Head-to-head: paraffin- versus ceramide-based moisturiser for paediatric AD

Both a paraffin-based and a ceramide-based moisturiser provided improvements in disease activity in children with mild-to-moderate atopic dermatitis (AD). The efficacy of the 2 therapies appeared to be similar. However, the authors emphasised that a larger, randomised-controlled trial is needed to confirm the current findings.

“Moisturisers are the first-line treatment option for patients with AD,” noted Prof. Sachin Gupta (All India Institute of Medical Sciences, India). “They improve skin barrier function and xerosis, reducing disease severity, transepidermal water loss, and the need for topical corticosteroids.” Since few studies have directly compared different moisturisers, Prof. Gupta and co-investigators randomised 53 children with mild-to-moderate AD to a paraffin-based or a ceramide-based moisturiser to compare the efficacy of the 2 therapies [1]. The primary endpoint was the change on the SCORing Atopic Dermatitis (SCORAD) scale at 3 months.

At baseline, the mean SCORAD values were 39.1 and 36.8 in the ceramide group and paraffin group, respectively. These rates had dropped to 17.0 and 15.4 after 3 months, indicating that the 2 therapies are equally efficacious (P=0.37; see Figure). Similarly, the Children's Dermatology Life Quality Index and Infants’ Dermatitis Quality of Life Index (CDLQI/IDQOI) scores at 6 months did not demonstrate a clear difference between the 2 study groups, with values of 7.0 in the ceramide group and 6.4 in the paraffin group (P=0.35). Of note, the use of corticosteroids was comparable across both arms. “Performing a regression analysis, we observed that the mean change in SCORAD was 0.78 at 3 months in both groups. However, the 95% CI was not within the predefined margin of equivalence, and we could therefore not prove equivalence,” explained Prof. Gupta.

Figure: Primary outcome results [1]

SCORAD, SCORing Atopic Dermatitis.

In conclusion, the paraffin-based and ceramide-based moisturisers appeared to be equally efficacious in children with AD, but larger studies are needed to validate these initial findings.

1. Gupta S, et al. Evaluation of a paraffin-based moisturizer as compared to a ceramide-based moisturizer in children with atopic dermatitis: a double-blinded two group equivalence randomized controlled trial. Late-breaker Session 3, WCD 2023, 3–8 July, Singapore, Singapore.