Estimating emollient usage in patients with eczema.

Abstract:

BACKGROUND:Atopic eczema (AE) is characterized by reduced skin hydration (SH) and impaired integrity of the skin. Proper emollient usage is an important facet of AE management and patients are encouraged to use emollients liberally. AIM:To evaluate whether the amount of emollient and skin cleanser used correlates with eczema severity, SH or transepidermal water loss (TEWL), and whether liberal usage alters disease severity, SH and TEWL. METHODS:We studied SH and TEWL at three common measurement sites on the forearm (antecubital flexure, 20 mm below the antecubital flexure, mid-forearm) and determined the SCORing Atopic Dermatitis (SCORAD) score, Nottingham Eczema Severity Score (NESS), Children's Dermatology Life Quality Index (CDLQI) and the amount of emollient and cleanser usage over a 2-week period in consecutive new patients seen at the paediatric skin clinic of a teaching hospital. RESULTS:In total, 48 subjects and 19 controls were recruited. Patients with AE had significantly higher TEWL and lower SH in the studied sites. Emollient and cleanser usage was significantly higher (P = 0.001 and P = 0.041, respectively) in patients with AE than in controls. The amount of emollient usage was correlated with NESS, SCORAD, CDLQI, TEWL and mid-forearm SH. No such correlation was found with cleanser usage. Regardless of SCORAD, prescribing 130 g/m(2)/week of emollient met the requirement of 95.8% of patients, and 73 g/m(2)/week met that of 85.4%; for the cleanser, prescribing 136 g/m(2)/week met the requirement of 91.7% of patients. Although skin dryness and SH were improved, there was no significant improvement in SCORAD or TEWL after 2 weeks. In terms of global acceptability of treatment, three-quarters of patients with AE and controls rated the combination of cream and cleanser as 'good' or 'very good'. CONCLUSIONS:Adequate amounts of emollient and bathing cleanser should be prescribed to patients with AE. These amounts can be conveniently estimated based on body surface area instead of the less readily available tools for disease severity, degree of SH or skin integrity. However, liberal usage of emollients and bathing cleanser alone does not seem to alter disease severity or TEWL within 2 weeks, implying that additional treatments are necessary to manage AE.

journal_name

Clin Exp Dermatol

authors

Hon KL,Ching GK,Leung TF,Choi CY,Lee KK,Ng PC

doi

10.1111/j.1365-2230.2009.03341.x

subject

Has Abstract

pub_date

2010-01-01 00:00:00

pages

22-6

issue

1

eissn

0307-6938

issn

1365-2230

pii

CED3341

journal_volume

35

pub_type

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