Professor Andrew Currie

Introduction: Eczema is a common, chronic inflammatory skin condition characterised by recurrent flares that may be exacerbated by increased Staphylococcus aureus colonisation in the setting of impaired skin barrier. In preterm infants, topical coconut oil improves skin integrity and demonstrates antimicrobial and anti-inflammatory properties, which are appealing characteristics of a treatment for eczema. However, there are concerns that transcutaneous sensitisation may lead to the development of food allergy in children with eczema.

Method: CocoKids was a single centre (Perth Children's Hospital), open label, pilot randomised controlled trial to investigate the safety, feasibility, clinical effects and skin microbial changes associated with topical coconut oil in children with eczema. Children <6 years old were randomised to standard eczema care with (intervention) or without (control) addition of daily topical coconut oil for 12 weeks. Children with coconut allergy or positive skin prick test (SPT) to coconut extract or coconut oil at screening were excluded. Outcomes were adverse events (including any new sensitisation to coconut on SPT or coconut specific IgE), adherence, changes in eczema severity and quality of life, and skin microbial changes associated with use of coconut oil.

Results: 58 participants were randomised (n = 27 intervention, n = 31 control; median age 1.55 years, range 0.2–5.9). Application of coconut oil was feasible, with 25/27 (93%) reporting daily application. No children in the coconut oil group developed a new positive coconut SPT or specific IgE following completion of the intervention period. Parent-reported eczema severity and quality of life improved significantly in the coconut oil group compared to controls, while eczema lesions showed reduced S. aureus load in those treated with coconut oil.

Conclusion: Daily application of coconut oil for 12 weeks was safe, with no evidence for de novo sensitisation to coconut in this cohort. The intervention was highly acceptable to parents and was associated with improvements in some clinical and microbiological outcomes. Results from this pilot study support the feasibility and rationale for larger trials of topical coconut oil in eczema.