Eczema 

Eczema is a common childhood condition where the skin is dry and itchy. Generally, children will be diagnosed and managed by their GP. The main treatments for eczema include moisturisers for skin hydration, and topical corticosteroids (which suppress inflammation in the skin when it reacts to allergens/irritants) or topical calcineurin inhibitors (which act on the immune system to reduce skin inflammation), to treat or prevent “flare-ups” of eczema. Moisturisers are applied directly to the skin, and work by reducing water loss or by directly adding water to dry skin. They may also aid in reducing skin inflammation.

Moisturisers (emollients)

There are many different moisturisers available, but very little evidence is available to suggest whether one is better than another. Moisturisers come in many formulations (lotions, creams, gels and ointments) and can be “light” to “heavy” in consistency. Recommendations on which moisturisers to prescribe vary, resulting in frustration for families, who often try multiple moisturisers, or “give up” altogether. Further research is required to determine which moisturiser is more suitable for GPs to recommend first.

BEE Study summary

The BEE research question is: “Which is the best type of moisturiser to prescribe for treating the symptoms of childhood eczema – a lotion, cream, gel or ointment?”

The BEE study aims to answer this question by recruiting 520 children with eczema (aged 6 months to 12 years), from 75 GP practices around England (in/around Bristol, Nottingham & Southampton). All children taking part in this study will be allocated to use just one of the four types of moisturiser, for 16 weeks; (1) Lotion, (2) Cream, (3) Gel, (4) Ointment.

The main outcomes will be patient-reported (Patient Orientated Eczema Measure, POEM) and researcher-collected (Eczema Area and Severity Index, EASI) measures of eczema severity. POEM will be administered weekly for 16 weeks and monthly thereafter for a year. A nested qualitative study, where we talk to parents and their children with eczema, will allow us to understand how moisturiser effectiveness relates to acceptability and implications for clinical practice.

The results of this study will provide important information regarding which of the four types of moisturiser is considered most acceptable and effective, to allow GPs and patients to make well informed decisions when deciding which moisturiser to prescribe to patients.

Qualitative Study

A nested qualitative study, where we talk to parents and their children with eczema, will allow us to understand the acceptability of the different types of moisturisers, including the perceived benefits and disadvantages to families and their plans regarding future use.  We will be asking a small number of families if they would like to take part in one or more interviews with one of the study researchers. We will conduct some interviews early on during the trial and some near the end of the trial. During the interviews, we will be exploring participants opinions and experiences of using moisturisers for their child’s eczema, even if they have stopped using their study moisturiser and are no longer taking part. In total, we plan to interview up to 60 parents/carers and, with permission, some older children who are taking part in the study.