Despite a compelling rationale and promising early indications of a possible benefit of emollients as a means of preventing eczema from developing in babies born to families with allergic disease, the BEEP study found no evidence to support a clinically useful benefit for emollients when used in this way. The BEEP study found no evidence that advice to use daily emollients for the first year of life can prevent eczema when defined in a range of ways, nor did emollients reduce the severity distribution of eczema or time to onset. The study did not show any other benefits in terms of prevention of associated conditions including food allergy, asthma and hay fever up to the age of 5 years. The intervention delivered in this study is unlikely to be considered cost effective.
Some uncertainty exists around possible harms of emollients used in the first year of life including a possible increase in food allergy and increased parental report of doctor-confirmed skin infections; these uncertainties need to be explored in future studies. The findings of the BEEP study are consistent with other studies that form part of an ongoing living systematic review and meta-analysis.129
Based on the BEEP study and other similar studies, advice to use daily emollients for the first year of life cannot be recommended as a method to prevent eczema and associated atopic diseases. This is a useful scientific finding as the burden of applying daily emollients for the first year of life is considerable, so it is one less thing for busy parents to do when coping with allergic disease in the family. Parents often feel guilty for not doing all they can to prevent ‘passing on’ eczema to their newborn child, so not applying emollients from birth is one less thing for parents to feel they should have done. Apart from testing earlier initiation of emollients and/or more potent skin barrier enhancers as a means of primary prevention, the addition of a lot more ‘me too’ studies is unlikely to be helpful. Enough research has been set up and conducted on emollients for preventing eczema. The emphasis should be on encouraging those leading existing skin barrier prevention studies to measure potential harms as well as benefits, and to share their individual patient data with the living systematic review in order to add precision to the outcome estimates and to explore the full range of interventions in different populations over the world. Future prevention of eczema should concentrate more on preventing potentially harmful skin-care practices during infancy and on identifying interventions that can influence the course of early skin barrier and immune development.