Why is Aqueous Cream bad for eczema?
The Medicines and Healthcare products Regulatory Agency (MHRA) issued a Drug Safety Update for Aqueous Cream on 27 March 2013.
The MHRA is the government agency, which is responsible for ensuring that medicines and medical devices work, and are acceptably safe. The MHRA have issued an official warning that Aqueous cream may cause skin irritation, particularly in children with eczema, possibly due to sodium lauryl sulfate (SLS), which is a known skin irritant.
Here is more information and the full Drug Safety Update on Aqueous Cream.
This will not, we imagine, come as significant news to members of the National Eczema Society. Indeed back in December 2007, the NICE guidelines for the management of atopic eczema in children clearly stated that aqueous cream BP should not be used as a leave-on emollient and research by Professor Mike Cork and his team in Sheffield (published 2003) demonstrated that for many children aqueous cream was an irritant.
In 2010, the results of a study carried out by Professor Richard Guy and his team at the University of Bath were published in the British Journal of Dermatology.
In this admittedly small study, volunteers who do not have eczema applied aqueous cream to their arm twice a day, leaving it on for 10 minutes, for 4 weeks.
The effects were then measured using laboratory tests - comparing the skin ‘treated’ with aqueous cream to adjacent ‘untreated’ skin. The research team measured the comparative thickness of the outer layer of the skin (the stratum cornea) and tested for transepidermal water loss.
Sodium lauryl sulfate and the skin barrier
Overall the areas that had been ‘treated’ were 12% thinner than the untreated areas. There was also an average 20% increase in water loss through the thinner ‘treated’ areas. This research also pinpoints one ingredient in aqueous cream as doing the damage - sodium lauryl sulfate, a harsh surfactant that truly has no place in a cream meant to treat eczema.
Given some of the confusing reports that did the rounds in the press, where the story was garbled in the retelling, we wanted to be sure that we were giving you the best information and so we have interviewed Prof. Richard Guy and also Prof. Mike Cork for their clinical opinion.
Prof. Guy has confirmed to us: ‘Aqueous cream contains 1% sodium lauryl sulphate (SLS) and this is the ingredient, we believe, that causes damage to the skin barrier.
The majority of other emollient creams in Europe do not contain SLS and are safe and effective products. It would be advisable to check the label of any emollient cream to verify that it does not contain SLS.’
Prof. Cork agrees: ‘This excellent paper from Professor Richard Guy’s group demonstrates that aqueous cream damages the skin barrier in volunteers who have never had atopic eczema.
Aqueous cream is likely to cause even more severe damage in the skin barrier in children and adults with atopic eczema. Aqueous cream should never be used as a leave-on emollient as it is likely to exacerbate, rather than improve, the eczema.’
Aqueous cream should never be used as a leave-on emollient as it is likely to exacerbate, rather than improve, the eczema.’