NICE has recommended that bath emollients are not prescribed for children under 12, in a new draft guideline published on 21 March 2023.

The updated guidance, out for consultation until 4 April, comes after NICE’s independent guideline committee considered new evidence from the randomised controlled BATHE trial, first published in 2018.

The research found that children who used emollient bath additives in addition to other standard treatments for eczema did not benefit more than children who did not use additives, suggesting that prescribers should stop focusing on bath additives in the treatment of eczema.

As such, the NICE committee considered that prescribing an ineffective product places unnecessary burdens on patients and carers, in terms of acquiring and using the product.

In cases where children benefit from or enjoy using bath additives, NICE’s committee suggests parents buy the products over the counter.

The updated draft guideline says affected children should be prescribed ‘a choice of unperfumed emollients to use every day for moisturising and washing’, and that this should be made available ‘in large quantities’.

Prescribers should explain to children and their parents or carers that bath emollients don’t help with eczema but can optionally be purchased over the counter as they don’t make the condition worse.

The guideline committee considered whether a different recommendation should be made for children with sensory processing disorders who are unable to tolerate leave-on emollients that are applied directly to the skin.

However it decided not to because ‘there was no evidence to suggest that emollient bath additives are effective for this group’ and because ‘leave-on emollients can be diluted in hot water and added to bath water, so there is already an alternative option available’.

The guideline underscores existing NHS England recommendations for GPs not to prescribe bath emollients on the grounds of cost efficiency, and the fact that they are available over the counter. NICE said its clinical recommendation ‘should further reduce prescribing of emollient bath additives’ which ‘would save money for the NHS and reduce geographical variation’.

Around one in five children suffer from atopic eczema, a chronic inflammatory itchy skin condition that usually develops in early childhood. According to NICE, the condition can have a profound psychological/psychosocial impact on the lives of children and their carers, affecting their quality of life in various ways.

Conventional management of atopic eczema involves advice on avoiding things that make the condition worse, the use of emollients to cleanse and moisturise the skin, and the use of topical corticosteroids (corticosteroids applied to the skin) to reduce irritation and inflammation.

This article was first published on our sister publication, Pulse. 

Draft NICE guidance on the treatment of childhood eczema Offer children with atopic eczema a choice of unperfumed emollients to use every day for moisturising and washing. This may be a combination of products or one product for all purposes. Prescribe large quantities of leave-on emollients (250g to 500g weekly) that are easily available to use at nursery, pre-school or school. [2007, amended 2023] When children with atopic eczema are using emollients and other topical products at the same time of day, explain that:

  • they should apply one product at a time, and wait several minutes before applying the next product
  • they can choose which product to apply first. [2007, amended 2023]  Do not offer emollient bath additives to children with atopic eczema. [2023] Explain to children with atopic eczema and their parents or carers that:

  • emollient bath additives do not help with atopic eczema
  • however, they do not make eczema worse, and they can be bought over the counter if the child and their parents or carers want to use them. [2023]

Source: NICE