Update on Emollients in Infants
Earlier this month, I was speaking at the College of Podiatry Online Conference discussing emollients and how they may be used. The focus was mainly on adults with dry skin consequently, it reminded me to have a look at the literature pertaining to emollient use particularly in children. So in this blog article, I will look at some recently published papers on this topic.
Dry skin is not such a common feature in the general paediatric population but most of the literature on emollient use pertains to atopic eczema where emollients are considered a major part of managing the condition in children. The use of emollients can reduce flares of the skin condition. In 2019, a paper was published in the British Medical Journal which investigated which emollients are safe and most effective for use in children with eczema (1).Many are available on the market from pharmacies and over the counter with a bewildering array of ingredients and claims of “dermatologically tested” and “hypoallergenic” etc., so which are best? The review looked at many papers on this topic. Ultimately, it could not discern which were more effective as there was too much uncertainty within the diverse range of studies. Consequently, they recommended that the best emollient is the one that the patient uses. Twice daily application of the chosen emollient is recommended. The study also concluded that generally, emollient use is safe – however, they emphasize that clothes which have been in contact with an emollient or emollient treated skin can rapidly ignite and so care must be needed particularly around naked flames.
The second paper published in the Lancet was a major piece of work undertaken under the name of the BEEP study (2). Atopic eczema commonly begins in infancy and can be carried through into adulthood in many cases. Additionally, for many atopic patients, they may go onto develop a food allergy. Curiously, sensitization and food allergy can occur through a defective skin barrier. Preceding studies had observed that it may be possible to prevent the development of eczema through the strict use of emollients in children of families with a high risk of eczema development. Consequently, the BEEP study was set up to test this hypothesis – could the use of emollients in the first year of life prevent the development of eczema?
The study was a randomised controlled trial 1394 newborn children from different locations in the UK meeting the criteria (with a strong family history of eczema) were enrolled and split into two groups. Group one received skincare advice plus emollients, whilst group two received skincare advice only. They were followed for a year to see how many went on to develop eczema (using predefined criteria). The results reported that in both groups around 25% of newborns had developed eczema in each group (23% intervention group v 25% in the control group). Ultimately, the study concluded that the use of emollients in newborns does not appear to prevent the development of eczema in high-risk infants. Interestingly, there was also a slightly higher rate of skin infections occurring in the emollient group. The authors conclude that since the study new products have come to market which may have a protective effect in eczema, along with using soft water and reducing soap use, may potentially prevent eczema development in children but of course, that hypothesis needs testing.
1. Ridd MJ, Roberts A, Grindlay D, Williams HC. Which emollients are effective and acceptable for eczema in children? 2019;367:5882.
2. Chalmers JR, Haines RH, Bradshaw LE, Montgomery AA, Thomas KS, Brown SJ, et al. Daily emollient during infancy for prevention of eczema: the BEEP randomised controlled trial. Lancet (London, England).2020;395(10228):962-72.