BATHE

A study to determine whether adding in a bath emollient is helpful in relieving childhood eczema.

Background

Eczema is a skin condition that is very common in young children. It causes itching and sleep problems which lead to distress for the child and the rest of the family and can also impact on schooling and everyday tasks. The main treatment is emollients which moisturise the skin, and steroid creams/ointments to treat flare-ups caused by skin inflammation. A government guideline on childhood eczema has recommended ‘complete emollient therapy’ – a care package that includes directly applied emollient, soap substitute emollient and bath emollient (a liquid added to the bath). However, the guideline highlighted that there is little research evidence on whether adding in a bath emollient is helpful.

Assessing the evidence

While health professionals agree about the benefits of directly applied emollients and avoiding soap for children with eczema, there is less confidence in the possible additional benefits of bath emollients. It is possible that they do help because they are easy to pour in the bath and it is likely that they come into contact with all of the skin. But it is also possible that the emollient effect is much less than the direct application of emollients onto the skin, and not enough to produce any benefit.

Bath emollients can have adverse effects as they sometimes cause stinging and redness of the skin, potentially cause accidents through leaving the bath slippery and may rot bath mats and lead to increased time spent cleaning the bath. Furthermore, there is concern that some families view bath emollients as an alternative to directly applied emollients and are therefore using a less effective therapy instead of something that would help their child’s eczema more. Bath emollients cost the NHS over £16 million per year, a substantial sum given the lack of evidence for their benefit.

The Bath Additives for the Treatment of Childhood Eczema (BATHE) trial will measure whether bath emollients help children with eczema.