Moisturizing bath washes may not help kids with eczema

There's less consensus in the medical community about whether children should also use emollient bath additives.

Children with eczema whose bath water contains added moisturizers may get no more relief from the itchy skin condition than they would without the extra bath products, a recent experiment suggests.

For the study, UK researchers followed 482 children aged 1 to 11 years old with eczema for one year. During the study, all of the kids stuck to their usual treatment routine - which could include moisturizing creams and ointments and topical corticosteroids as needed - and half of them were also randomly asked to bathe with one of three popular bath additives.

There was no meaningful difference in the severity of eczema symptoms between the two groups after four months, or after one year, the study found.

“This is important for families of children with eczema as it simplifies treatment in that they no longer need to use emollient bath additives, although they should continue to use their other treatments, including leave-on emollients, also known as moisturizers,” said lead study author Dr. Miriam Santer of the University of Southampton.

“Leave-on emollients such as moisturizers or topical creams or ointments help to lock moisture into the skin and lock out irritants,” Santer said by email. “Previously there was some suggestion that emollient bath additives poured into the water can leave a greasy ‘film’ on the child providing a similar effect, but our study shows this doesn’t work.”

Eczema is common in childhood, and is often treated with different forms of emollients, or moisturizers that can help soften and smooth irritated skin. During flare-ups of more severe symptoms, kids may also be prescribed topical corticosteroids.

Doctors generally agree that kids should use moisturizing creams and ointments, and that children shouldn’t wash with soap because it can irritate the skin, researchers note in The BMJ. But there’s less consensus in the medical community about whether children should also use emollient bath additives.

In the current study, doctors prescribed one of the three most-prescribed bath additives in the UK - Oilatum, Balneum or Aveeno - to the group chosen to add these to their treatment regimen. Kids could also use other bath additives, as long as they didn’t contain antimicrobials, which can irritate the skin.

Overall, 93 percent of parents of children in the bath additives group said they always used these products or did so at least half of the time. In the other group, 92 percent of parents said they never used bath additives or did it less than half of the time.

By the end of the study, there were no meaningful differences between groups in the number of eczema exacerbations, the impact of eczema on quality of life or the type or quantity of corticosteroids used for severe flare-ups.

One limitation of the study is that it wasn’t designed to test the effectiveness of different types of emollients, the authors note. While the findings suggest that bath additives don’t help eczema, the results don’t offer fresh insight into the effectiveness of leave-on creams and ointments to prevent eczema flare-ups or the use of emollients as soap substitutes.

“It is important to note that the study encouraged the use of emollient soap substitutes and regular emollient use during the day as well as anti-inflammatory treatment as prescribed by the local family doctor, so what the study says is that bath emollients do not have a significant add-on effect, in addition to standard care,” said Carsten Flohr, co-author of an accompanying editorial and a researcher with St. John’s Institute of Dermatology at King’s College London.

“Bath additives only stay on the skin for a short period of time and therefore are unlikely to have a large effect,” Flohr said by email.

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