Patient acceptability, efficacy, and skin biophysiology of a cream and cleanser containing lipid complex with shea butter extract versus a ceramide product for eczema

Hong Kong Med J. 2015 Oct;21(5):417-25. doi: 10.12809/hkmj144472. Epub 2015 Aug 28.


Objectives: To investigate patient acceptability, efficacy, and skin biophysiological effects of a cream/cleanser combination for childhood atopic dermatitis.

Setting: Paediatric dermatology clinic at a university teaching hospital in Hong Kong.

Patients: Consecutive paediatric patients with atopic dermatitis who were interested in trying a new moisturiser were recruited between 1 April 2013 and 31 March 2014. Swabs and cultures from the right antecubital fossa and the worst eczematous area, disease severity (SCORing Atopic Dermatitis index), skin hydration, and transepidermal water loss were obtained prior to and following 4-week usage of a cream/cleanser containing lipid complex with shea butter extract (Ezerra cream; Hoe Pharma, Petaling Jaya, Malaysia). Global or general acceptability of treatment was documented as 'very good', 'good', 'fair', or 'poor'.

Results: A total of 34 patients with atopic dermatitis were recruited; 74% reported 'very good' or 'good', whereas 26% reported 'fair' or 'poor' general acceptability of treatment of the Ezerra cream; and 76% reported 'very good' or 'good', whereas 24% reported 'fair' or 'poor' general acceptability of treatment of the Ezerra cleanser. There were no intergroup differences in pre-usage clinical parameters of age, objective SCORing Atopic Dermatitis index, pruritus, sleep loss, skin hydration, transepidermal water loss, topical corticosteroid usage, oral antihistamine usage, or general acceptability of treatment of the prior emollient. Following use of the Ezerra cream, mean pruritus score decreased from 6.7 to 6.0 (P=0.036) and mean Children's Dermatology Life Quality Index improved from 10.0 to 8.0 (P=0.021) in the 'very good'/'good' group. There were no statistically significant differences in the acceptability of wash (P=0.526) and emollients (P=0.537) with pre-trial products. When compared with the data of another ceramide-precursor moisturiser in a previous study, there was no statistical difference in efficacy and acceptability between the two products.

Conclusions: The trial cream was acceptable in three quarters of patients with atopic dermatitis. Patients who accepted the cream had less pruritus and improved quality of life than the non-accepting patients following its usage. The cream containing shea butter extract did not differ in acceptability or efficacy from a ceramide-precursor product. Patient acceptability is an important factor for treatment efficacy. There is a general lack of published clinical trials to document the efficacy and skin biophysiological effects of many of the proprietary moisturisers.

Keywords: Ceramides/therapeutic use; Eczema; Plant oils.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Adolescent
  • Ceramides / pharmacology
  • Ceramides / therapeutic use*
  • Child
  • Dermatitis, Atopic / complications
  • Detergents / chemistry
  • Detergents / therapeutic use
  • Eczema / drug therapy*
  • Eczema / etiology
  • Emollients / therapeutic use
  • Female
  • Humans
  • Lipids / pharmacology
  • Lipids / therapeutic use*
  • Male
  • Patient Acceptance of Health Care*
  • Phytotherapy*
  • Plant Extracts / pharmacology
  • Plant Extracts / therapeutic use*
  • Pruritus / drug therapy
  • Pruritus / etiology
  • Quality of Life
  • Sapotaceae
  • Severity of Illness Index
  • Skin Cream / chemistry
  • Skin Cream / therapeutic use
  • Water Loss, Insensible / drug effects
  • Young Adult


  • Ceramides
  • Detergents
  • Emollients
  • Lipids
  • Plant Extracts