COMET

Background

Eczema is the most common inflammatory skin disease of childhood.  It can have a significant impact on the quality of the affected child’s life and that of their family.  Moisturisers (emollients) are the mainstay of treatment but despite their importance, there is a weak evidence to guide which should be used first or even how often.  More information on emollient effectiveness emerged as one of the top four priorities (shared by patients/carers and clinicians) in a recent prioritisation exercise of treatments for eczema.

About COMET

COMET (Choice Of Moisturiser in Eczema Treatment) is an NIHR Research for Patient Benefit funded study to determine the feasibility of a large trial to answer the research question “What is the most clinically and cost effective primary emollient to prescribe for infants with eczema?”  A feasibility study is necessary because there are a number of key uncertainties, including: optimal means of patient recruitment; the choice of interventions; and the feasibility of long-term patient-reported data collection.

We aim to recruit 160 children aged between 1 month and 3 years of age with eczema via their general practice.  Participants will be randomised to one of four treatments (Aveeno, Diprobase, Doublebase or Hydromol), which are commonly used and represent the different classes of emollient (lotion, cream, gel and ointment respectively), and followed-up for 3 months.  During this time, carers will be asked to complete daily diaries about their child’s symptoms, use of emollients and other treatment for eczema; and a research nurse (blinded to the treatment) will independently assess the severity of eczema at monthly intervals.  As part of the study, a mobile phone study “app” will be developed, so we can assess its acceptability and the completeness of participant data collected by this route compared with conventional paper diaries.

In addition to establishing the feasibility of the definitive study, we will undertake important methodological work to establish the minimal clinically important differences (MCID) of a biophysical (corneometry) and an objective clinical (EASI) measure of eczema severity.  Establishing the MCID thresholds (and hence what proportion of patients can be considered “responders”) will aid the interpretation of previous studies of emollients and inform future trials of eczema treatments.

For more information

Email study chief investigator, Dr Matthew Ridd.