Randomized controlled trial on the efficacy and safety of virgin coconut oil compared to mineral oil in the treatment of uremic xerosis

Abstract

Background. Uremic xerosis is the most common dermatologic condition present in patients with chronic kidney disease. Emollients were shown to be beneficial and are considered to be the first-line of treatment. Objective. To assess the efficacy and safety of virgin coconut oil (VCO) compared to mineral oil as a therapeutic moisturizer for uremic xerosis. Methods. Adult patients undergoing hemodialysis who have uremic xerosis were randomized using a computer-generated list and were instructed to apply either VCO or mineral oil twice daily on the legs for 4 weeks. Primary outcome measures included investigator-assessed clinical efficacy based on overall dry skin score (ODSS), change in skin hydration (corneometer readings), change in skin lipids (sebumeter readings), and quality of life scores. Secondary outcome measures included patient-assessed efficacy and advent of adverse effects. Overall therapeutic response was determined in which treatment success was defined as total clearance of xerosis or reduction of ODSS score and increased objective measurements (i.e., corneometer and sebumeter readings) plus moderate to marked patient-assessed efficacy, while treatment failure was defined as failure in any one of these parameters. Results. A total of 45 (22 VCO group, 23 mineral oil group) were recruited and 36 (18 VCO group, 18 mineral oil group) completed the study. The majority of patients in both treatment groups showed improved ODSS, corneometer readings, and quality of life scores. Most patients considered both treatment oils to be moderately to markedly effective. Analysis of overall therapeutic response revealed treatment success of 4 out of 22 in the VCO group and 4 out of 23 in the mineral oil group. VCO demonstrated a trend to benefit in improving xerotic skin (RRR = 1.0%, 95% CI: -30, 26.3; RR = 0.99, 95% CI: 0.76, 1.3) but results are inconclusive due to the wide confidence interval. Conclusion. The application of VCO or mineral oil for 4 weeks may be equally beneficial and safe in improving uremic xerosis. VCO showed a trend to benefit compared to mineral oil in terms of overall therapeutic response but this needs to be confirmed in larger randomized controlled trials.