Guidance
Rationale and impact
This section briefly explains why the committee made the recommendations and how they might affect practice.
Emollient bath additives
Recommendations 1.5.1.4, 1.5.1.10 and 1.5.1.11
Why the committee made the recommendations
Evidence from the BATHE trial indicated that emollient bath additives are not clinically or cost effective when used in addition to standard care (which included applying leave-on emollients and washing with emollients or emollient soap substitutes). While evidence suggested that emollient bath additives are not harmful, prescribing a product with no additional benefit places unnecessary burdens on patients and carers, in terms of acquiring and using the product.
Some children with sensory processing disorders are unable to tolerate leave-on emollients that are applied directly to the skin, and emollients applied during bathing or showering may be their only option. The committee discussed making a different recommendation on emollient bath additives for this group, but decided not to because:
-
there was no evidence on the effectiveness of emollient bath additives compared with no emollient use
-
they can wash with leave-on emollients or emollient soap substitutes, so there is already a way for them to benefit from emollients
-
leave-on emollients can also be diluted in hot water and added to bath water, so there is an alternative option available.
The committee recommended personalised advice on washing because children face a variety of issues in controlling their eczema:
-
while some children with sensory processing disorders are unable to tolerate leave-on emollients, not all children in this group have the same needs
-
for children who cannot tolerate leave-on emollients, and who are using emollient bath additives alone to control their eczema, they and their families would benefit from advice on how to wash with leave-on emollients or emollient soap substitutes
-
families who buy emollient bath additives over the counter could save money if they knew they did not need to use these products.
How the recommendations might affect practice
NHS England advised that emollient bath additives should not be prescribed, in their 2019 guidance on items which should not routinely be prescribed in primary care. Despite this, prescribing of emollient bath additives has continued, and there has been geographical variation in prescribing.
The new recommendation supports the NHS England guidance and should further reduce prescribing of emollient bath additives. This would save money for the NHS and reduce geographical variation.