BEEP Trial

Design and population. The Barrier Enhancement for Eczema Prevention (BEEP) trial (Chalmers et al., Lancet 2020) was a pragmatic, multicentre RCT in 12 hospitals and four primary-care sites across the UK. Between 2014 and 2016 it randomised 1,394 term newborns at high risk of eczema (at least one parent or sibling with doctor-diagnosed eczema, hay fever or asthma) to daily emollient plus standard skin-care advice (693) or advice alone (701). It tested the idea that reinforcing the skin barrier from birth, when Transepidermal Water Loss predicts later eczema, could stop Atopic Dermatitis starting. BEEP Trial [relates] Skin Barrier Dysfunction BEEP Trial [relates] Transepidermal Water Loss

Intervention and primary outcome. Parents applied Diprobase cream or Doublebase gel to the whole body (not the scalp) every day for the first year, starting at a median of 11 days old. Adherence was 88% at 3 months, 82% at 6 months and 74% at 12 months. The primary outcome was eczema in the past year at age 2, judged by research nurses blinded to allocation using UK Working Party criteria. BEEP Trial [part-of] Emollient Therapy

Result. At 2 years eczema affected 23% (139/598) of the emollient group and 25% (150/612) of controls (adjusted RR 0.95, 95% CI 0.78–1.16; p = 0.61). Skin infections were more common with emollient (0.23 vs 0.15 per child in year 1; IRR 1.55, 95% CI 1.15–2.09). Food allergy at 2 years was 7.5% vs 5.1% (aRR 1.47, 0.93–2.33), a possible but non-significant increase. The 5-year follow-up by parental questionnaire (Bradshaw et al., Allergy 2023) found no late benefit: doctor-diagnosed eczema between 12 and 60 months was 31% vs 28% (aRR 1.10, 0.93–1.30), and doctor-diagnosed Food Allergy by age 5 was 15% vs 14% (aRR 1.11, 0.84–1.45). Asthma and hay fever were also similar. The NIHR report judged daily emollient not cost-effective for prevention. BEEP Trial [contradicts] Emollient Therapy BEEP Trial [relates] Atopic March

Limitations. Two different emollients were used, which might have different effects. Families were not blinded and reported some outcomes themselves, and fewer than 20% of controls also used emollients. Starting at a median of 11 days may be later than ideal. Follow-up from 3 to 5 years relied on parental report. Its findings agree with PreventADALL and with the Cochrane review of infant skin care (Kelleher 2022), which found regular emollients “probably” do not prevent eczema. BEEP Trial [supports] Cochrane PreventADALL Trial [supports] BEEP Trial

What it means for toddlers. Moisturising a baby every day will not stop eczema developing, even in an allergic family, and may slightly raise skin infections. Emollients remain the foundation of treating established eczema in a 1–4-year-old (Emollient Therapy); BEEP is about prevention only. Parents who did not moisturise from birth have not “caused” their toddler’s eczema. BEEP Trial [relates] Eczema Prognosis

Connections

• Emollient Therapy — no prevention benefit, source: Lancet 2020
• Food Allergy — no difference by age 5 (15% vs 14%), source: Bradshaw, Allergy 2023
• Atopic March — no reduction in asthma or hay fever to age 5, source: Bradshaw, Allergy 2023
• Transepidermal Water Loss — trial tested the barrier-first rationale, source: Chalmers 2020
• PreventADALL Trial — companion prevention trial, also negative, source: Medicina 2024
• Cochrane — included in Kelleher 2022 infant skin-care review, source: Cochrane
• Petrolatum — paraffin-based emollients (Diprobase/Doublebase) used daily from birth did not prevent eczema, source: Chalmers 2020