by Zoe Wilkins, Trial Administrator, Centre for Academic Primary Care, University of Bristol
It’s safe to say that I knew little about eczema before working as an administrator on the Best Emollients for Eczema (BEE) trial and even less so about emollients, the different types of moisturiser used to treat the condition.
My own children occasionally suffered with very mild eczema; tiny patches here and there that would clear up with a couple of days of moisturisation. So, it was only after starting work on the trial that I began to understand the complexity of this condition. Some suffer seasonal ‘flare-ups’, for others year-round torment, which can be triggered by many different factors.
Although I knew that if you had eczema it was important to keep skin moisturised, I had not heard of the word ‘emollient’ before. Emollient is the medical word for moisturiser and comes in the form of lotions, creams, gels and ointments. I didn’t realise that, if used on a regular basis, emollients are very important in helping to improve skin and can be used effectively alongside other treatments. I thought there might be a few different emollients available but how wrong I was! I was surprised to learn that there is a vast array of products – well over 100 to choose from.
More astonishing still, although eczema is the most common skin disease in children, with an annual cost of eczema management to the NHS of over £100 million, there is little evidence comparing different types of emollients. I began to realise the difficulty for GPs when parents ask: “which are the best emollients for eczema?”. It must be to tricky to choose both a suitable and effective emollient. Currently parents often work on ‘a hit and miss approach’ in finding which works best and I now understand more clearly the importance of the study and the benefits it may bring.
As the trial has progressed, I have realised that trying to unpick which type of emollients work best is a complicated process. I had never really thought about ‘acceptability’ before – not just whether a treatment works but whether it is ‘acceptable’ to patients. This will play a significant part in determining which of the four types of emollients being compared are recommended. A parent or child might find an ointment too greasy if it gets on bed sheets and clothes, or has to be applied too often if it is a lotion. Acceptability appears subjective and adds to the complex nature of determining which types of emollients are best.
It is wonderful that so many people want to take part in research and that they hope to make a difference by helping to improve treatments and quality of life both now and for future generations. I have loved working on the trial – one thing that has really struck me is the impact the results could have on the everyday lives of children diagnosed with eczema, as well as their families, parents and carers. It is great to play a part in something which might make a difference to people’s lives.
About the Best Emollients for Eczema (BEE) study
The Best Emollients for Eczema (BEE) study is a National Institute for Health Research (NIHR) funded randomised trial, comparing the effectiveness of four types of commonly prescribed emollients for children with eczema (aged between 6 months and 12 years). It aims to offer guidance to parents and clinicians on the most suitable emollient to try first. Results are expected in 2021.
This research was funded by the NIHR Health Technology Assessment (ref 15/130/07). The views expressed are those of the author and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.