Effectiveness and safety of lotion, cream, gel, and ointment emollients for childhood eczema

Eczema is characterised by dry and inflamed, itchy skin and affects around 20% of children. A recent study compared the clinical effectiveness and safety of the four main emollient categories (lotions, creams, gels, and ointments).

It randomized children aged between 6 months and 12 years with eczema (Patient Orientated Eczema Measure [POEM] score >2) to lotions, creams, gels, or ointments. The initial emollient prescription included 500 g or 500 mL, to be applied twice daily and as required. The family determined subsequent prescriptions. The study then looked for parent-reported eczema severity over 16 weeks (weekly POEM) and safety.

The study observed the following-

• It assessed 12417 children for eligibility.
• It randomly assigned 550 children to a treatment group (137 to lotion, 140 to cream, 135 to gel, and 138 to ointment). 
• 131 participants in the lotion group, 137 in the cream group, 130 in the gel group, and 126 in the ointment group contributed to at least two POEM scores and were included in the primary analysis. 
• The baseline median age was four years; 46% of participants were girls, 54% were boys, 86% of participants were White, and the mean POEM score was 9•3. 
• No differences were seen in eczema severity between emollient types over 16 weeks, with adjusted POEM pairwise differences of cream versus lotion being 0•42, gel versus lotion being 0•17, ointment versus lotion being −0•01, gel versus cream being −0•25, ointment versus cream being −0•43, and ointment versus gel being −0•18. 
• This result remained consistent even after multiple imputations, sensitivity, and subgroup analyses. 
• The total number of adverse events was similar between the treatment groups (lotions 36%, creams 39%, gels 40%, and ointments 35%).
• Stinging was less common with ointments (9% of participants) than lotions (20%), creams (17%), or gels (19%).

Thus this study described no difference in effectiveness between the four main types of emollients for childhood eczema. Patients must choose from a range of emollients to find one that they are more likely to use effectively.

Ridd MJ, Santer M, MacNeill SJ, et al. effectiveness and safety of lotion, cream, gel, and ointment emollients for childhood eczema: a pragmatic, randomized, phase 4, superiority trial. The Lancet Child & Adolescent Health. 2022;6(8):522-532. https://doi.org/10.1016/S2352-4642(22)00146-8.