PracticeUpdate: Dermatology - Vol 1 - No.1 - 2017

EDITOR’S PICKS 5

Regular use of emollient containing glycerol and paraffin reduces flares in children with atopic dermatitis 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. Pediatric Dermatology

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.

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. At 12 weeks, significantly fewer children treated with emollients required corticosteroids or immunosuppressants (23.6%) 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 than patients not treated with emollients (43.3%).

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.

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.

VOL. 1 • NO. 1 • 2017