How and what adverse events are reported and captured in randomized control trials of emollients in the treatment of eczema?

Emollients are universally accepted as a treatment for atopic dermatitis; however, our knowledge of the frequency and nature of adverse effects associated with their use is limited. We sought to determine how well adverse events are reported in randomized controlled trials of emollients for eczema. We concluded that they are poorly reported and agreement should be reached on how and what adverse events should be collected to standardize reporting across studies. Background Emollients are universally recommended for atopic dermatitis/eczema ('eczema'), to improve the skin barrier and reduce symptoms. However, our knowledge of the frequency and nature of adverse effects associated with their use is limited. Objectives We sought to determine how well adverse events are reported in randomized controlled trials (RCTs) of emollients for eczema. Methods MEDLINE was searched from inception (1946) to May 2022. Inclusion criteria were RCTs of moisturizers or emollients used as a leave-on treatment (as the intervention or control) in adults or children with eczema. Exclusion criteria were non-RCTs; patients with other diagnoses included; use of emollient as bath additives, soap substitutes or as preventative; and not published in English. References of eligible papers were reviewed for any additional, relevant research. Data were extracted into an Excel spreadsheet and analysed descriptively. An assessment of study quality was carried out using the Joanna Briggs Institute tool for RCTs. Results From 369 potential papers, 35 papers (reporting on 34 studies) were included. Most research was conducted in research centres or hospitals (unclear in 34%). In total, 89% reported collecting data on adverse events related to emollient treatment use but the methods used were poorly reported (40% unclear). Four papers used patient questionnaires/diaries. However, it was unclear how and what was collected as only two studies showed the questionnaires used. Conclusions Reporting of adverse events related to emollient use in trials of patients with eczema is poor and inconsistent. Agreement should be reached on how and what adverse events should be collected, to standardize reporting across studies.

Automated summary

Emollients are widely used for treating atopic dermatitis, but there is limited knowledge about the adverse effects associated with their use. This study aimed to evaluate the reporting of adverse events in randomized controlled trials of emollients for eczema. The results showed poor and inconsistent reporting of adverse events, indicating the need for standardized reporting guidelines.