Adding emollient bath additives to standard eczema management for children with eczema: the BATHE RCT

Santer, Miriam; Rumsby, Kate; Ridd, Matthew J; Francis, Nick A.; Stuart, Beth; Chorozoglou, Maria; Roberts, Amanda; Liddiard, Lyn; Nollett, Claire; Hooper, Julie; Prude, Martina; Wood, Wendy; Thomas-Jones, Emma; Becque, Taeko; Thomas, Kim S.; Williams, Hywel C.; Little, Paul

Abstract

Plain English Summary
Eczema is very common in children and can have a significant impact, causing itching and sleep problems. The main treatments are emollients, which are used to moisturise the skin, and steroid creams or ointments to treat flare-ups. Guidelines have suggested that people with eczema should use ‘complete emollient therapy’, including an emollient for washing (soap substitute), an emollient applied directly to the skin (leave-on emollient) and an emollient liquid added to the bath (bath additive). However, there is little evidence to show that using bath additives is helpful. This trial measured whether or not bath additives help children with the symptoms of eczema.

Children with eczema aged between 1 and 11 years were all given standard eczema management. Half of the children were also asked to use a bath additive, and this was decided at random. Bath additives were prescribed by the child’s general practitioner (GP). We suggested that children used Oilatum® (Stiefel Skin Science Solutions, a GlaxoSmithKline company, Middlesex, UK), Balneum® (Almirall Ltd, Middlesex, UK) or Aveeno® (Johnson & Johnson Ltd, Maidenhead, UK) bath additives, as these are the most frequently prescribed, but parents/carers and GPs could choose an alternative. Parents/carers completed short questionnaires about their child’s eczema severity weekly for the first 16 weeks, then every 4 weeks from weeks 16 to 52. We asked parents/carers about any side effects or difficulties they had in using the treatment and whether or not they used any additional treatments. We also checked how many flare-ups of eczema were recorded in their GP records over 1 year and what
treatments had been prescribed.

A total of 482 children from 96 general practices took part in the study. We found no difference between the two groups, either in eczema severity or in problems, such as stinging, redness or slipping. The Bath Additives for the Treatment of Eczema in cHildren (BATHE) trial found that, although emollient bath additives are safe, they are not a useful additional treatment for children who are receiving standard eczema care, such as using leave-on emollients and emollients as soap substitutes.

Citation

Santer, M., Rumsby, K., Ridd, M. J., Francis, N. A., Stuart, B., Chorozoglou, M., …Little, P. (2018). Adding emollient bath additives to standard eczema management for children with eczema: the BATHE RCT. Health Technology Assessment, 22(57), 1-116. https://doi.org/10.3310/hta22570

• Journal Article Type: Article
• Acceptance Date: Apr 1, 2018
• Online Publication Date: Oct 31, 2018
• Publication Date: Oct 31, 2018
• Deposit Date: Nov 26, 2018
• Publicly Available Date: Nov 27, 2018
• Journal: Health Technology Assessment
• Print ISSN: 1366-5278
• Electronic ISSN: 2046-4924
• Publisher: NIHR Journals Library
• Peer Reviewed: Peer Reviewed
• Volume: 22
• Issue: 57
• Pages: 1-116
• DOI: https://doi.org/10.3310/hta22570
• Keywords: Health Policy
• Public URL: https://nottingham-repository.worktribe.com/output/1308569
• Publisher URL: https://www.journalslibrary.nihr.ac.uk/hta/hta22570#/abstract
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