Should we use bath emollients for atopic eczema?

What is the evidence of the uncertainty? We searched PubMed, the Cochrane Library, Clinical E vidence, and the Current Clinical Trials database to identify published and ongoing randomised controlled trials and systematic reviews that have assessed the efficacy of bath emollients in patients with atopic eczema. This search followed previous wide consultation among specialists, as well as drug companies, to identify relevant published evidence while preparing an article on bath emollients for the Drug and Therapeutics Bulletin. No published randomised controlled trials have specifically assessed the clinical efficacy of bath emollients in atopic eczema. 8 Also, we are not aware of any longstanding clinical experience of benefit from bath emollients to match that for directly applied emollients. The quantities of emollient deposited on the skin during bathing are likely to be far lower than with directly applied emollients. These points highlight the weakness of the case for using bath emollients. Additionally, we found no published evidence that “complete emollient therapy” has a “maximal effect.” Moreover, the unproved concept of “complete emollient therapy” has fostered assumptions that each of the individual components (including bath emollients) contributes to a worthwhile benefit, despite the absence of confirmatory data. On current evidence, bath emollients could be offering little or no benefit. If so, people who use them in place of directly applied emollients are unknowingly receiving substandard emollient therapy.