewer flares (1 study, 43 participants; RR 0.31, 95% CI 0.12 to 0.7; low‐quality evidence) and reduced use of topical corticosteroids (2 studies, 222 participants; MD ‐9.30g, 95% CI 15.3 to ‐3.27; low‐quality evidence), but more adverse events (1 study, 173 participants; Peto odds ratio (OR) 7.26, 95% CI 1.76 to 29.92; low‐quality evidence).
We compared all moisturisers to placebo, vehicle, or no moisturiser. Participants considered moisturisers to be more effective for reducing eczema (5 studies, 572 participants; RR 2.46, 95% CI 1.16 to 5.23; low‐quality evidence) and itch (7 studies, 749 participants; SMD ‐1.10, 95% CI ‐1.83 to ‐0.38) than control. Participants in both treatment arms reported comparable satisfaction (3 studies, 296 participants; RR 1.35, 95% CI 0.77 to 2.26; low‐quality evidence). Moisturisers led to lower investigator‐assessed disease severity scores (12 studies, 1281 participants; SMD ‐1.04, 95% CI ‐1.57 to ‐0.51; high‐quality evidence) and fewer flares (6 studies, 607 participants; RR 0.33, 95% CI 0.17 to 0.62; moderate‐quality evidence), without a difference in adverse events (10 studies, 1275 participants; RR 1.03, 95% CI 0.82 to 1.30; moderate‐quality evidence).
Topical active treatment combined with moisturiser was more effective than active treatment alone in reducing investigator‐assessed disease severity scores (3 studies, 192 participants; SMD ‐0.87, 95% CI ‐1.17 to ‐0.57; moderate‐quality evidence) and flares (1 study, 105 participants; RR 0.43, 95% CI 0.20 to 0.93), and was preferred by participants (both low‐quality evidence). There was no clear difference in number of adverse events (1 study, 125 participants; RR 0.39, 95% CI 0.13 to 1.19; very low‐quality evidence). Participant‐assessed disease severity was not addressed.
Authors' conclusions
Most moisturisers showed some beneficial effects; prolonging time to flare, reducing the number of flares and the amount of topical corticosteroids needed to achieve similar reductions in eczema severity. Moisturisers combined with active treatment gave better results than active treatment alone. We did not find reliable evidence that one moisturiser is better than another.</description><identifier>ISSN: 1465-1858</identifier><identifier>EISSN: 1465-1858</identifier><identifier>EISSN: 1469-493X</identifier><identifier>DOI: 10.1002/14651858.CD012119.pub2</identifier><identifier>PMID: 28166390</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>1. Preventive measures ; Adrenal Cortex Hormones ; Adrenal Cortex Hormones - therapeutic use ; Atopic dermatitis/eczema ; C. DERMATITIS AND ECZEMA ; C1 Atopic dermatitis (atopic eczema, childhood eczema) ; Child health ; Eczema ; Eczema & dermatitis ; Eczema - drug therapy ; Emollients ; Emollients - chemistry ; Emollients - therapeutic use ; Humans ; Medicine General & Introductory Medical Sciences ; Patient Satisfaction ; Randomized Controlled Trials as Topic ; Severity of Illness Index ; Skin ; Skin disorders ; Symptom Flare Up ; use of emollients (moisturisers)</subject><ispartof>Cochrane database of systematic reviews, 2017-02, Vol.2020 (8), p.CD012119</ispartof><rights>Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4732-f2f6c8a969a9f1890c896dc67a4c1e9b695379595a3e4af9fef00dc71fafb2e03</citedby><cites>FETCH-LOGICAL-c4732-f2f6c8a969a9f1890c896dc67a4c1e9b695379595a3e4af9fef00dc71fafb2e03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28166390$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zuuren, Esther J</creatorcontrib><creatorcontrib>Zuuren, Esther J</creatorcontrib><creatorcontrib>Fedorowicz, Zbys</creatorcontrib><creatorcontrib>Christensen, Robin</creatorcontrib><creatorcontrib>Lavrijsen, Adriana PM</creatorcontrib><creatorcontrib>Arents, Bernd WM</creatorcontrib><title>Emollients and moisturisers for eczema</title><title>Cochrane database of systematic reviews</title><addtitle>Cochrane Database Syst Rev</addtitle><description>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 participants; RR 2.14, 95% CI 1.58 to 2.89), fewer flares (3 studies, 397 participants; RR 0.18, 95% CI 0.11 to 0.31), and lower Eczema Area and Severity Index (EASI) scores (4 studies, 426 participants; MD ‐4.0, 95% CI ‐5.42 to ‐2.57), but the MID was unmet. The number of participants reporting adverse events was not statistically different (4 studies, 430 participants; RR 1.03, 95% CI 0.79 to 1.33). Evidence for these outcomes was moderate quality.
Participants reported skin improvement more frequently with urea‐containing cream than placebo (1 study, 129 participants; RR 1.28, 95% CI 1.06 to 1.53; low‐quality evidence), with equal satisfaction between the two groups (1 study, 38 participants; low‐quality evidence). Urea‐containing cream improved dryness (investigator‐assessed) (1 study, 128 participants; RR 1.40, 95% CI 1.14 to 1.71; moderate‐quality evidence), and produced fewer flares (1 study, 44 participants; RR 0.47, 95% CI 0.24 to 0.92; low‐quality evidence), but caused more adverse events (1 study, 129 participants; RR 1.65, 95% CI 1.16 to 2.34; moderate‐quality evidence).
Three studies assessed glycerol‐containing moisturiser versus vehicle or placebo. More participants in the glycerol group noticed skin improvement (1 study, 134 participants; RR 1.22, 95% CI 1.01 to 1.48; moderate‐quality evidence), which also included improved investigator‐assessed SCORAD scores (1 study, 249 participants; MD ‐2.20, 95% CI ‐3.44 to ‐0.96; high‐quality evidence), but the MID was unmet. Participant satisfaction was not addressed. The number of adverse events reported was not statistically significant (2 studies, 385 participants; RR 0.90, 95% CI 0.68 to 1.19; moderate‐quality evidence).
Four studies investigated oat‐containing moisturisers versus no treatment or vehicle. No significant differences between groups were reported for participant‐assessed disease severity (1 study, 50 participants; RR 1.11, 95% CI 0.84 to 1.46; low‐quality evidence), satisfaction (1 study, 50 participants; RR 1.06, 95% CI 0.74 to 1.52; very low‐quality evidence), or investigator‐assessed disease severity (3 studies, 272 participants; standardised mean difference (SMD) ‐0.23, 95% CI ‐0.66 to 0.21; low‐quality evidence). In the oat group, there were fewer flares (1 study, 43 participants; RR 0.31, 95% CI 0.12 to 0.7; low‐quality evidence) and reduced use of topical corticosteroids (2 studies, 222 participants; MD ‐9.30g, 95% CI 15.3 to ‐3.27; low‐quality evidence), but more adverse events (1 study, 173 participants; Peto odds ratio (OR) 7.26, 95% CI 1.76 to 29.92; low‐quality evidence).
We compared all moisturisers to placebo, vehicle, or no moisturiser. Participants considered moisturisers to be more effective for reducing eczema (5 studies, 572 participants; RR 2.46, 95% CI 1.16 to 5.23; low‐quality evidence) and itch (7 studies, 749 participants; SMD ‐1.10, 95% CI ‐1.83 to ‐0.38) than control. Participants in both treatment arms reported comparable satisfaction (3 studies, 296 participants; RR 1.35, 95% CI 0.77 to 2.26; low‐quality evidence). Moisturisers led to lower investigator‐assessed disease severity scores (12 studies, 1281 participants; SMD ‐1.04, 95% CI ‐1.57 to ‐0.51; high‐quality evidence) and fewer flares (6 studies, 607 participants; RR 0.33, 95% CI 0.17 to 0.62; moderate‐quality evidence), without a difference in adverse events (10 studies, 1275 participants; RR 1.03, 95% CI 0.82 to 1.30; moderate‐quality evidence).
Topical active treatment combined with moisturiser was more effective than active treatment alone in reducing investigator‐assessed disease severity scores (3 studies, 192 participants; SMD ‐0.87, 95% CI ‐1.17 to ‐0.57; moderate‐quality evidence) and flares (1 study, 105 participants; RR 0.43, 95% CI 0.20 to 0.93), and was preferred by participants (both low‐quality evidence). There was no clear difference in number of adverse events (1 study, 125 participants; RR 0.39, 95% CI 0.13 to 1.19; very low‐quality evidence). Participant‐assessed disease severity was not addressed.
Authors' conclusions
Most moisturisers showed some beneficial effects; prolonging time to flare, reducing the number of flares and the amount of topical corticosteroids needed to achieve similar reductions in eczema severity. Moisturisers combined with active treatment gave better results than active treatment alone. We did not find reliable evidence that one moisturiser is better than another.</description><subject>1. Preventive measures</subject><subject>Adrenal Cortex Hormones</subject><subject>Adrenal Cortex Hormones - therapeutic use</subject><subject>Atopic dermatitis/eczema</subject><subject>C. DERMATITIS AND ECZEMA</subject><subject>C1 Atopic dermatitis (atopic eczema, childhood eczema)</subject><subject>Child health</subject><subject>Eczema</subject><subject>Eczema & dermatitis</subject><subject>Eczema - drug therapy</subject><subject>Emollients</subject><subject>Emollients - chemistry</subject><subject>Emollients - therapeutic use</subject><subject>Humans</subject><subject>Medicine General & Introductory Medical Sciences</subject><subject>Patient Satisfaction</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Severity of Illness Index</subject><subject>Skin</subject><subject>Skin disorders</subject><subject>Symptom Flare Up</subject><subject>use of emollients (moisturisers)</subject><issn>1465-1858</issn><issn>1465-1858</issn><issn>1469-493X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>RWY</sourceid><sourceid>EIF</sourceid><recordid>eNqFkM1OwzAQhC0EoqXwClVO3FLWTuLYFyQI5UeqxAXOluPY1CiJK7sFlacnUWhVuHDalWbn291BaIphhgHIFU5phlnGZsUdYIIxn602JTlC416Ie-X4oB-hsxDeARLKSX6KRoRhShMOY3Q5b1xdW92uQyTbKmqcDeuNt0H7EBnnI62-dCPP0YmRddAXP3WCXu_nL8VjvHh-eCpuFrFK84TEhhiqmOSUS24w46AYp5WiuUwV1rykPEtynvFMJjqVhhttACqVYyNNSTQkE3Q9cLtvGl2p7i4va7HytpF-K5y04rfS2qV4cx-CpjQFyjoAHQDKuxC8NnsvBtEnJ3bJiV1yPZF0xunh5r1tF1U3cDsMfNpab4Vyaullq__h_tnyDbTtf5s</recordid><startdate>20170206</startdate><enddate>20170206</enddate><creator>Zuuren, Esther J</creator><creator>Zuuren, Esther J</creator><creator>Fedorowicz, Zbys</creator><creator>Christensen, Robin</creator><creator>Lavrijsen, Adriana PM</creator><creator>Arents, Bernd WM</creator><general>John Wiley & Sons, Ltd</general><scope>7PX</scope><scope>RWY</scope><scope>ZYTZH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope></search><sort><creationdate>20170206</creationdate><title>Emollients and moisturisers for eczema</title><author>Zuuren, Esther J ; Zuuren, Esther J ; Fedorowicz, Zbys ; Christensen, Robin ; Lavrijsen, Adriana PM ; Arents, Bernd WM</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4732-f2f6c8a969a9f1890c896dc67a4c1e9b695379595a3e4af9fef00dc71fafb2e03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>1. Preventive measures</topic><topic>Adrenal Cortex Hormones</topic><topic>Adrenal Cortex Hormones - therapeutic use</topic><topic>Atopic dermatitis/eczema</topic><topic>C. DERMATITIS AND ECZEMA</topic><topic>C1 Atopic dermatitis (atopic eczema, childhood eczema)</topic><topic>Child health</topic><topic>Eczema</topic><topic>Eczema & dermatitis</topic><topic>Eczema - drug therapy</topic><topic>Emollients</topic><topic>Emollients - chemistry</topic><topic>Emollients - therapeutic use</topic><topic>Humans</topic><topic>Medicine General & Introductory Medical Sciences</topic><topic>Patient Satisfaction</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Severity of Illness Index</topic><topic>Skin</topic><topic>Skin disorders</topic><topic>Symptom Flare Up</topic><topic>use of emollients (moisturisers)</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zuuren, Esther J</creatorcontrib><creatorcontrib>Zuuren, Esther J</creatorcontrib><creatorcontrib>Fedorowicz, Zbys</creatorcontrib><creatorcontrib>Christensen, Robin</creatorcontrib><creatorcontrib>Lavrijsen, Adriana PM</creatorcontrib><creatorcontrib>Arents, Bernd WM</creatorcontrib><collection>Wiley-Blackwell Cochrane Library</collection><collection>Cochrane Library</collection><collection>Cochrane Library (Open Aceess)</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Cochrane database of systematic reviews</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zuuren, Esther J</au><au>Zuuren, Esther J</au><au>Fedorowicz, Zbys</au><au>Christensen, Robin</au><au>Lavrijsen, Adriana PM</au><au>Arents, Bernd WM</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Emollients and moisturisers for eczema</atitle><jtitle>Cochrane database of systematic reviews</jtitle><addtitle>Cochrane Database Syst Rev</addtitle><date>2017-02-06</date><risdate>2017</risdate><volume>2020</volume><issue>8</issue><spage>CD012119</spage><pages>CD012119-</pages><issn>1465-1858</issn><eissn>1465-1858</eissn><eissn>1469-493X</eissn><abstract>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 participants; RR 2.14, 95% CI 1.58 to 2.89), fewer flares (3 studies, 397 participants; RR 0.18, 95% CI 0.11 to 0.31), and lower Eczema Area and Severity Index (EASI) scores (4 studies, 426 participants; MD ‐4.0, 95% CI ‐5.42 to ‐2.57), but the MID was unmet. The number of participants reporting adverse events was not statistically different (4 studies, 430 participants; RR 1.03, 95% CI 0.79 to 1.33). Evidence for these outcomes was moderate quality.
Participants reported skin improvement more frequently with urea‐containing cream than placebo (1 study, 129 participants; RR 1.28, 95% CI 1.06 to 1.53; low‐quality evidence), with equal satisfaction between the two groups (1 study, 38 participants; low‐quality evidence). Urea‐containing cream improved dryness (investigator‐assessed) (1 study, 128 participants; RR 1.40, 95% CI 1.14 to 1.71; moderate‐quality evidence), and produced fewer flares (1 study, 44 participants; RR 0.47, 95% CI 0.24 to 0.92; low‐quality evidence), but caused more adverse events (1 study, 129 participants; RR 1.65, 95% CI 1.16 to 2.34; moderate‐quality evidence).
Three studies assessed glycerol‐containing moisturiser versus vehicle or placebo. More participants in the glycerol group noticed skin improvement (1 study, 134 participants; RR 1.22, 95% CI 1.01 to 1.48; moderate‐quality evidence), which also included improved investigator‐assessed SCORAD scores (1 study, 249 participants; MD ‐2.20, 95% CI ‐3.44 to ‐0.96; high‐quality evidence), but the MID was unmet. Participant satisfaction was not addressed. The number of adverse events reported was not statistically significant (2 studies, 385 participants; RR 0.90, 95% CI 0.68 to 1.19; moderate‐quality evidence).
Four studies investigated oat‐containing moisturisers versus no treatment or vehicle. No significant differences between groups were reported for participant‐assessed disease severity (1 study, 50 participants; RR 1.11, 95% CI 0.84 to 1.46; low‐quality evidence), satisfaction (1 study, 50 participants; RR 1.06, 95% CI 0.74 to 1.52; very low‐quality evidence), or investigator‐assessed disease severity (3 studies, 272 participants; standardised mean difference (SMD) ‐0.23, 95% CI ‐0.66 to 0.21; low‐quality evidence). In the oat group, there were fewer flares (1 study, 43 participants; RR 0.31, 95% CI 0.12 to 0.7; low‐quality evidence) and reduced use of topical corticosteroids (2 studies, 222 participants; MD ‐9.30g, 95% CI 15.3 to ‐3.27; low‐quality evidence), but more adverse events (1 study, 173 participants; Peto odds ratio (OR) 7.26, 95% CI 1.76 to 29.92; low‐quality evidence).
We compared all moisturisers to placebo, vehicle, or no moisturiser. Participants considered moisturisers to be more effective for reducing eczema (5 studies, 572 participants; RR 2.46, 95% CI 1.16 to 5.23; low‐quality evidence) and itch (7 studies, 749 participants; SMD ‐1.10, 95% CI ‐1.83 to ‐0.38) than control. Participants in both treatment arms reported comparable satisfaction (3 studies, 296 participants; RR 1.35, 95% CI 0.77 to 2.26; low‐quality evidence). Moisturisers led to lower investigator‐assessed disease severity scores (12 studies, 1281 participants; SMD ‐1.04, 95% CI ‐1.57 to ‐0.51; high‐quality evidence) and fewer flares (6 studies, 607 participants; RR 0.33, 95% CI 0.17 to 0.62; moderate‐quality evidence), without a difference in adverse events (10 studies, 1275 participants; RR 1.03, 95% CI 0.82 to 1.30; moderate‐quality evidence).
Topical active treatment combined with moisturiser was more effective than active treatment alone in reducing investigator‐assessed disease severity scores (3 studies, 192 participants; SMD ‐0.87, 95% CI ‐1.17 to ‐0.57; moderate‐quality evidence) and flares (1 study, 105 participants; RR 0.43, 95% CI 0.20 to 0.93), and was preferred by participants (both low‐quality evidence). There was no clear difference in number of adverse events (1 study, 125 participants; RR 0.39, 95% CI 0.13 to 1.19; very low‐quality evidence). Participant‐assessed disease severity was not addressed.
Authors' conclusions
Most moisturisers showed some beneficial effects; prolonging time to flare, reducing the number of flares and the amount of topical corticosteroids needed to achieve similar reductions in eczema severity. Moisturisers combined with active treatment gave better results than active treatment alone. We did not find reliable evidence that one moisturiser is better than another.</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>28166390</pmid><doi>10.1002/14651858.CD012119.pub2</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1465-1858 |
| ispartof | Cochrane database of systematic reviews, 2017-02, Vol.2020 (8), p.CD012119 |
| issn | 1465-1858 1465-1858 1469-493X |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6464068 |
| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection; Cochrane Library |
| subjects | 1. Preventive measures Adrenal Cortex Hormones Adrenal Cortex Hormones - therapeutic use Atopic dermatitis/eczema C. DERMATITIS AND ECZEMA C1 Atopic dermatitis (atopic eczema, childhood eczema) Child health Eczema Eczema & dermatitis Eczema - drug therapy Emollients Emollients - chemistry Emollients - therapeutic use Humans Medicine General & Introductory Medical Sciences Patient Satisfaction Randomized Controlled Trials as Topic Severity of Illness Index Skin Skin disorders Symptom Flare Up use of emollients (moisturisers) |
| title | Emollients and moisturisers for eczema |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-28T04%3A20%3A24IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-wiley_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Emollients%20and%20moisturisers%20for%20eczema&rft.jtitle=Cochrane%20database%20of%20systematic%20reviews&rft.au=Zuuren,%20Esther%20J&rft.date=2017-02-06&rft.volume=2020&rft.issue=8&rft.spage=CD012119&rft.pages=CD012119-&rft.issn=1465-1858&rft.eissn=1465-1858&rft_id=info:doi/10.1002/14651858.CD012119.pub2&rft_dat=%3Cwiley_pubme%3ECD012119.pub2%3C/wiley_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_id=info:pmid/28166390&rfr_iscdi=true |