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Regular use of emollient
containing glycerol and paraffin
reduces flares in children with
atopic dermatitis
Pediatric Dermatology
Take-home message
•
Children from ages 2 to 6 with mild to moderate atopic dermatitis (AD; n = 335) were
randomized to receive emollients (15% glycerol, 10% soft paraffin) twice daily vs no
emollient. The children treated with emollients had a longer time to first flare, fewer
flares, higher complete remission rates, less corticosteroid consumption, and lower
IGA and SCORAD scores than those who were not. At 12 weeks, significantly fewer
children treated with emollients required corticosteroids or immunosuppressants
(23.6%) than patients not treated with emollients (43.3%).
•
Although emollients are part of standard treatment for AD, there has been limited
evidence that they prevent flares. This study suggests that regular emollient use
in children with mild to moderate AD can reduce flares and use of corticosteroids.
Abstract
BACKGROUND/OBJECTIVES
Emollients are part of
the standard treatment for atopic dermatitis (AD),
although there is limited evidence that regu-
lar use of emollients as management therapy
reduces the frequency of flares and corticoster-
oid consumption. The objective of this study was
to evaluate the benefit of emollient use in the
management of mild to moderate AD in children
by assessing the ability of two different emol-
lients (particularly V0034CR) to prevent flares
and to reduce the use of corticosteroids.
METHODS
In this randomized, open-label study,
patients with a current flare were treated with
a potent topical corticosteroid. After flare res-
olution, patients were centrally randomized to
V0034CR emollient, reference emollient, or no
emollient (1:1:1 ratio) for 12 weeks. New flares
were medically assessed before being treated
with a moderately potent corticosteroid.
RESULTS
A total of 335 children 2 to 6 years of
age were randomized. At 12 weeks, the per-
centage of patients with one or more flares was
statistically significantly lower with V0034CR
(35.1%) than without emollient (67.6%; p < 0.001).
Fewer patients treated with V0034CR required
any corticosteroids or immunosuppressants
(23.6%) than patients with no emollient (43.3%)
at 12 weeks. The difference was significant at
all time points (p = 0.002). Patients treated with
emollients had a longer time to first flare, fewer
flares, higher complete remission rates, less
corticosteroid consumption, lower Investigator
Global Assessment scores, and lower Scoring
Atopic Dermatitis scores than those who were
not. V0034CR was well tolerated, with no spe-
cific safety concerns.
CONCLUSION
Regular emollient use in children
with mild to moderate AD reduces flares and
corticosteroid consumption.
Prevention of flares in children with atopic dermatitis
with regular use of an emollient containing glycerol and
paraffin: a randomized controlled study.
Pediatr
Dermatol
2017 Mar 07;[EPub Ahead of Print], GS
Tiplica, A Kaszuba, L Malinauskienė, et al.
COMMENT
By Robert Sidbury
MD, MPH
R
egular emollient use is an unambig-
uous good for atopic dermatitis. This
international, multi-center, parallel,
open-label randomized trial of children
aged 2-6 years with mild to moderate
atopic dermatitis has documented this
point anew. Children applying a glycerol
and paraffin containing emollient twice
daily to their entire bodies, including
face, had fewer, delayed flares, used less
topical corticosteroids, and had lower
global assessment scores than a simi-
lar group using a different emollient, or
none at all.
Any comparative conclusions based
upon the specific emollients used are
hampered by potential bias, asymmetrical
study design, and the universally vexing
challenge of defining a disease flare. Nev-
ertheless, this study has demonstrated
that emollients are beneficial in the short
term by improving the skin barrier and
decreasing inflammation. Emerging data
suggest that if emollients are started early
enough, they may likewise have long-
term benefit through primary prevention
of not only eczema but potentially other
atopic co-morbidities.
Dr Sidbury is Associate
Professor at the
Department of Pediatrics,
Chief, Division of
Dermatology, University of
Washington School of
Medicine and at Seattle
Children’s Hospital,
Seattle, Washington.
At 12 weeks, significantly
fewer children treated with
emollients required
corticosteroids or
immunosuppressants (23.6%)
than patients not treated
with emollients (43.3%).
EDITOR’S PICKS
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VOL. 1 • NO. 1 • 2017