Review of Moisturizer Efficacy in Eczema
Among patients with eczema, most moisturizers showed some benefit but better results were seen when used with topical active treatment, according to a Cochrane Review.
Keeping the skin moisturized is an important part of treating eczema but the efficacy of moisturizers is not definite. To assess the effects of moisturizers for eczema, study authors researched 5 trial registers for randomized controlled trials in patients with eczema.
A total of 77 studies were included (n=6,603) of which 24 studies assessed the primary outcome of participant-assessed disease severity, 13 assessed satisfaction, and 41 assessed adverse events. Secondary outcomes included investigator-assessed disease severity, skin barrier function, flare prevention, quality of life, and corticosteroid use.
Six studies that compared moisturizer use vs. no moisturizer use showed lower SCORAD among moisturizer users (mean difference [MD] -2.42, 95% CI: -4.55 to -0.28) but the minimal important difference (MID) was not met. Use of moisturizers led to fewer flares, prolonged time to flare, and less topical corticosteroids required. However, there was no statistically significant difference in adverse event. Data for these outcomes were deemed low quality.
Three studies that evaluated Atopiclair, 174/232 patients had improvement in participant-assessed disease severity vs. 27/158 in the vehicle group (RR 4.51, 95% CI: 2.19-9.29). Atopiclair use led to reduced itching and more frequent satisfaction, as well as fewer flares and lower EASI but MID was unmet. Data for these outcomes were deemed moderate quality.
Skin improvement was more frequently reported in patients using urea-containing cream vs. placebo (RR 1.28, 95% CI: 1.06-1.53) with equal satisfaction between the 2 groups. Urea-containing cream improved dryness more frequently with fewer flares but more adverse events were reported in this group.
Three studies that compared glycerol-containing moisturizer vs. vehicle or placebo found that skin improvement was seen in glycerol-containing moisturizer users (RR 1.22, 95% CI: 1.01-1.48). An improvement in investigator-associated SCORAD was also seen in this group but the mID was unmet.
Four studies that compared oat-containing moisturizers vs. no treatment or vehicle found no significant differences between for patient-assessed disease severity (RR 1.11, 95% CI: 0.84-1.46), satisfaction, and investigator-assessed disease severity (standardized MD [SMD] -0.23, 95% CI: -0.66 to 0.21). Fewer flares and less topical corticosteroids were needed among oat-containing moisturizer users but more adverse events were reported.
All of the moisturizers mentioned above were compared against placebo, vehicle, or no moisturizer. Patients generally considered moisturizers more effective in reducing eczema (RR 2.46, 95% CI: 1.16-5.23) and itch (SMD -1.10, 95% CI: -1.83 to -0.38) vs. control. Both treatment groups showed comparable satisfaction (RR 1.35, 95% CI: 0.77-2.26). There was lower investigator-assessed disease severity (SMD -1.04, 95% CI: -1.57 to -0.51) and fewer flares (RR 0.33, 95% CI: 0.17-0.62) but no difference in adverse events.
Study authors also reported that topical active treatment with moisturizer was more effective than active treatment alone in lowering investigator-assessed disease severity (SMD -0.87, 95% CI: -1.17 to -0.57), the number of flares (RR 0.43, 95% CI: 0.20-0.93), and was preferred by participants. No statistically significant difference was seen in the number of adverse events.
In conclusion, use of moisturizers with active treatment resulted in prolonging time to flare, and reducing the number of flares and amount of topical corticosteroids needed to achieve similar reductions in eczema severity. Study authors, however, did not find substantial evidence for greater efficacy for 1 moisturizer over any another.
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