Cochrane Review: All Moisturizers Created Equally for Eczema

No one moisturizer is better than another when it comes to relieving the symptoms of eczema, according to a new Cochrane Review.

Overall, most moisturizers show beneficial effects for eczema, work better with active treatment, prolong time to flare, and reduce the number of flares and amount of topical corticosteroids needed to achieve similar reductions in eczema severity.

The researchers reviewed 77 studies (6603 participants, mean age: 18.6 years, mean duration: 6.7 weeks).  Of these, almost a third of the studies reported how people assessed their eczema. Only 13 assessed satisfaction with the moisturizer. The studies mostly evaluated physician-assessed eczema severity (65 studies). Other outcomes addressed were skin barrier function (29 studies), flare prevention (16), quality of life (10), and corticosteroid use (8).

Moisturizers reduced eczema severity compared with no moisturizer (three studies), but the reduction was too small to be considered important enough for a patient, according to the physicians. Moreover, there were fewer flares (two studies) and less topical corticosteroids were needed (two studies).

Participants thought Atopiclair (containing glycyrrhetinic acid) was more than four times more effective in improving eczema-severity than the vehicle, i.e. carrier (three studies). However, the physicians did not find a difference considered important enough for a patient. Atopiclair led to greater reduction of itch (four studies), more frequent satisfaction (two studies), and fewer flares (three studies). The number of reported adverse events was similar in each group, the review found.

Four studies evaluated urea-containing cream. Participants using urea reported skin improvement more often than those using placebo (one study). Satisfaction ratings were comparably positive between the two groups (one study).  In addition, urea-containing cream improved dryness more often (physician assessment) (one study) and led to fewer flares (one study), but more adverse events were reported in this group.

Three studies assessed glycerol-containing moisturizer versus vehicle or placebo. More participants in the glycerol group considered their skin to be improved (one study), as did the physicians, but this was not considered important enough for patients. There was no difference in the number of adverse events reported in these studies.

Four studies investigated oat-containing moisturizers versus no treatment or vehicle. No differences between groups were observed for participant assessment of improvement (one study), satisfaction (one study), or physician-assessed improvement (three studies). However, fewer flares were reported in the oat group (one study), and less topical corticosteroids were needed (two studies). Oat creams caused more adverse events.

Participants considered moisturizers more than twice as effective in improving eczema than placebo, vehicle, or no moisturizer (five studies) and more effective on itch (seven studies). Participants in both treatment arms reported comparable satisfaction (three studies). The physicians, reported that moisturizers decreased eczema severity more than the control (12 studies) and led to fewer flares (six studies). There were no differences between the groups in the number of adverse events reported.

Topical corticosteroids were more effective in improving eczema when used together with a moisturizer, rather than alone, according to the physicians (three studies) and also reduced the number of flares (one study). Patients also preferred the combination. There was no difference in the number of adverse events reported.