Emollients and moisturisers for eczema: abridged Cochrane systematic review including GRADE assessments

Summary

Eczema is a chronic inflammatory skin disorder with considerable impact on quality of life. Emollients or moisturisers are widely recommended, but are these effective and safe? We searched for randomised controlled trials (RCTs) in the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library, Medline, Embase, LILACS, GREAT database and five trial registers to December 2015. We included 77 RCTs with 6603 participants. Seven studies (9.1%) were at low risk of bias, 34 (44.2%) at unclear and 36 (46.8%) at high risk. The quality of the evidence was mainly low or moderate for the prespecified outcomes. The most important comparison ‘moisturiser versus no moisturiser’ showed an improved SCORAD in the moisturiser group compared to no moisturiser (mean difference (MD) -2.42, 95% confidence interval (CI) -4.55 to -0.28), but did not meet the minimal important difference (MID) of 8.7. Fewer flares were seen (risk ratio (RR) 0.40, 95% CI 0.23 to 0.70) and rate of flare was reduced (hazard ratio (HR) 3.74, 95% CI 1.86 to 7.50). The groups applying moisturiser used less topical corticosteroids over six to eight weeks (MD -9.30 g, 95% CI 15.3 to -3.27). Glycyrrhetinic acid-containing cream, urea-containing and glycerol-containing creams worked better than their control (vehicle, placebo or no moisturiser) according to both participants and physicians. More flares were reported with moisturiser alone than when combined with twice weekly fluticasone propionate (RR 2.17, 95% CI 1.55 to 3.11). Adding moisturisers to topical anti-inflammatory treatment was more effective than anti-inflammatory treatment alone and with fewer flares.

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