Skin Care Advice Research Articles

Emollient application from birth to prevent eczema in high-risk children: the BEEP RCT.

Atopic eczema is a common childhood skin problem linked with asthma, food allergy and allergic rhinitis that impairs quality of life. To determine whether advising parents to apply daily emollients in the first year can prevent eczema and/or other atopic diseases in high-risk children. A United Kingdom, multicentre, pragmatic, two-arm, parallel-group randomised controlled prevention trial with follow-up to 5 years. Twelve secondary and four primary care centres. Healthy infants (at least 37 weeks' gestation) at high risk of developing eczema, screened and consented during the third trimester or post delivery. Infants were randomised (1 : 1) within 21 days of birth to apply emollient (Doublebase Gel®; Dermal Laboratories Ltd, Hitchin, UK or Diprobase Cream®) daily to the whole body (excluding scalp) for the first year, plus standard skin-care advice (emollient group) or standard skin-care advice only (control group). Families were not blinded to allocation. Primary outcome was eczema diagnosis in the last year at age 2 years, as defined by the UK Working Party refinement of the Hanifin and Rajka diagnostic criteria, assessed by research nurses blinded to allocation. Secondary outcomes up to age 2 years included other eczema definitions, time to onset and severity of eczema, allergic rhinitis, wheezing, allergic sensitisation, food allergy, safety (skin infections and slippages) and cost-effectiveness. One thousand three hundred and ninety-four newborns were randomised between November 2014 and November 2016; 693 emollient and 701 control. Adherence in the emollient group was 88% (466/532), 82% (427/519) and 74% (375/506) at 3, 6 and 12 months. At 2 years, eczema was present in 139/598 (23%) in the emollient group and 150/612 (25%) in controls (adjusted relative risk 0.95, 95% confidence interval 0.78 to 1.16; p = 0.61 and adjusted risk difference -1.2%, 95% confidence interval -5.9% to 3.6%). Other eczema definitions supported the primary analysis. Food allergy (milk, egg, peanut) was present in 41/547 (7.5%) in the emollient group versus 29/568 (5.1%) in controls (adjusted relative risk 1.47, 95% confidence interval 0.93 to 2.33). Mean number of skin infections per child in the first year was 0.23 (standard deviation 0.68) in the emollient group versus 0.15 (standard deviation 0.46) in controls; adjusted incidence rate ratio 1.55, 95% confidence interval 1.15 to 2.09. The adjusted incremental cost per percentage decrease in risk of eczema at 2 years was £5337 (£7281 unadjusted). No difference between the groups in eczema or other atopic diseases was observed during follow-up to age 5 years via parental questionnaires. Two emollient types were used which could have had different effects. The median time for starting emollients was 11 days after birth. Some contamination occurred in the control group (< 20%). Participating families were unblinded and reported on some outcomes. We found no evidence that daily emollient during the first year of life prevents eczema in high-risk children. Emollient use was associated with a higher risk of skin infections and a possible increase in food allergy. Emollient use is unlikely to be considered cost-effective in this context. To pool similar studies in an individual patient data meta-analysis. This trial is registered as ISRCTN21528841. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 12/67/12) and is published in full in Health Technology Assessment; Vol. 28, No. 29. See the NIHR Funding and Awards website for further award information.

Anti-aging trends in Australia.

Anti-aging trends in Australia have changed considerably since the country emerged from the lockdowns associated with the SARS-Cov2 pandemic. People now rely on social media influencers for skin care advice and skin care products, including professional skin care treatments that can be purchased on Internet platforms. The quest for the perfect 'zoom face' led to a 300% rise in cosmetic procedures across Australia in the year to April 2021. People now want to use less products on their skin, while looking healthy and natural (termed 'skin minimalism'). The popularity of retinoid derivatives for preventing wrinkles has been superseded by non-irritating actives like hyaluronic acid (HA) and niacinamide that provide skin barrier protection, skin hydration, plumping and anti-inflammatory effects. Botulinum toxin injections remain the most popular non-surgical cosmetic procedure, followed by HA fillers, and biostimulators that promote the synthesis of collagen and give longer lasting but more gradual results than HA fillers. Laser resurfacing is widely used for epidermal resurfacing and skin tightening, as well as non-ablative lasers, intense pulsed light and radiofrequency or ultrasound skin tightening devices. Superficial chemical peels are still popular because they are relatively gentle, inexpensive, and require no downtime, whereas medium-to-deep chemical peels have largely been superseded by laser technology. However, the most efficient approach to prevent skin aging is adopting a healthy lifestyle and taking action against all factors of the skin aging exposome.

The influence of social media on public attitudes and behaviors towards cosmetic dermatologic procedures and skin care practices: A study in Saudi Arabia.

Social media has fostered a landscape where trends, ideals, and beauty standards have significantly proliferated. Images of flawless skin, sculpted features, and curated aesthetics inundate user feeds, potentially shaping their self-perceptions and aspirations. The rise of influencers, dermatologist social media engagement, and beauty campaigns sharing skincare routines and product recommendations wield substantial influence over individual appearance-related decisions. The main aim of this study is to determine the pattern of behavior in using social media to seek dermatological procedures and skin care routine. We conducted a nationwide, online cross-sectional study targeting the general Saudi population. Our survey aimed to understand participant social media behaviors and gather insights into skincare products, cosmetic procedures, and makeup habits. Gender-related differences emerged in seeking skincare advice. Females preferred dermatologists on social media (p < 0.001) and beauty influencers (p < 0.001), whereas men leaned towards pharmacists (p < 0.001). Women displayed stronger engagement with dermatologist social media reputation regarding non-cosmetic concerns (p < 0.001), education (p < 0.001), and social media impact on cosmetic decisions (p = 0.001). They frequently sought dermatologists on social media before appointments (p = 0.001), whereas men emphasized dermatologists' fame (p = 0.024). Common cosmetic barriers included high costs (62.5%), complications (40.3%), and trust issues (40.2%). Women underwent various cosmetic procedures (p < 0.05), influenced by social media in their decisions and skincare routines. Our study reveals significant gender-based disparities in seeking skincare advice. Women rely on social media, clinics, friends, and beauty influencers, whereas men prefer pharmacists. Additionally, women depend on dermatologists' social media reputation and conduct thorough pre-appointment research. Their heightened social media engagement links to skincare practices and influences cosmetic procedure considerations based on age and usage frequency.

Routine infant skincare advice in the UK: A cross-sectional survey.

Routine infant skincare advice in the UK: A cross-sectional survey.

Evidence-Based Consensus Recommendations for Skin Care in Healthy, Full-Term Neonates in India.

Neonatal skin care practices guided by personal experience and preferences might be substantially different across different hospital settings. The aim of this consensus recommendation is to provide clinical practice guidance to healthcare practitioners on evidence-based neonatal skin care practices from delivery-to-discharge, in hospital settings. A Scientific Advisory Board meeting on "Evidence-based Neonatal Skin Care Practices and Protocols" was held in December 2020 with an expert panel comprising neonatologists, pediatricians, obstetricians and gynecologists and pediatric dermatologist. Comprehensive literature search was performed up to 23 March 2021 using PubMed and Google Scholar to retrieve relevant evidence. Recommendations were developed on critical aspects of skin care in healthy full-term neonates including cleansing at birth, skin-to-skin care, cord care, diaper area care, initial and routine bathing, cleansers and emollients use, and criteria to choose appropriate skin care products. Recommendations include inclusion of skin assessment in routine neonatal care, first bath timing after cardio-respiratory and thermal stabilization, 6-24 hours after birth; bathing with water alone or adding a mild liquid cleanser could be considered appropriate as it does not impact the developing skin barrier; use of emollients is recommended for neonates with higher risk of development of eczema to maintain and enhance skin barrier function and integrity; and inclusion of skin care advice in neonatal discharge checklist. Importance of rigorous quality control, high-quality clinical trials for assessment of baby products, usage of products that are formulated appropriately for newborns, and full label transparency for baby products were highlighted. The panel identified gaps in literature and discussed the scope for future research. These recommendations may help to standardize evidence-based skin care for healthy full-term neonates in Indian hospital settings to improve the quality of care that neonates receive in hospital and facilitate improvement in overall neonatal health outcomes.

BC03 Skincare in acne: are we letting our patients down?

Abstract Acne vulgaris is a chronic and recurrent inflammatory condition of the pilosebaceous unit. A combination of topical and systemic agents is often required to achieve symptom control, improve quality of life and reduce the risk of scarring. The role of skincare products in the management of acne has been well defined in the literature as a key adjunct to other therapies. We conducted an observational retrospective study to explore the patient experience of acne skincare advice provided by their dermatologist. Patients in the acne clinic, to which they would be referred for treatment with oral isotretinoin, were invited to participate. A survey incorporating multiple choice questions and an open comment box was distributed electronically. Twenty-nine per cent of patients acknowledged the importance of skincare products in managing their acne. Only 39% of respondents felt they had the opportunity to discuss skincare during their consultation. Over 86% of patients had been prescribed oral isotretinoin at least once; however, 60% had not received any skincare advice from their dermatologist. Only 31% of patients felt more confident with their skincare routine after their dermatology consultation than they did before. The internet and social media were the most popular sources of information for accessing skincare advice, with over 77% of patients identifying it as their main informant. Yet the majority of patients (88%) were likely to adhere to skincare advice if instructed by their dermatologist, clearly preferring this to social media. The most recurring theme from open comments was the desire to discuss skincare with their dermatologist and get signposted to a more reliable source of information for skincare. The data suggest that clinicians are failing to address or discuss skincare with patients, leaving them at the mercy of social media and at risk of exposure to scientifically unproven or incorrect advice. Integrating such advice when reviewing patients with acne would not only help with the management of their condition post-treatment with oral isotretinoin but also improve patient satisfaction and avoid misinformation. As a single-centre study, our results may not be representative of all patients, and the data collected were dependent on patient recall. Our results highlight the need for dermatologists to disseminate evidence-based skincare advice specific to acne-prone skin to their patients. Going forward, we aim to provide all our patients with acne with an information leaflet on skincare to complement their medical treatment.

Effects of Early Emollient Use in Children at High Risk of Atopic Dermatitis: A German Pilot Study.

Several small studies have indicated that daily emollient use from birth might delay, suppress or prevent atopic dermatitis (AD). Two larger trials did not confirm this; however, a recent smaller study indicated a protective effect if daily emollient use is used in the first 2 months of life. Further research is needed to evaluate the effect of emollient use on development of AD. The current study randomly assigned 50 newborns who were at high risk of developing AD (1:1) to receive general infant skin-care advice (control group), or skin-care advice plus emollient with advice to apply emollient at least once daily until 1 year of age (intervention group). Repeated skin examinations, skin physiology measurements and skin microbiome profiling were performed. Of the children in the intervention and control groups, 28% and 24%, respectively, developed AD (adjusted Relative Risk (RR) 1.19, p = 0.65, adjusted risk difference 0.05). Skin pH decreased and transepidermal water loss and stratum corneum hydration increased over time in both groups with no significant differences. In the intervention group skin microbiome alpha diversity increased earlier, and the abundance of Streptococcus and Staphylococcus species were significantly reduced at month 1. Daily early emollient use in children with high risk of AD was safe, but it did not significantly reduce the risk of developing AD or impact skin physiology development.

Dermatology through the lens of social media: A qualitative study among adolescents.

Social media (SM) use has accelerated at an unprecedented pace and dermatology literature evaluating SM use is primarily centered on the quality and quantity of dermatologic content, with minimal research on how adolescent patients experience such content. We recruited 15 patients between the ages of 13-18 years from the Atrium Health Wake Forest Baptist Department of Dermatology to interview regarding their experience with dermatologic content on SM. Despite most participants' insightful comments on SM use and the relative lack of dermatologic content validation on SM, many participants adopted skin care advice from SM. Adolescents are particularly vulnerable to social influence and it is important dermatologists understand how pervasive skin-related content is on these platforms.

Sorbi Khattak

After graduating as a pharmacist in 2019, Sorbi Khattak started to grow her portfolio career, working in the community and general practice, as well as co-founding a digital pharmacy-led skincare advice platform. “I would love to have a career which touches every aspect of pharmacy in the best of my capacity,” she says. “Pharmacy is […]

New NICE guidance on acne vulgaris: implications for first-line management in primary care.

Acne Vulgaris: Management , published on 25 June 2021, is a National Institute for Health and Care Excellence (NICE) guideline for patients with acne, their families and carers, their healthcare professionals, and commissioners.1 It does not consider neonatal acne. This article highlights parts of the guideline that cover skin care advice and first-line medication options in the management of acne. The guideline also covers further areas such as ‘Referral to specialist care’, ‘Oral isotretinoin’, Physical treatment’, ‘Relapse’, Maintenance treatment’, and ‘Management of acne-related scarring’, which will not be covered in this article. Acne vulgaris is one of the commonest inflammatory skin conditions, reported to create 3.5 million general practice consultations per year in the UK.2 It usually affects adolescents and young adults, and can last for several years. Acne vulgaris most commonly affects the face but chest, back, and shoulders may be involved. Lesions are a combination of non-inflammatory (comedones) and inflammatory lesions (papules, pustules, cysts, nodules), often leading to scarring. The committee agreed to grade acne vulgaris into ‘Mild to Moderate’ or ‘Moderate to Severe’ in order to conduct separate network meta-analysis, while accepting that acne lies along a continuum. This is easily accomplished in busy clinics and provides a baseline for assessing treatment response. Mild-to-moderate acne vulgaris includes patients who have one or more of:

O19 A case of pyogenic arthritis, pyoderma gangrenosum and acne syndrome

Case report - IntroductionConsidering an auto-inflammatory disorder is important where recurrent fevers are a presenting feature. Performing a genetic panel is essential in these cases; however, it can be negative even in the presence of an underlying auto-inflammatory disorder. Our case highlights the importance of this with a reminder that a negative gene panel does not completely exclude an underlying auto-inflammatory disorder in the presence of suggestive history and clinical examination findings.Case report - Case descriptionA 5-year-old girl presented with recurrent episodes of fever (>38 °C), abdominal pain and joint pains (back, wrist, hip, knee & ankle). Past medical history included episodes of self-resolving neutropenia. Initial clinical examination revealed mouth ulcers, a significant number of dental caries, a petechial rash and genital erythema. There was no active joint disease. A pustular like itchy rash developed on/off over time affecting the buttocks, genital area, knees and elbows. Episodes increased in frequency becoming once per month, lasting for 5 days on average, resulting in a significant amount of time off school. Initial differential diagnosis included periodic fever and cyclical neutropenia. White blood cells ranged from 4.3 to 20.1 (10^9/l), Neutrophils ranged from 1.1 to 11.4 (10^9/l), CRP 0.7 to 149.5 (mg/L), ESR 2 to 15 (mm/hr). Serum Amyloid A ranged from 8.0 to 370 (mg/L). Immunology and haematology consults were sought with cyclical neutropenia deemed unlikely. A primary immunodeficiency screen was negative. Initial genetic analysis for periodic fever was negative; however, this was later reanalysed and revealed a pathogenic mutation in the PSTPIP1 gene and a mutation in the TMEM173 gene. A mutation in the PSTPIP1 gene, on chromosome 15q24 is associated with Pyogenic Arthritis, Pyoderma gangrenosum and Acne (PAPA) Syndrome.A trial of colchicine was commenced, with eventual titration of the dose, achieving a good response. Occasional episodes now occur 1—2-times monthly with a reduced temperature rise, minimal arthralgia and are of a shorter duration. Dental extraction was also performed due to 9 periodontal abscesses. Skin care advice included use of emollient-barrier creams, antihistamines and oral antibiotics when indicated.Case report - DiscussionPAPA – Pyogenic Arthritis, Pyoderma Gangrenosum and Acne are a triad of symptoms that together combine to form this rare auto-inflammatory disorder. It is an autosomal dominant condition. It is the result of a mutation of the (PSTPIP1/CD2BP1) gene located on chromosome 15. Studies of families affected have revealed a variable penetrance, including some asymptomatic carriers. Clinicians should be mindful when ascertaining what conditions and symptoms other family members have, as PAPA could be the underlying causative condition. The recurrent aseptic inflammation of the joints normally manifests within the first two decades of life. The skin symptoms manifest within the third decade. All three symptoms rarely appear instantaneously. The diagnosis is clinical with confirmation by genetic testing. Reported treatments includes the use of corticosteroids, arthrocentesis – for relieving pain, and biologics – namely anti IL1 and anti TNF therapy. We felt this case was interesting as the patient described demonstrated a good response to colchicine and highlighted the difficulties that can present in making the diagnosis. With a confirmed diagnosis the clinician can then appropriately follow up the patient, giving them and potential family members the best care available.Case report - Key learning pointsOur case highlights the importance of multi-specialty input particularly when faced with a rare or complex case in order to exclude other potential causes. Although genetic testing has significantly improved in helping with the diagnosis of auto-inflammatory disorders, it must be highlighted the importance of good clinical assessment and interpretation of more standard investigations. This is particularly relevant where genetic panelling is returned as negative and concerns persist of an underlying auto-inflammatory disorder. We hope to raise awareness of the varied presentation of PAPA syndrome particularly in the younger age groups where skin presentations may not be a predominant presenting feature. It is also important to emphasise that the main features of PAPA syndrome rarely present simultaneously. Current clear treatment pathways do not exist due to the rarity of this condition within the paediatric population – a number of agents are suggested in the literature with colchicine achieving good control in our patient described.

A Snapshot of Lymphedema in Ireland: Results from LIMPRINT.

Background: To estimate the prevalence and impact of chronic edema (CE) in two Irish health care settings as part of LIMPRINT, an international study developed and co-ordinated by the International Lymphoedema Framework (ILF), and researched in Ireland by the National Lymphoedema Framework Ireland (NLFI). Methods and Results: Data were collected using clinical assessment tools previously validated by the ILF. Three hospital settings were chosen, both an in-patient and out-patient oncology unit in Galway and a vascular out-patient unit in Dublin. Patients attending an oncology clinic or in an in-patient ward on a specified day were invited to participate as desired, and all patients attending vascular out-patients for a 4-week period were included in the study. All patients were assessed for the presence of CE, and if present, patients were asked to answer several questionnaires regarding diagnosis, available services, quality of life, and wound care where appropriate. The collection of data was anonymized and was inputted to a central database (Clindex). A total of 152 patients were assessed, 76 from the oncology service and 76 from the vascular service. Eighty-seven (57%) patients were female and 65 (43%) patients were male. The mean age was 65 years with a range 15-93 years. Twenty-five patients (16%) had CE, 8 (11%) in the oncology service and 17 (22%) in the vascular service. All the oncology patients were normal weight while almost 60% (n = 10) of the vascular patients were obese. Two (25%) of the oncology patients had a history of cellulitis, whereas seven (41%) of the vascular patients had a history of cellulitis. Four of the oncology patients (50%) received full lymphedema management whereas two oncology patients (20%) received no treatment at all. In contrast, in the vascular group, only two patients (12%) received full lymphedema management. Eight patients (47%) were receiving no treatment at all and seven (41%) were in compression garments and received skin care advice only. Conclusion: Though number of patients are small, these results highlight the high prevalence of CE in both oncology and vascular service patients as well as the disparities in management. In addition, there is a high incidence of cellulitis reported that is possibly not surprising given the low number of patients receiving full lymphedema care. Good data collection is essential if we are to provide and fund a comprehensive service in the future.

Association Between Access to Specialists and History of Cellulitis Among Patients with Lymphedema: Secondary Analysis Using the National LIMPRINT Database.

Background: Cellulitis is frequently encountered in patients with lymphedema despite existing prevention protocols. To resolve this issue, social aspects surrounding patients, such as communication with patients and professionals, are necessary to consider new approaches. This study aimed to clarify the association between the history of cellulitis in patients with lymphedema and access to specialists after adjustment for relevant confounding factors. Methods and Results: This study was a secondary analysis of the Lymphoedema IMpact and PRevalence-INTernational (LIMPRINT) study using a national Japanese database of adult lymphedema compiled between 2014 and 2015 (n = 113). Descriptive data were collected for patient characteristics. Multivariate logistic regression analysis was conducted to explore possible risk factors for patients having experienced cellulitis. The duration of edema ranged from <6 months (16.2%) to 10 years or longer (25.2%), with varying severity. History of cellulitis was observed in 31.9% of patients. The prevalent treatment techniques within the context of complex decongestive therapy included skin care advice (52.2%), compression garments (55.8%), exercise advice (41.6%), multilayer bandages (38.1%), cellulitis advice (49.6%), and massage (61.1%). Overall, 57.1% of patients had access to lymphedema specialists. Longer duration of lymphedema (adjusted odds ratio [AOR] = 4.10, p = 0.005) and access to lymphedema specialists (AOR = 0.28, p = 0.009) were significantly associated with a history of cellulitis. Conclusions: A history of cellulitis in patients with lymphedema is associated with limited access to specialists. To support self-care in this patient population, reasonable consideration systems, including telehealth, should be developed to facilitate communication between specialists and patients and decrease the occurrence of cellulitis in lymphedema.

Effects of an emollient application on newborn skin from birth for prevention of atopic dermatitis: a randomized controlled study in Thai neonates.

Enhancing the skin barrier in high-risk neonates by daily use of emollients during infancy might prevent atopic dermatitis (AD); however, there have been no studies on this topic in a country with a tropical climate. Climate may affect the results of the use of emollients in neonates for AD prevention and possible adverse cutaneous eruptions. To test the hypothesis that emollients used during infancy can prevent AD in high-risk neonates in a country with a tropical climate and to evaluate other possible adverse cutaneous eruptions in this population. This was a randomized controlled study in a tertiary care hospital with a 6 months' duration. Eligible neonates were randomly assigned to receive either emollient and skincare advice (emollient group) or skincare advice only (control group). The intervention was started within 3 weeks of birth. The emollient group showed a significant reduction in the cumulative incidence of AD at 6 months (relative risk, 0.39; 95% CI 0.24-0.64; P < 0.001). The emollient group started to develop AD later and had a lower severity of AD than the control group (P < 0.001). Compared to moderate adherence, low adherence to emollient application was associated with a lower number of patients with AD (P = 0.008). Potentially emollient-related cutaneous eruptions, such as miliaria, and suspected cutaneous infections, such as impetigo, were more frequent in the emollient group. Exposure to passive smoking showed a significant difference in the development of AD compared to non-smoking exposure, both during pregnancy and after the child's birth (P < 0.001). This study suggests that, in a tropical climate, emollient applied to the skin of at-risk neonates on an 'as needed' basis (depending on environmental factors, level of skin dryness), rather than on a 'daily basis', can provide a substantial benefit for AD prevention.

Designing Online Virtual Advisors to Encourage Customer Self-disclosure: A Theoretical Model and an Empirical Test

ABSTRACT Virtual advisors (VA) are tools that assist users in making decisions. Using VAs necessitates the disclosure of personal information, especially when they are employed in personalized contexts such as healthcare, where disclosure is vital to providing valid and accurate advice. Yet, extant research has largely overlooked the factors that encourage or inhibit users’ from disclosing to VAs. In contrast, this study investigates the determinants of users’ intentions to self-disclose, and examines how VAs can be designed to enhance these intentions. The results of a study in the context of skin care advice reveal that the intention to disclose to a VA is not only the product of a rational process, but that perceptions of the VA and the relationship with it are important. The results further show that a parsimonious set of design elements can be used to endow a VA with desired characteristics that enhance the willingness to disclose. The study contributes to our understanding of the factors influencing users’ intentions to provide personal information to a VA, which extend beyond the expected benefits and costs. The study further demonstrates that social exchange theory can be applied in contexts in which humans are interacting with automated VAs.

Daily Emollient During Infancy for Prevention of Eczema: The BEEP Randomized Controlled Trial

JR Chalmers, RH Haines, LE Bradshaw. Lancet . 2020;395(10228):962–972 To investigate whether daily use of emollient in the first year of life prevents development of eczema at 2 years of age in children at high risk. 1394 high-risk newborns in the UK. High-risk is defined by presence of a first-degree relative with eczema, allergic rhinitis, or asthma. Infants were randomly assigned to the control group (standard skin-care advice only) or emollient group (additionally advised to apply emollient at least once daily and after every bath for the first year of life). Interim follow-up at 2 weeks, 3, 6, 12, and 18 months …

Daily emollient during infancy for prevention of eczema: the BEEP randomised controlled trial

SummaryBackgroundSkin barrier dysfunction precedes eczema development. We tested whether daily use of emollient in the first year could prevent eczema in high-risk children.MethodsWe did a multicentre, pragmatic, parallel-group, randomised controlled trial in 12 hospitals and four primary care sites across the UK. Families were approached via antenatal or postnatal services for recruitment of term infants (at least 37 weeks' gestation) at high risk of developing eczema (ie, at least one first-degree relative with parent-reported eczema, allergic rhinitis, or asthma, diagnosed by a doctor). Term newborns with a family history of atopic disease were randomly assigned (1:1) to application of emollient daily (either Diprobase cream or DoubleBase gel) for the first year plus standard skin-care advice (emollient group) or standard skin-care advice only (control group). The randomisation schedule was created using computer-generated code (stratified by recruiting centre and number of first-degree relatives with atopic disease) and participants were assigned to groups using an internet-based randomisation system. The primary outcome was eczema at age 2 years (defined by UK working party criteria) with analysis as randomised regardless of adherence to allocation for participants with outcome data collected, and adjusting for stratification variables. This trial is registered with ISRCTN, ISRCTN21528841. Data collection for long-term follow-up is ongoing, but the trial is closed to recruitment.Findings1394 newborns were randomly assigned to study groups between Nov 19, 2014, and Nov 18, 2016; 693 were assigned to the emollient group and 701 to the control group. Adherence in the emollient group was 88% (466 of 532) at 3 months, 82% (427 of 519) at 6 months, and 74% (375 of 506) at 12 months in those with complete questionnaire data. At age 2 years, eczema was present in 139 (23%) of 598 infants with outcome data collected in the emollient group and 150 (25%) of 612 infants in the control group (adjusted relative risk 0·95 [95% CI 0·78 to 1·16], p=0·61; adjusted risk difference –1·2% [–5·9 to 3·6]). Other eczema definitions supported the results of the primary analysis. Mean number of skin infections per child in year 1 was 0·23 (SD 0·68) in the emollient group versus 0·15 (0·46) in the control group; adjusted incidence rate ratio 1·55 (95% CI 1·15 to 2·09).InterpretationWe found no evidence that daily emollient during the first year of life prevents eczema in high-risk children and some evidence to suggest an increased risk of skin infections. Our study shows that families with eczema, asthma, or allergic rhinitis should not use daily emollients to try and prevent eczema in their newborn.FundingNational Institute for Health Research Health Technology Assessment.

Development of a Pediatric Dermatology Screening Tool Based on Two Parent-Reported Skin Symptoms: Comparison of Parental Recognition and Physician Diagnosis of Skin Symptoms of Infants and Toddlers.

AimThe objective of the present study was to develop a tool for mothers to assess their children’s skin condition with the ultimate goal of its wider use in general health checkups for infants and toddlers.MethodsThis was a single-institution, cross-sectional study in Japan, targeting parents of 200 infants and toddlers who visited a dermatology clinic between December 2018 and March 2019. The parents completed a self-administered survey of the mother’s perception of her child’s dermatological symptoms, itchiness, and sleep status, and a quality-oflife assessment, using a nine-question version of the Quality of life in Primary Caregivers of children with Atopic Dermatitis questionnaire (QP9). The attending physician was asked to complete a form about the child’s dermatological condition and the treatment prescribed. The severity of the dermatological condition noted by the physician was compared with the combined response to the 3 perception items (dermatological condition, itchiness, and sleep) reported by the parents, in order to identify the optimal cutoff score.ResultsOf 200 parent questionnaires distributed, 198 (99% response rate) were returned and analyzed, along with the responses from 198 physician records (100% response rate). The optimal cutoff score was 2/3 for the total score (range 0-6) for 2 items, itchiness and sleep status (sensitivity 73%, specificity 64%). There was a significant difference in QP9 scores between the 2 groups categorized by the cutoff scoreConclusionsA pediatric dermatological screening tool based on 2 symptoms reported by the parents of children with atopic dermatitis was developed, and its precision and criterion-related validity were confirmed. This simple tool could help parents become better aware of their children’s skin condition and allow healthcare workers to provide adequate skin care advice. This practical tool could be widely applicable in primary child care and public health service settings.

An evaluation of the skincare management of patients receiving radiotherapy for breast cancer

AbstractAim:Breast cancer patients experience skin reactions during radiotherapy. Radiation-induced skin reactions can result in treatment delivery being interrupted. The aim of this paper is to evaluate the skincare management of patients receiving radiotherapy for breast cancer in order to inform best practice.Method:A literature search was undertaken using USearch and HONNI in support of the first-hand evidence gained from the supervised on-treatment review of patients receiving radiotherapy for breast cancer.Results:There is evidence to suggest that the skincare advice given to patients varies widely between departments in the UK with many not following nationally recommended guidelines. Studies demonstrate that there are ways to reduce skin reactions and that there are a range of effective management strategies being adopted. Prophylactic skincare has been explored to improve the resilience of the skin prior to commencing radiotherapy.Findings:Further investigation is required in order to clearly establish the optimum national skincare management for breast cancer patients. More studies are required to test the effectiveness and viability of prophylactic measures. Skincare guidance needs to be robustly developed and effectively promoted by therapeutic radiographers for radiotherapy patients to benefit from reduced, radiation-induced, skin reactions.

Dermatology prescribing update: Rosacea

Rosacea is a chronic skin condition that affects the face. Because of this, it can be very distressing to the patient. Mild-to-moderate rosacea should be managed in primary care following current guidance. Nurse prescribers are ideally placed to manage rosacea and support patients with lifestyle advice. Treatment should be matched to the type of rosacea, and a 3-month treatment rule should be applied before review. This article addresses rosacea and its subtypes, treatment and practical skin care advice.