What if it were possible to prevent your child from getting eczema — a costly, inflammatory skin disorder — just by applying something as inexpensive as petroleum jelly every day for the first six months of his or her life?
A Northwestern Medicine study published earlier this month in JAMA Pediatrics found that seven common moisturizers would be cost-effective in preventing eczema in high-risk newborns. By using the cheapest moisturizer in the study, petroleum jelly, the cost benefit for "prophylactic moisturization" was only $353 per quality-adjusted life year — a generic measure of disease burden that assesses the monetary value of medical interventions in one's life.
Eczema affects as many as 20% of children and costs the U.S. healthcare system as much as $3.8 billion dollars every year. Previous studies have shown that families caring for a child with the costly skin disorder can spend as much as 35% of their discretionary income — an average of $274 per month.
"It's not only terrible for the kids, but also for their families," said lead and corresponding study author Steve Xu, a resident physician in dermatology at Northwestern University Feinberg School of Medicine. "Eczema can be devastating. Beyond the intractable itch, a higher risk of infections and sleep problems, a child with eczema means missed time from school, missed time from work for parents and huge out-of-pocket expenses. So if we can prevent that with a cheap moisturizer, we should be doing it."
Early studies from Japan, the U.S. and the U.K. have suggested that full-body application of moisturizers for six to eight months, beginning within the first few weeks of life, can reduce the risk that eczema will develops. Xu's study took that one step further and examined the cost-effectiveness of seven common, over the counter moisturizer products, such as petroleum jelly, Aquaphor, Cetaphil and Aveeno.
"There's an important economic argument to be made here," Xu said. "Moisturizers are an important intervention dermatologists use to treat eczema. They play a big role in getting our patients better. But insurers do not usually cover the cost of moisturizers. We're arguing for their inclusion in health insurance coverage."
Xu acknowledges the evidence is preliminary on prophylactic moisturizing but pointed out the minimal risk associated with putting Vaseline on babies versus giving them an oral drug or injecting them with a medication — and doing so could potentially prevent what Xu calls "a very devastating disease."
In addition to preventing eczema, Xu cites emerging work that preserving the skin barrier may also reduce the risk of other health problems like food allergies. He notes that larger, long-term clinical studies are underway to see if prophylactic moisturizing leads to sustained benefits.