GPs should not prescribe bath emollients for children under 12, suggests NICE

NICE has recommended that GPs not prescribe bath softeners for children under 12, in a draft new guideline published today.

The updated guidelines, in consultation until April 4comes after NICE’s independent guidelines committee reviewed new evidence of the BATHE randomized controlled trial, first published in 2018.

Research found that children who used bath emollient additives in addition to other standard eczema treatments benefited no more than children who did not use additives, suggesting that prescribers should stop focusing on bath additives in the treatment of eczema.

Thus, the NICE committee considered that the prescription of an ineffective product imposes unnecessary burdens on patients and caregivers, in terms of acquisition and use of the product.

In cases where children benefit from or enjoy using bath additives, the NICE committee suggests that parents purchase the products over-the-counter.

The updated draft guidance says affected children should be prescribed “a choice of unscented emollients for daily use for moisturizing and cleansing”, and that this should be made available “in large quantities “.

General practitioners should explain to children and their parents or guardians that bath softeners do not help with eczema but can possibly be purchased without a prescription as they do not aggravate the condition.

The guidelines committee considered whether a different recommendation should be made for children with sensory processing disorders who cannot tolerate leave-on emollients applied directly to the skin.

However, he decided against it because “there was no evidence to suggest that bath emollient 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 emphasizes existing recommendations from NHS England GPs not to prescribe bath softeners for reasons of cost effectiveness and because they are available without a prescription. NICE said its clinical recommendation “should further reduce the prescription of bath emollient additives”, which would “save money for the NHS and reduce geographical variation”.

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

Conventional management of atopic eczema involves counseling to avoid things that make the condition worse, using emollients to cleanse and moisturize the skin, and using topical corticosteroids (corticosteroids applied to the skin) to reduce irritation and inflammation.