O12 Does frequency of bathing impact eczema symptoms? Results of the first Rapid Eczema Trials project randomized controlled trial

Abstract The aim of this study was to test whether a weekly bath or shower improves eczema symptoms compared with a daily bath or shower for people with eczema. This was an online, pragmatic, superiority randomized controlled trial, codesigned by people with eczema (citizen scientists), healthcare professionals and researchers. The Eczema Bathing Study is the first citizen-science trial to be completed as part of the Rapid Eczema Trials project (www.RapidEczemaTrials.org). Online surveys and discussion groups informed the study design to maximize inclusivity and accessibility. The codesign group decided the research question, interventions and comparators, duration of follow-up, and choice and timing of outcome assessments. People with self-report of eczema aged ≥ 1 year in the UK were included. The trial was registered with number ISRCTN12016473. People with very mild eczema [Patient-Orientated Eczema Measure (POEM) ≤ 2] were excluded. One person per household was eligible. Participants were randomized 1 : 1 to the weekly bathing group (bath or shower one or two times a week) or the daily bathing group (six or more times a week). It was not possible to mask participants to their randomized allocation. Prior belief was assessed at baseline. The primary outcome was participant-reported eczema symptoms collected weekly over 4 weeks using POEM (range 0–28; higher scores indicate more severe eczema). In total, 438 people with eczema (108 aged < 16 years and 330 adults) were randomized. The primary analysis included 195 of 218 (89%) in the daily bathing group and 193 of 220 (88%) in the weekly bathing group. Overall, 61% of participants fully adhered to the allocated bathing strategy for all 4 weeks. The mean (SD) POEM scores at baseline were 14.5 (5.7) in the daily bathing group and 14.9 (6.3) in the weekly bathing group. The adjusted difference in mean POEM score over 4 weeks for weekly vs. daily bathing was −0.4 points (95% confidence interval −1.3 to 0.4, P = 0.30). Sensitivity analysis, imputing missing values, was consistent with the main result: difference −0.7 (95% confidence interval −1.5 to 0.1). No serious unintended effects or harms were reported. In conclusion, we found no difference in eczema symptoms between daily and weekly bathing or showering. These results are helpful for people with eczema, giving them the freedom to choose what suits them best. The next question to be addressed by the Rapid Eczema Trials project is ‘Can using a topical corticosteroid for longer during a flare-up help keep eczema clear for longer?’.