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How parents and children evaluate emollients for childhood eczema: a qualitative study
Eileen Sutton1, Alison Rg Shaw1, Matthew J Ridd1
1Bristol Population Health Sciences Institute, University of Bristol, Bristol.
Insights
No single emollient suits all children with eczema. Parents and children prioritize different factors like thickness and absorbency when choosing eczema treatments. Effectiveness drives continued use of emollients.
Area of Science:
- Dermatology
- Pediatrics
- Qualitative Research
Background:
- Eczema is common in UK children, affecting one in five.
- Emollients are standard treatment, but choosing the best type is challenging.
- Current 'trial and error' methods cause frustration for families and clinicians.
Purpose of the Study:
- To understand how parents and children experience and evaluate different emollient types for eczema.
- To identify key factors influencing emollient selection and use in pediatric eczema management.
Main Methods:
- A qualitative interview study nested within the Best Emollients for Eczema (BEE) trial.
- Semi-structured interviews were conducted with 44 parents and 24 children with eczema.
- Participants were selected based on emollient type, age, and eczema severity.
Main Results:
- No single emollient type was preferred; experiences varied significantly across lotions, creams, gels, and ointments.
- Thickness and absorbency were key evaluation criteria, viewed both positively and negatively.
- While effectiveness and acceptability were considered, effectiveness was the primary factor for continued use.
- Trial participation improved emollient knowledge and led to more regular, longer-term use for some.
Conclusions:
- Individualized emollient selection is crucial, as preferences and priorities differ.
- Future research should explore decision aids and tester pots to facilitate collaborative emollient choice.
- Empowering families and clinicians with better tools can improve eczema management outcomes.
Background:
Eczema affects one in five children in the UK. Regular application of emollients is routinely recommended for children with eczema. There are four main emollient types, but no clear evidence of which is best. The current 'trial and error' approach to find suitable emollients can be frustrating for parents, children, and clinicians.
Aim:
To identify how parents and children experience and evaluate emollients.
Design And Setting:
Qualitative interview study, nested within a primary care trial of emollients (Best Emollients for Eczema [BEE] trial).
Method:
Semi-structured interviews with children with eczema and their parents were conducted. Participants were purposively sampled on emollient type (lotion, cream, gel, or ointment), age, and eczema severity.
Results:
Forty-four parents were interviewed, with children participating in 24 of those interviews. There was no clear preference for any one emollient type. The strongest theme was the variation of experience in each of the four types. Participants focused on thickness and absorbency, both positively and negatively, to frame their evaluations. Effectiveness and acceptability were both considered when evaluating an emollient but effectiveness was the primary driver for continued use. For some, participating in the trial had changed their knowledge and behaviour of emollients, resulting in use that was more regular and for a longer duration.
Conclusion:
There is no one emollient that is suitable for everyone, and parents/children prioritise different aspects of emollients. Future research could evaluate decision aids and/or tester pots of different types, which could enable clinicians and parents/children to work collaboratively to identify the best emollient for them.
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