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Umesh Modi is a chartered accountant, and Pamini Jatheeskumar is a chartered certified accountant at Silver Levene...
  Don Lavoie is alcohol programme manager at Public Health England and Gul Root is lead...
Don Lavoie is alcohol programme manager at Public Health England and Gul Root is lead pharmacist, Health and Wellbeing Directorate, Public Health England
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a child eczema imageMay 9 2018

A study has found no evidence of clinical benefit from including bath emollients in the standard management of eczema in children. However, the researchers point out that further research is needed into optimal regimes for leave-on emollients and soap substitutes.

The trial involved 483 children aged from 1 to 11 years old with atopic dermatitis. The average age was 5 years, and the cohort had an 84% white ethnicity. The study excluded children with very mild eczema and those who bathed less than once a week. 

Participants in the intervention group were prescribed emollient bath additives by their usual clinical team for regular use over 12 months, while the control group were asked not to use bath additives for 12 months.

Both groups were able to continue with other standard eczema treatments such as leave-on emollients, and advice about washing was standardised.

Outcomes were measured weekly for the first 16 weeks using the patient-oriented eczema measure (POEM) which scores 0-7 for mild eczema, 8-16 for moderate, and 17-28 for severe eczema. Secondary outcomes were measured including eczema severity at 52 weeks, the number of exacerbations requiring a primary care consultation, quality of life, and use of other treatments including topical corticosteroids and topical calcineurin inhibitors. 

Results indicate that the baseline POEM score was 9.5 in the bath additives group and 10.1 in the control group. Over the 16 weeks, the mean POEM score was 7.5 for the bath additives group and 8.4 for the control, meaning no significant difference was found between the groups. 

Furthermore, after controlling for aspects such as baseline severity, and use of treatments other than bath additives, the POEM scores for the emollient group was 0.41 higher than the control group. 

While the researchers from the University of Southampton could not exclude the possibility of a small benefit among children bathing more than five times a week or among children aged less than 5 years, they said differences were sufficiently small to be unlikely to be clinically useful. 

Another aspect that could be studied further is the use of antiseptic emollient bath additives for children with recurrent skin infections.

Bath additives are widely prescribed at a cost of more than £23m annually to the NHS in England. The researchers say their findings may help guide decisions around effective prescribing in this area.

Links:
M Santer et al. ‘Emollient bath additives for the treatment of childhood eczema (BATHE): multicentre pragmatic parallel group randomised controlled trial of clinical and cost effectiveness’. BMJ 2018. 361: k1332    

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