Practical Dermatology Chief Medical Editor Neal Bhatia, MD, FAAD, is joined by Dawn Eichenfield, MD, PhD, to discuss “Emollients to Prevent Pediatric Eczema” from JAMA Dermatology.
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Dr. Neal Bhatia:Hi, I'm Dr. Neal Bhatia. I'm Chief Medical Editor of Practical Dermatology. And this is another installment of Type II Inflammation Journal Club. I'm happy to have Dr. Dawn Eichenfield. She's assistant professor at UCSD. Thanks for coming, Dawn.
Dr. Dawn Eichen...:Thank you.
Dr. Neal Bhatia:I've got the better of the two Eichenfields with me, so thank you.
Dr. Dawn Eichen...:(Laughs). It's a pleasure to be here.
Dr. Neal Bhatia:So we're going to talk about this article that was in JAMA Derm. It's a little bit about the need and really to educate everybody about, why kids have to moisturize and how it can be used to prevent eczema and kind of keep eczema at bay. Why is this topic so important?
Dr. Dawn Eichen...:I think we sometimes don't get a chance to emphasize how important it is to moisturize, and kind of really good skincare is so important for atopic dermatitis. And now there's more literature showing us that moisturizing isn't just about keeping the skin moist, but moisturizing in younger kids can actually prevent atopic dermatitis. And I think that's really interesting, and that's of interest to a lot of parents out there, parents who probably have other older kids with atopic dermatitis, or they themselves have atopic dermatitis and they're interested in preventing it for their kids, so their kids don't have to worry about the same things they worry about.
Dr. Neal Bhatia:Yeah. I mean, I've heard the analogies that moisturizing should be like toothpaste to the skin, right?
Dr. Dawn Eichen...:Yeah.
Dr. Neal Bhatia:And especially for eczema kids.
Dr. Dawn Eichen...:Yeah.
Dr. Neal Bhatia:But in the conversation with parents about the ingredients of emollients or about moisturizers, agnostic to any brands or anything else, what would you recommend in terms of what should a good moisturizer have?
Dr. Dawn Eichen...:I think really good moisturizers... I usually tell parents to get a moisturizer that is usually for eczema just because in order for a moisturizer to be marketed as for eczema, they have to meet certain requirements. And one of the requirements is that they have to have some type of anti-inflammatory nature of the moisturizer. Usually that means they either put, like, topical steroid or they put colloidal oatmeal in there. And I think the colloidal oatmeal is actually really important for the anti-inflammatory nature.
Dr. Neal Bhatia:Yeah.
Dr. Dawn Eichen...:I also think that moisturizers should help buffer and make up your skin barrier a lot better. So moisturizers that have ceramides are actually going to be much more important for atopic dermatitis patients.
Dr. Neal Bhatia:Yeah. And there's a bunch of moisturizers out there that we're all familiar with. And some have anti-itch ingredients like pramoxine and some of the other topicals in there, like colloidal oatmeal is a very important one.
Dr. Dawn Eichen...:Yeah.
Dr. Neal Bhatia:Talk about a little bit with this study, there was a kind of a discrepancy with how well the control group did and how well the active treatment arm did. It was a kind of interesting dynamic.
Dr. Dawn Eichen...:I think it was a really interesting study. So, what was interesting about the study is first of all, you had a choice for the type of moisturizer that you got to use. So it wasn't just they were assigned a moisturizer, they got to choose from a number of different moisturizers, and a lot of them actually had ceramides in them. So they were good eczema moisturizers, so to speak. And then what was also interesting was that these kids started really early, and then ultimately, what was interesting about the control arm, as you're alluding to, is that the control arm actually had a pretty high level of atopic dermatitis that developed, higher than what we normally see. I think it was like in the 30 something percentile. Whereas, in the intervention group, of course, that was lower. So if you say you were to do this intervention in a different group of patients, maybe you would even see a bigger result, just because it's possible that this study was selecting for patients who were already very heightened and doing things to help control their atopic dermatitis, and they were going to be predisposed to atopic dermatitis to begin with just because they're really interested in the study.
Dr. Neal Bhatia:Yeah. So taking that, you know, as a observational point to talk to parents, you can again make the case. If you moisturize early in their childhood, moisturize obviously a couple times a day, perhaps before bed, because that was kind of thinking abou twhat was the schedule that they were sticking to in the trial.
Dr. Dawn Eichen...:. So I think the schedule was just once a day.
Dr. Neal Bhatia:Once a day, yeah.
Dr. Dawn Eichen...:Yeah. So I think what's really interesting in this trial is I think there's been a lot of back and forth. There's also Cochrane Reviews, a lot of back and forth about whether or not moisturizing is important. I think there have been multiple studies saying yes and multiple saying no. I think what's really important about this study is they used a very good moisturizer. So something containing ceramides. And I think that it is important to use a moisturizer that just isn't grease.
Dr. Neal Bhatia:Yeah, exactly.
Dr. Dawn Eichen...:So, I come from a place where people are using, like, beef tallow. Do you hear that, too?
Dr. Neal Bhatia:I hear that all. Yeah.
Dr. Dawn Eichen...:I'm sure. You come from the same area. Yeah.
Dr. Neal Bhatia:Same profile.
Dr. Dawn Eichen...:Of course.
Dr. Neal Bhatia:Exactly.
Dr. Dawn Eichen...:Yeah. And I feel like, I don't think beef tallow contains ceramides, unfortunately.
Dr. Neal Bhatia:Yeah. It doesn't. And what's even worse is again when you think about fragrance, when you think about some of the other ingredients that could actually cause more problems than help.
Dr. Dawn Eichen...:Yeah, like lavender.
Dr. Neal Bhatia:Exactly. But then we're dealing with ethnic groups and some bias that actually makes, they come with some resistance. So part of that, too, is I couldn't figure out a downside to moisturizing. Could you think of one single negative reason to not moisturize?
Dr. Dawn Eichen...:Generally, no. I think, I think there have been some thoughts about if you're greasing up your baby, would you be trapping bacteria or funguses in there? I think there were some smaller studies earlier on that were showing that. I think a lot of the more recent moisturizers are not as occlusive as some of the stuff that was utilized for some of the earlier studies. So I think what you moisturize with is going to be really important.
Dr. Neal Bhatia:Yeah. And we were talking before about taking kids to the pool. You know, that's another good time to moisturize, especially if they're atopic.
Dr. Dawn Eichen...:Yeah.
Dr. Neal Bhatia:And then, you know, you catch your kids itching and you can see if they're dry.
Dr. Dawn Eichen...:Yeah.
Dr. Neal Bhatia:But what points would you want to tell the audience about talking to parents? Because sometimes, again, the parents have their hands up and they may be the biggest obstacle sometimes.
Dr. Dawn Eichen...:So I think the major point is just reiterating that moisturizing with a good moisturizer is something that's going to help your skin barrier, is kind of the cornerstone of atopic dermatitis prevention, and for atopic dermatitis management and treatment.
Dr. Neal Bhatia:That sounds great. How would you spin that into sunscreens? Because obviously we have the same obstacles sometimes with parents and sunscreens. Would you have any pearls for the audience just to tell them about, I mean the parents?
Dr. Dawn Eichen...:Yeah. I think I'm, well, of course, we're big proponents of sunscreen-
Dr. Neal Bhatia:Absolutely.
Dr. Dawn Eichen...:... because we're dermatologists. I think I say the same thing. I mean, I tell them, you're not going to see the damage today, you're going to see the damage that's always cumulative to the skin. You don't want to get skin cancers when you're older. I think a lot of times it's not the parents. Parents usually want their kids to use sunscreen. It's more the kids.
Dr. Neal Bhatia:Yeah.
Dr. Dawn Eichen...:It's more kind of the adolescents and the teenagers who don't want something greasy, don't want something on their skin.
Dr. Neal Bhatia:Yeah.
Dr. Dawn Eichen...:It's too much time. So I think there's lots of great cosmetically elegant formulations that apply nicely to the skin. There's sprays that work well too. I think there's so many things that are available now that we're really not stuck with just using, like, really gross, like-
Dr. Neal Bhatia:Exactly.
Dr. Dawn Eichen...:... sort of things that we used to be.
Dr. Neal Bhatia:Right, right. I mean, we joke about the San Diego soccer moms who know more than we do, right? But I had the same problem when I worked in Wisconsin, and I was trying to get, you know, kids to use sunscreen in the wintertime. And they said, "No, it's cold." I said, "It's not about the temperature. It's about what ultraviolet light you're getting. And same thing with kids now with phones and devices. They're getting blue invisible light, and they should protect themselves. So that's good. Well, these are great pearls, Dawn, thank you. And this was another installment of Type II Inflammation Journal Club, and we'll see you next time.
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Practical Dermatology Chief Medical Editor Neal Bhatia, MD, FAAD, is joined by Dawn Eichenfield, MD, PhD, to discuss “Emollients to Prevent Pediatric Eczema” from JAMA Dermatology.
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