Atopic dermatitis in children is a chronic inflammatory disease with a genetic predisposition. It is estimated that it affects 10% to 20% of children in industrialized countries. Treatment involves topical steroids and emollients. Although emollient therapy is widely recommended, its benefit has not been proven in a controlled study. In a randomized, controlled study, 173 infants were assigned to a control group (no emollients; n = 82) or a treatment group (emollient; n = 91) for 6 weeks. The use of moderate- or high-potency topical steroids was monitored in both groups. Changes in the disease and quality of life were assessed by using 3 standardized scoring systems: scoring atopic dermatitis index, infant's dermatitis quality of life index, and dermatitis family life impact scale. Emollient use decreased the use of moderately potent steroids by only 7% compared with the control group. In contrast, emollients resulted in a significant reduction (42%) in use of high-potency steroids. The concurrent use of emollients was also associated with a significant improvement in the quality of life for infants and their parents.
COMMENTARY: Numerous studies have shown that defects in the epidermal lipid barrier of humans are an important part of the pathogenesis of atopic dermatitis. To date, no such defect in dogs has been documented. Until this question is answered conclusively, controlled studies such as this one cannot be constructed for dogs. It is unknown how bathing and emollient therapy, which can be expensive and time consuming, will affect the dog's quality of life and need for other antipruritic agents. The use of emollients may be beneficial in some patients but not others, for very different reasons.
The steroid sparing effect of an emollient therapy in infants with atopic dermatitis: A randomized controlled study. Grimalt R, Mengeaud V, Cambazard F. DERMATOLOGY 214:61-67, 2007.