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Emollients improve treatment results with topical corticosteroids in childhood atopic dermatitis: a randomized
Jolanta Szczepanowska1, Adam Reich, Jacek C Szepietowski
1Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland.
Insights
Adding emollients to topical corticosteroid therapy significantly improves outcomes for children with atopic dermatitis. This combination therapy enhances skin hydration and reduces itching, leading to sustained clinical improvement after treatment cessation.
Area of Science:
- Dermatology
- Pediatrics
- Clinical Research
Background:
- Atopic dermatitis (AD) is a chronic inflammatory skin condition common in children.
- Topical corticosteroids are a mainstay treatment, but often require adjunctive therapies for optimal outcomes.
- Improving skin barrier function and managing symptoms like xerosis and pruritus are key therapeutic goals in AD management.
Purpose of the Study:
- To evaluate the efficacy of adding emollients to standard topical corticosteroid therapy in pediatric atopic dermatitis.
- To assess the impact on disease severity, skin hydration (xerosis), and itching (pruritus).
- To determine if emollient use influences treatment outcomes and long-term disease control.
Main Methods:
- A randomized study involving 52 children (2-12 years) with atopic dermatitis.
- Group A received 0.1% methylprednisolone aceponate cream daily for 2 weeks.
- Group B received the same corticosteroid plus emollients throughout the 6-week study period (2 weeks treatment, 4 weeks follow-up).
- Disease severity was assessed using the Eczema Area and Severity Index (EASI); xerosis and pruritus were clinically and instrumentally evaluated.
Main Results:
- Both groups showed significant improvement in EASI scores (p < 0.001).
- Group B demonstrated significantly better improvement in xerosis, both clinically and via corneometry (p < 0.001).
- A trend towards faster pruritus resolution was observed in Group B (p < 0.001).
- Disease recurrence was noted in Group A after treatment cessation, while Group B maintained clinical improvement (EASI at day 42: 5.29 vs. 1.25, p = 0.01).
Conclusions:
- Concomitant use of emollients with topical corticosteroids significantly enhances the management of pediatric atopic dermatitis.
- Emollients improve xerosis and pruritus during treatment and help maintain clinical benefits post-therapy.
- Integrating emollients into the treatment regimen offers a more sustainable approach to controlling atopic dermatitis in children.
Abstract:
The aim of the study was to investigate whether adding emollients to the standard topical corticosteroid therapy influences the outcome of children with atopic dermatitis. Fifty-two children aged between 2 and 12 yr were divided randomly in two subgroups consisting of 26 children each. Both groups applied 0.1% methylprednisolone aceponate cream on lesional atopic skin once daily for 2 wk and were observed for another 4 wk after treatment discontinuation. Group B used additionally emollients for the whole study period. Patients were evaluated at days 0 (baseline), 7, 14 (end of therapy), 28 and 42 (follow-up). Both groups demonstrated significant improvement of disease severity according to EASI (Eczema Area and Severity Index) scale (group A: 6.8 +/- 3.59 before and 0.87 +/- 1.25 after therapy, p < 0.001; group B: 9.6 +/- 8.39 before and 1.11 +/- 2.37 after therapy, p < 0.001). Xerosis improved significantly better in group B compared to group A, both clinically (group A: 1.38 +/- 0.57 scores before and 1.5 +/- 0.58 scores after therapy, p = 0.11; group B: 1.62 +/- 0.64 scores before and 0.12 +/- 0.33 scores after therapy, p < 0.001), and by corneometry assessment (group A: 41.7 +/- 9.1 units before and 51.3 +/- 11.3 units after therapy, p < 0.001; group B: 38.9 +/- 12.9 units before and 58.2 +/- 13.5 units after therapy, p < 0.001). A trend towards faster resolving of pruritus in group B (group A: 5.44 +/- 2.6 scores before and 3.22 +/- 2.31 scores after therapy, p = 0.001; group B: 5.87 +/- 2.79 scores before and 2.24 +/- 1.59 scores after therapy, p < 0.001) was also observed. In group B, the improvement was maintained for couple of weeks after treatment discontinuation, while in group A recurrence of the disease was noted (EASI at day 42 in group A vs. group B: 5.29 +/- 5.6 vs. 1.25 +/- 1.4, p = 0.01). Similar results were also observed for xerosis (p < 0.001) and pruritus (p = 0.002). Concomitant usage of emollients significantly improves xerosis and pruritus during corticosteroid treatment of atopic dermatitis and enables to maintain clinical improvement after therapy discontinuation.
