Cochrane for Clinicians
Putting Evidence into Practice
Effectiveness of Moisturizers in the Treatment of Patients with Eczema
Am Fam Physician. 2018 Jan 1;97(1):18-19.
Author disclosure: No relevant financial affiliations.
Are moisturizers an effective treatment for eczema?
Moisturizers decrease the rate of eczema flare-ups by 3.7 times vs. no treatment (number needed to treat [NNT] = 4), as well as the amount of topical corticosteroids used per eczema flare-up (9.3 g less). Adverse effects are minimal.1 (Strength of Recommendation: A, based on consistent, good-quality patient-oriented evidence.)
Over the past three decades, the prevalence of eczema has tripled in industrialized countries, with a prevalence of 15% to 30% in children and 2% to 10% in adults.2 Severe eczema is associated with a higher frequency of health care system use, numerous chronic comorbid conditions, and a decrease in overall quality of health.3 This Cochrane review addressed whether moisturizers are an effective treatment for eczema.1
The authors examined 77 randomized controlled trials involving 6,603 participants four months to 84 years of age (mean age = 18.6 years) who had mild to moderate eczema. Outcomes were not separated by age. Patients with contact dermatitis, nummular eczema, and dyshidrotic eczema were excluded. Various validated scoring systems were used to characterize eczema severity, including the Eczema Area and Severity Index (EASI), the objective SCORing Atopic Dermatitis (SCORAD) scale, and the Patient Oriented Eczema Measure (POEM). The authors included comparisons between different emollients and placebo for a variety of outcomes.
Compared with patients using placebo, vehicle, or no treatment, participants found that moisturizers more effectively treated eczema (NNT = 2; 95% confidence interval [CI], 2 to 3) based on a validated Likert scale survey. Moisturizers decreased the overall rate of flare-ups over six weeks to six months compared with control (NNT = 4; 95% CI, 3 to 5). Moisturizer use decreased topical corticosteroid use (9.3 g less; P = .003) over two months.
According to patient assessment on a validated Likert scale, a steroid- and parab
The practice recommendations in this activity are available at http://www.cochrane.org/CD012119.
Referencesshow all references
1. van Zuuren EJ, Fedorowicz Z, Christensen R, Lavrijsen A, Arents BW. Emollients and moisturisers for eczema. Cochrane Database Syst Rev. 2017;(2):CD012119....
2. Bieber T. Atopic dermatitis. N Engl J Med. 2008;358(14):1483–1494.
3. Silverberg JI, Simpson EL. Association between severe eczema in children and multiple comorbid conditions and increased healthcare utilization. Pediatr Allergy Immunol. 2013;24(5):476–486.
4. Eichenfield LF, Tom WL, Berger TG, et al. Guidelines of care for the management of atopic dermatitis. Section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014;71(1):116–132.
5. Chiang C, Eichenfield LF. Quantitative assessment of combination bathing and moisturizing regimens on skin hydration in atopic dermatitis. Pediatr Dermatol. 2009;26(3):273–278.
6. National Institute for Health and Clinical Excellence (NICE). Atopic eczema in children: management of atopic eczema in children from birth up to the age of 12 years. London, United Kingdom: NICE; 2007.
These are summaries of reviews from the Cochrane Library.
This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.
A collection of Cochrane for Clinicians published in AFP is available at http://www.aafp.org/afp/cochrane.
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