Potent Topical Corticosteroids Research Articles

409 Dupilumab prevents flares in adults with moderate-to-severe atopic dermatitis in a 52-week, randomized, controlled, phase 3 trial

Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by flares, defined by US and EU guidelines as acute, clinically significant worsening of signs and symptoms of AD requiring therapeutic intervention. Flare prevention is a hallmark of long-term disease control in AD. Here, we report the effect of dupilumab treatment for 52 weeks on flare prevention in adults with moderate-to-severe AD from the LIBERTY AD CHRONOS trial (NCT02260986). In this trial, 740 patients (pts) with moderate-to-severe AD were randomized 3:1:3 to subcutaneous dupilumab 300 mg once weekly, dupilumab 300 mg every 2 weeks (q2w), or placebo (PBO); all pts also received a standardized regimen of medium potency topical corticosteroids (TCS).

Protecting medical staff from skin injury/disease caused by personal protective equipment during epidemic period of COVID-19: experience from China.

Linked articles: COVID‐19 SPECIAL FORUM. J Eur Acad Dermatol Venereol 2020; 34: e210–e216.

Clinical profile of Tinea pseudoimbricata: an observational study from a tertiary care institution in western Maharashtra, India

<p class="abstract"><strong>Background:</strong> Topical steroid-modified tinea corporis and tinea cruris is on the rise due to the ease of availability of over-the-counter potent topical corticosteroid preparations and their inappropriate use, alters the true morphology of lesion. As there is paucity of literature about increasing prevalence and varied presentation of this condition, we aimed to study the clinical profile and dermoscopic features of <em>Tinea pseudoimbricata</em> due to topical steroid abuse. We present a case-series of 77 cases of a distinct morphological pattern with central erythematous, scaly, pruritic concentrically spreading plaques with raised and scaly borders known as <em>Tinea pseudoimbricata</em>.</p><p class="abstract"><strong>Methods:</strong> We evaluated 77 clinically diagnosed patients of <em>Tinea pseudoimbricata</em> with positive 10% potassium hydroxide examination and culture. Dermoscopy was performed in all patients. The demographic, clinical, and mycological features of each patient were recorded on a predesigned proforma.<strong></strong></p><p class="abstract"><strong>Results:</strong> There were 52 male and 25 female patients with a mean age of 28.66 and a mean disease duration of 7.6 months. There was a history of application of potent or super-potent topical steroid for varying durations. Culture isolates were <em>Trichophyton rubrum</em> species. Dermoscopic analysis showed features of steroid abuse.</p><p class="abstract"><strong>Conclusions:</strong> Injudicious and inappropriate use of topical steroid causes <em>Tinea pseudoimbricata</em>; a special subset of tinea incognito, which is very common now a days. This should alert the dermatologist about the steroid abuse and requires systemic anti-fungal treatment for prolong time.</p>

Soaking oro-pharyngeal pack with triamcinolone acetonide lowers discomfort in functional endoscopic sinus surgeries

background: Postoperative sore throat (POST) is defined as pain or discomfort in the throat following general anesthesia. Throat packs are used by many surgical subspecialties for different benifits, however they may increase the incidence of POST. Many interventions can be used to decrease incidence of POST. Triamcinolone acetonide (TA) is a moderately potent topical corticosteroid preparation. In this study, we hypothesized that soaking the throat pack with TA may decrease POST. Methods and Material: This prospective interventional comparative study was performed on 54 patients planned for Functional Endoscopic Sinus Surgeries (FEES) surgery. After endotracheal intubation, a standard length of oro-pharyngeal pack was placed, then patients were randomly allocated into: Group I: Oro-pharyngeal packs were soaked with 15 mg Triamcinolone acetonide 0.1% and Group II: packs were soaked with the same volume of lubricating gel (K-Y gel®). The patients were postoperatively asked about: sore throat, dysphagia, hoarseness of voice and nausea and vomiting. Results: Thirty minutes and 24 hours after extubation, Group I patients showed lower but statistically insignificant sore throat scores. Two to six hours after extubation, Group I showed a statistically significant reduction in sore throat scores. Six patients suffered dysphagia in group I compared with 8 patients in group II. Hoarseness of voice occurred in 1 patient in group I and 3 patients in group II. No patient complained of nausea or vomiting. Conclusión: Soaking oropharyngeal pack with triamcinolone acetonide in orabase gel was able to decrease POST in FESS patients.

A case of tinea incognito mimicking subcorneal pustular dermatosis

An 89-year-old woman presented with plaque-like lesions, accompanied with pustules and desquamation on the back and front of the trunk for approximately one year. Long term use of potent topical corticosteroids was ineffective. Because of the chronicity of her condition, the diagnoses of subcorneal dermatosis or subcorneal pustular dermatosis type of IgA pemphigus were considered. However, fungal hyphae were observed in the potassium hydroxide examination. Therefore, we present this case since this clinical appearance of tinea incognito can also mimic various pustular dermatoses.

Treatment Effect of Omalizumab on Severe Pediatric Atopic Dermatitis

Systemic treatments for severe childhood atopic dermatitis have limited evidence and/or are unlicensed. Despite the efficacy of anti-IgE medication (omalizumab) in the treatment of atopy, no large randomized studies in childhood atopic dermatitis have been published. To determine the effectiveness of omalizumab in treating severe atopic dermatitis in children. The Atopic Dermatitis Anti-IgE Pediatric Trial (ADAPT) was a 24-week single-center, double-blind, placebo-controlled randomized clinical trial with a 24-week follow-up. Conducted from November 20, 2014, to August 31, 2017, at Guy's and St Thomas' Hospital NHS Foundation Trust and King's College London in the United Kingdom, this trial recruited participants after a screening visit. Eligible participants (n = 62) were aged 4 to 19 years and had severe eczema (with objective Scoring Atopic Dermatitis [SCORAD] index >40) that was unresponsive to optimum therapy. Statistical analysis was conducted using the intention-to-treat principle. Subcutaneous omalizumab or placebo for 24 weeks. The drug manufacturer's dosing tables were used to determine the dosage based on total IgE (30-1500 IU/mL) and body weight (in kilograms) at randomization. Objective SCORAD index after 24 weeks of treatment. In total, 62 children (mean [SD] age, 10.3 [4.2] years; 32 (52%) were male) were randomized to either omalizumab (n = 30) or placebo (n = 32). Five participants withdrew from treatment (4 [13%] from the placebo group, and 1 [3%] from the omalizumab group). Follow-up attendance was 97% at week 24 and 98% at week 48. After adjustment for baseline objective SCORAD index, age, and IgE level, the mean difference in objective SCORAD index improvement between groups at week 24 was -6.9 (95% CI, -12.2 to -1.5; P = .01), significantly favoring omalizumab therapy and reflecting the results in other assessments of atopic dermatitis severity. Improved quality-of-life scores were seen in the omalizumab group, as measured by the Children's Dermatology Life Quality Index/Dermatology Life Quality Index (-3.5; 95% CI, -6.4 to -0.5) and Pediatric Allergic Disease Quality of Life Questionnaire score (-0.5; 95% CI, -0.9 to -0.0). Improvements in disease severity occurred despite lower potent topical corticosteroid use in the omalizumab group compared with the placebo group (median [interquartile range (IQR)] percentage of body surface area covered, 16% [10%-46%] vs 31% [14%-55%]; median [IQR] number of days of use, 109 [34-164] days vs 161 [82-171] days). This randomized clinical trial found that omalizumab significantly reduced atopic dermatitis severity and improved quality of life in a pediatric population with atopy and severe eczema despite highly elevated total IgE levels at baseline. The result was associated with a potent topical corticosteroid sparing effect and may suggest that omalizumab is a treatment option for difficult-to-manage severe eczema in children with atopy. ClinicalTrials.gov identifier: NCT02300701.

Eudragit RS100 based microsponges for dermal delivery of clobetasol propionate in psoriasis management

Clobetasol propionate (CP), a super potent dihalogenated topical corticosteroid for psoriasis, displays common side effects like allergic contact dermatitis, steroid acne, skin atrophy, hypo-pigmentation and systemic absorption, on topical application. Hence, entrapment of CP in an appropriate carrier system could minimise the aforementioned side effects, while controlling its percutaneous absorption. Therefore, motive behind current work was to fabricate and evaluate CP loaded microsponges (MS). The microsponges were successfully crafted by employing quasi-emulsion solvent diffusion method. For preparation of MS, organic phase comprising CP, Eudragit RS 100 and dichloromethane was added to aqueous phase (polyvinyl alcohol solution), while stirring. During optimization of MS formulations, factors (drug: polymer ratio, aqueous and organic phase volume) affecting the physical properties of microsponges were also investigated. The prepared microsponges were found to possess particle size in the range 12.2 ± 8.2–45.80 ± 12.3 μm, entrapment efficiency: 60.00 ± 0.06 to 96.37 ± 0.04 % and drug release: 60.60 ± 0.13 to 92.82 ± 0.15 %. Additionaly, CP loaded microsponges were evaluated for topography, thermal and photostability. Finally, optimized CPMS were incorporated into Carbopol gel base, which was subsequently evaluated. In vitro release of CPMS was compared with plain CP and release results were fitted into different kinetic models. CPMS formulation followed zero order kinetics indicating release of drug at constant rate, with absence of initial burst release. This delivery system resulted in extended CP release and its maximum therapeutic activity, with minimum toxic effects. In vivo antipsoriatic activity of CPMS gel performed using mouse tail model exhibited significant therapeutic efficacy in comparison to plain CP gel, which was further supported by the histopathological findings.

Efficacy of alitretinoin depending on the concomitant use of topical corticosteroids in chronic hand eczema patients.

Alitretinoin is the only systemic agent approved for the treatment of severe chronic hand eczema (CHE) unresponsive to potent topical corticosteroids. Clinical trials have shown the efficacy of oral alitretinoin with topical emollients for CHE treatment, but most studies have failed to reach a therapeutic success rate of 50%. Reasonably, we thought it would be more effective to combine topical corticosteroids with oral alitretinoin, but the concomitant use of topical corticosteroids has not been studied yet. One-hundred and seven Korean patients diagnosed with CHE were recruited. The participants were divided into two groups depending on the concomitant use of topical corticosteroids. Comparative analysis was performed between the combined therapy (alitretinoin and topical corticosteroids) and monotherapy groups (alitretinoin only) by using physician global assessment (PGA), patient's global assessment (PaGA), modified total lesion symptom score (mTLSS), and recurrence rates. The combined therapy group showed a significantly higher treatment success rate than the alitretinoin monotherapy group for all efficacy parameters (PGA: P<0.001, PaGA: P<0.001, mTLSS changes: P<0.001), but there was no significant difference in recurrence rates between the groups (P=0.266). Combined use of topical corticosteroids is recommended for CHE patients being treated with oral alitretinoin due to clinically rapid and superior effectiveness.

Treatment patterns of pediatric patients with atopic dermatitis: A claims data analysis

Real-world evidence on treatment patterns of pediatric patients with atopic dermatitis (AD) is sparse. To assess current treatment patterns in pediatric AD patients. Retrospective observational analysis of commercial insurance and Medicaid administrative claims data (January 2011-December 2016) for pediatric AD patients, stratified by age and provider type. The analytic sample comprised 607,258 pediatric AD patients. Median observation period was 30.3months. Overall, 78.6% were prescribed ≥1 AD medication; 86.7% were prescribed topical corticosteroids, and 5.4% were prescribed a calcineurin inhibitor. Systemic corticosteroids (SCSs) were prescribed for 24.4% of patients, 51.8% of whom did not have asthma or allergic comorbidities. Of the 46.6% prescribed an antihistamine and 16.2% prescribed montelukast, 62.0% and 41.3%, respectively, did not have asthma or allergic comorbidities. Systemic immunosuppressants were rarely prescribed (<0.5%). Higher potency topical corticosteroid and SCS use increased with age. Treatment patterns varied by provider type; specialists were more likely to prescribe higher potency topicals and/or systemics, regardless of patient age. A minority of patients were treated by or referred to a specialist. Identification of AD patients relied on billing diagnoses; the disease severity was proxied by the treatment prescribed. Results indicate that SCSs, despite known risks, and other medications with disproven efficacy in AD are frequently prescribed, suggesting a need for safer and more effective alternatives.

Treatment of postscabies prurigo with diflucortolone and chlorquinaldol in a group of African refugees.

Postscabies prurigo (PSP) is caused by a delayed hypersensitivity reaction to antigens of the mite. Treatment is based on potent topical or intralesional corticosteroids. We present the results of a study on the effectiveness of a topical combination of diflucortolone and chlorquinaldol. Eighteen African patients who had been previously affected by scabies and treated with permethrin were enrolled. The diagnosis of PSP was made by excluding other causes through microscopic examinations. All patients were treated with the drug combination by two applications daily for two weeks. The primary study objective was to evaluate the itch by a visual analogue scale (VAS) of 0-100. Fifteen patients (83.3%) could be evaluated. All reported improvements: from 86/100 at the start to 29/100 (-57/100) at the end of treatment. Chlorquinaldol, known as an antiseptic agent, demonstrated, according to results of this study, an important anti-itch action.

Treatment responses in patients with vitiligo to very potent topical corticosteroids combined with vitaminotherapy in Madagascar

Vitiligo is a refractory disease in which treatment modalities are not yet established. We aim to assess results obtained 10years after the initiation ofa therapeutic protocol which combines very potent topical corticosteroids (TCS), vitaminotherapy (B12 and C), and suppression of microtraumas in the management of nonsegmental vitiligo in Madagascar. It was a prospective and descriptive study over a period of 6years (2011-2016) in the Department of Dermatology, Joseph Raseta Befelatanana, Antananarivo, Madagascar. The diagnosis of vitiligo was based on clinical data. Patients who agreed to follow the treatment protocol, which combined very potent TCS (two applications/day for 10days, and then one application/day for the following 10days), oral vitamin C 500mg/day for 20days, and oral vitamin B12 100mg/day for 20days, were included in the study. Two successive courses of treatment were made 10days apart. The details of 308 vitiligo patients were analyzed. The mean age of patients was 33.3years. There was a female preponderance (sex ratio: 0.6). The duration of treatment in our patients varied from 3 to 18months. Two hundred and thirty-nine patients had good therapeutic compliance and attended regular follow-up. Excellent repigmentation (more than 76% area repigmented) was noted in 50 patients (65.7%) less than 14yearsof age. Lesions evolving inless than 1year in 31 patients (36.9%) had excellent response to treatment. Localized lesions responded favorably to treatment with excellent repigmentation in 108 patients. These results show that therapeutic response is better in young people, lesions less than 1year of evolution, and for localization of vitiligo in the face and neck.

Evaluation of topical human platelet lysate versus topical clobetasol in management of methotrexate-induced oral ulceration in rheumatoid arthritis patients: Randomized-controlled clinical trial

BackgroundThere is no mainstay protocol for management of Methotrexate-induced oral ulcers; commonly used protocols are cessation of Methotrexate, folic acid treatment, corticosteroids or combination. A new era of oral ulcers management is represented by platelet concentrates. The current study assessed the effect of topical human platelet lysate compared to topical Clobetasol Propionate in management of methotrexate-induced oral ulceration in rheumatoid arthritis patients. MethodsThis randomized controlled clinical trial include 30 patients in two parallel groups (intervention - human platelet lysate, control - Clobetasol Propionate), with allocation ratio 1:1. Outcome measures were pain intensity using numerical rating scale, WHO scale for oral mucositis, measuring size of the largest ulcer and total number of oral ulcers. ResultsA statistically significant difference was detected between HPL and Clobetasol groups on comparing numerical rating scale, WHO mucositis scale, size and total number of oral ulcers throughout all visits. A considerable quick pain reduction and clinical improvement were noticed in HPL group compared to Clobetasol. ConclusionHuman platelet lysate has superior effect when compared to one of the most potent topical corticosteroids, Clobetasol Propionate, in reducing pain and clinical signs of Methotrexate-induced oral ulcers in patients with rheumatoid arthritis.

Iatrogenic Cushing Syndrome due to Application of Potent Topical Corticosteroid: A Case Report

Corticosteroids are over the counter and cheaper drugs available in every medical stores in Nepal. Iatrogenic Cushing syndrome due to topical steroids application is a very rare phenomenon in adults.A 32 year female from Janakpur presented with complaints of swelling of face, weight gain, excessive facial hair and fatigue since two years that gradually increased over last one year. She had a past medical history of on and off application of multiple potent topical corticosteroids for disseminated Tinea infection. She was obese with moon facies, buffalo hump and multiple striae over her abdomen. Her blood pressure was raised and her blood sugar was in pre-diabetic range. Laboratory studies were consistent with iatrogenic Cushing syndrome. Patient recovered after discontinuation of topical corticosteroids and treatment with antifungals.Although iatrogenic Cushing syndrome following application of topical corticosteroid is a rare phenomenon in adults, this can happen in a setup like ours where corticosteroids are prescribed as over the counters and patients have very little knowledge about their use. Therefore, we emphasize that patients and pharmacist should be well educated about the consequences of their prolong application and their side effects

Generalized ILVEN or Blaschkoid Psoriasis: A Persistant Dilemma

A 24-year-old man presented with itchy verrucous, scaly red-brown papules, &amp; linear plaques distributed in a blaschkoid pattern all over the body since last 20 years associated with itching. A skin biopsy was consistent with ILVEN (inflammatory linear verrucous epidermal nevus). Histopathologically, it can be difficult to distinguish it from linear psoriasis. It may respond to conventional anti-psoriatic therapies like potent topical corticosteroids applied under occlusion, or systemic treatments like acitretin.

Efficacy and Safety of Dupilumab Chronic Hands Eczema Refractory to Highly Potent Topical Corticosteroids

Efficacy and Safety of Dupilumab Chronic Hands Eczema Refractory to Highly Potent Topical Corticosteroids

Elephantiasic Pretibial Myxedema: A Rare Manifestation in Graves’ Disease

Elephantiasic pretibial myxedema is an extremely rare condition, affecting patients with thyroid disease. The clinical manifestation is difficult to diagnosis, and the treatment is challenging. Herein, the authors report on a case of a patient with Graves’ disease, who had a long-standing enlargement of bilateral legs, and histopathologic studies confirmed the diagnosis as; pretibial myxedema. The patient was treated with an antithyroid drug, iodine-131 (131I) irradiation, a potent topical corticosteroid, with occlusion, and compression therapy, however, the patient’s skin condition remained unchanged. This report aims to demonstrate a rare form of pretibial myxedema, to review the clinical presentations, differential diagnosis as well as therapeutic options.

Efficacy and safety of oral alitretinoin as treatment for chronic hand eczema in France: a real-life open-label study.

Chronic hand eczema is an inflammatory dermatosis that results in a significant psychological and socio-economic burden. Alitretinoin (AL) is indicated in adults with severe chronic hand eczema (sCHE) unresponsive to potent topical corticosteroids. To assess AL effectiveness and safety in patients with sCHE under real-life conditions based on a prospective observational study in France (2010-2014). Clinical severity was assessed using Physician Global Assessment (PGA) and Modified Total Lesion Symptom Score (mTLSS) and quality of life by Skindex and visual analogue scales. Patients were treated with AL for 12-24 weeks and followed for 24 months. Responders were patients with clear/almost clear skin based on PGA at the end of treatment and the primary outcome was remission (clear, almost clear, or mild skin) at one and two years after treatment. A total of 394 patients with severe or moderate PGA were included in the study by 109 dermatologists. AL treatment duration was 5.4 ± 4.1 months (mean ± SD) and 112/274 patients evaluated at the end of treatment were responders. Of the 112 responders, 41/51 evaluable patients were in remission after one year and 36/46 after two years. At the end of treatment, Skindex improved from 48.8 ± 18.1% to 27.1 ± 23.2%. Among the 112 responders, 68/84 did not relapse (mTLSS increased >75% from baseline). The most common adverse events were headache (24%) and dyslipidaemia (4%). This study supports a positive benefit/risk profile for AL for sCHE patients unresponsive to topical corticosteroids.

Nanoencapsulation of betamethasone valerate using high pressure homogenization–solvent evaporation technique: optimization of formulation and process parameters for efficient dermal targeting

Betamethsone valerate (BMV), a medium potency topical corticosteroid, is one of the most commonly employed pharmacological agents for the management of atopic dermatitis in both adults and children. Despite having remarkable pharmacological efficacy, these agents have limited clinical implication due to poor penetration across the startum cornum (SC). To mitigate issues related to targeted delivery, stability, and solubility as well as to potentiate therapeutic and clinical implication, the nanodelivery systems have gained remarkable recognition. Therefore, this study was aimed to encapsulate BMV into the chitosan nanoparticles (CS-NPs) for optimum dermal targeting and improved penetration across the SC. The prepared NPs were characterized for particle size, zeta potential, polydispersity index, entrapment efficiency, loading capacity, crystallinity, thermal behavior, morphology, in vitro release kinetics, drug permeation across the SC, and percentage of drug retained into various skin layers. Results showed that optimized BMV-CS-NPs exhibited optimum physicochemical characteristics including small particle size (< 250 ± 28 nm), higher zeta potential (+58 ± 8 mV), and high entrapment efficiency (86 ± 5.6%) and loading capacity (34 ± 7.2%). The in vitro release study revealed that BMV-CS-NPs displayed Fickian-diffusion type mechanism of release in simulated skin surface (pH 5.5). Drug permeation efficiency and the amount of BMV retained into the epidermis and the dermis were comparatively higher in case of BMV-CS-NPs compared to BMV solution. Conclusively, we anticipated that BMV-CS-NPs could be a promising nanodelivery system for efficient dermal targeting of BMV and improved anti-AD efficacy.

SUBCUTANEOUS ALLERGEN IMMUNOTHERAPY IN THE TREATMENT OF ATOPIC DERMATITIS

Introduction Atopic dermatitis has a wide variety of therapies, including topical moisturizers, topical corticosteroids, and biologics. However, there is still a debate regarding the efficacy of allergen immunotherapy in the treatment of atopic dermatitis. We report atopic dermatitis treated successfully with allergen immunotherapy. Case Description A patient was referred to our practice for the treatment of severe atopic dermatitis. A 48-year old man presented with a history of severe atopic dermatitis since childhood. Previous therapies, including mid and high potency topical corticosteroids, as well as the calcineurin inhibitors, pimecrolimus and tacrolimus, were ineffective. He had also required multiple doses of systemic corticosteroids for exacerbations. Biologic therapy was not available. He had positive specific IgE and allergy skin testing to multiple inhaled allergens, including dust mite, weeds, trees, grasses, mold, cat, and dog. The IgE level was 10,000 IU/mL. His initial Scoring Atopic Dermatitis Index (SCORAD) was 79.4. He was started on subcutaneous allergen immunotherapy to these inhaled allergens, while his topical therapies remained the same. In one year, at maintenance therapy at 1:1 dilution (0.5 cc injections), patient reported significant benefit in symptoms, and SCORAD index decreased to 48.5. He did not require systemic systemic steroid therapy once he reached maintenance dose of immunotherapy. Discussion Subcutaneous allergen immunotherapy can be an effective therapy for atopic dermatitis. This therapy can be used in conjunction with other treatments, including topical ones. Larger studies are required to further evaluate this therapy in atopic dermatitis.

Cost and effectiveness of prescribing emollient therapy for atopic eczema in UK primary care in children and adults: a large retrospective analysis of the Clinical Practice Research Datalink

BackgroundThe Clinical Practice Research Datalink (CPRD) was used to evaluate the overall costs to the National Health Service, including healthcare utilisation, of prescribing emollients in UK primary care for dry skin and atopic eczema (DS&E).MethodsPrimary care patients in the UK were identified using the CPRD and their records were interrogated for the 2 years following first diagnosis of DS&E. Data from patients with (n = 45,218) and without emollient prescriptions (n = 9780) were evaluated. Multivariate regression models were used to compare healthcare utilisation and cost in the two matched groups (age, sex, diagnosis). Two sub-analyses of the Emollient group were performed between matched groups receiving (1) a colloidal oatmeal emollient (Aveeno-First) versus non-colloidal oatmeal emollients (Aveeno-Never) and (2) Aveeno prescribed first-line (Aveeno-First) versus prescribed Aveeno later (Aveeno-Subsequently). Logistic regression models calculated the odds of prescription with either potent / very potent topical corticosteroids (TCS) or skin-related antimicrobials.ResultsCosts per patient were £125.80 in Emollient (n = 7846) versus £128.13 in Non-Emollient (n = 7846) matched groups (p = 0.08). The Emollient group had fewer visits/patient (2.44 vs. 2.66; p < 0.0001) and lower mean per-visit costs (£104.15 vs. £113.25; p < 0.0001), compared with the Non-Emollient group. Non-Emollient patients had 18% greater odds of being prescribed TCS and 13% greater odds of being prescribed an antimicrobial than Emollient patients. In the Aveeno-First (n = 1943) versus Aveeno-Never (n = 1943) sub-analysis, costs per patient were lower in the Aveeno-First compared with the Aveeno-Never groups (£133.46 vs. £141.11; p = 0.0069). The Aveeno-Never group had ≥21% greater odds of being prescribed TCS or antimicrobial than the Aveeno-First group. In the Aveeno-First (n = 1357) versus Aveeno-Subsequently (n = 1357) sub-analysis, total costs were lower in the Aveeno-First group (£140.35 vs. £206.43; p < 0.001). Patients in the Aveeno-Subsequently group had 91% greater odds of being prescribed TCS and 75% greater odds of being prescribed an antimicrobial than the Aveeno-First group.ConclusionsAcknowledging limitations from unknown disease severity in the CRPD, the prescription of emollients to treat DS&E was associated with fewer primary care visits, reduced healthcare utilisation and reduced cost. Prescribing emollients, especially those containing colloidal oatmeal, was associated with fewer TCS and antimicrobial prescriptions.Trial registrationThe study is registered at http://isrctn.com/ISRCTN91126037.