The quality of evidence is downgraded by study limitations (unclear allocation concealment and lack of blinding).
A Cochrane review [Abstract] 1 included 77 studies with a total of 6 603 subjects with mainly mild to moderate eczema and with a mean age of 18.6 years (age varied between 4 months and 84 years). Most studies lasted between 2 to 6 weeks, with a few lasting 6 months.
Six studies evaluated moisturiser versus no moisturiser. Moisturiser use yielded lower SCORAD (Scoring atopic dermatitis) than no moisturiser (MD -2.42, 95% CI -4.55 to -0.28; 3 studies, n=276), but the minimal important difference (MID 8.7) was unmet. There were fewer flares with moisturisers (RR 0.40, 95% CI 0.23 to 0.70; 2 studies, n=87; NNTB=3, 95% CI 2 to 5), time to flare was prolonged (median 180 versus 30 days), and less topical corticosteroids were needed over 6 to 8 weeks (MD -9.30 g, 95% CI -15.3 to -3.27; 2 studies, n=222). There was no statistically significant difference in adverse events.
All moisturisers were compared to placebo, vehicle, or no moisturiser (14 studies). Participants considered moisturisers more effective in reducing eczema (RR 2.46, 95% CI 1.16 to 5.23; 5 studies, n=572; NNTB=2, 95% CI 2 to 3) and itch (SMD -1.10, 95% CI -1.83 to -0.38; 7 studies, n=749) than control. Participants in both treatment arms reported comparable satisfaction. Moisturisers led to lower investigator-assessed disease severity (SMD -1.04, 95% CI -1.57 to -0.51; 12 studies, n=1281) and fewer flares (RR 0.33, 95% CI 0.17 to 0.62; 6 studies, n=607; NNTB=4, 95% CI 3 to 5). There was no difference in adverse events.
Topical active treatment combined with moisturiser was more effective than active treatment alone in reducing investigator-assessed disease severity (SMD -0.87, 95% CI -1.17 to -0.57; 3 studies, n=192) and flares (RR 0.43, 95% CI 0.20 to 0.93; 1 study, n=105; NNTB=6, 95% CI 3 to 57), and was preferred by participants. There was no statistically significant difference in number of adverse events.
Four studies examined urea-containing cream versus vehicle, placebo, or no treatment. Urea-containing cream increased participant reported skin improvement compared to placebo (RR 1.28, 95% CI 1.06 to 1.53; 1 study, n=129; NNTB=5, 95% CI 3 to 18), with equal satisfaction between the two groups (1 study, n=38). Urea-containing cream improved investigator-assessed dryness more frequently (RR 1.40, 95% CI 1.14 to 1.71; 1 study, n=128; NNTB=4, 95% CI 3 to 9) with fewer flares (RR 0.47, 95% CI 0.24 to 0.92; 1 study, n=44; NNTB=3, 95% CI 2 to 11), but more participants in this group reported adverse events (RR 1.65, 95% CI 1.16 to 2.34; 1 study, n=129; NNTH=4, 95% CI 2 to 11).
Three studies assessed glycerol-containing moisturiser versus vehicle or placebo. Glycerol-containing cream increased participant reported skin improvement compared to vehicle or placebo (RR 1.22, 95% CI 1.01 to 1.48; 1 study, n=134; NNTB=6, 95% CI 3 to 60), and improved investigator-assessed SCORAD (MD -2.20, 95% CI -3.44 to -0.96; 1 study, n=249), but MID was unmet. There was no statistically significant difference in adverse events.
Four studies compared atopiclair (containing glycyrrhetinic acid) versus vehicle. Atopiclair improved participant-assessed disease severity compared to vehicle (RR 4.51, 95% CI 2.19 to 9.29; 3 studies, n=390; NNTB=2, 95% CI 1 to 2), decreased itching (MD -2.65, 95% CI -4.21 to -1.09; 4 studies, n=396) and achieved more frequent satisfaction (RR 2.14, 95% CI 1.58 to 2.89; 2 studies, n=248; NNTB=2, 95% CI 2 to 3), fewer flares (RR 0.18, 95% CI 0.11 to 0.31; 3 studies, n=397; NNTB=3, 95% CI 3 to 5), and lower Eczema Area and Severity Index (EASI) (MD -4.0, 95% CI -5.42 to -2.57; 4 studies, n=426), but MID (6.6) was unmet. The number of participants reporting adverse events was not statistically different.
Four studies investigated oat-containing moisturisers versus no treatment or vehicle. No significant differences between groups were reported for participant-assessed disease severity, satisfaction, and investigator-assessed disease severity. In the oat group, there were fewer flares (RR 0.31, 95% CI 0.12 to 0.77; 1 study, n=43; NNTB=2, 95% CI 1 to 5) and less topical corticosteroids needed (MD -9.30g, 95% CI -15.3 to -3.27; 2 studies, n=222), but more adverse events were reported (Peto OR 7.26, 95% CI 1.76 to 29.92; 1 study, n=173).
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