King's College London

The effect of domestic water quality on skin barrier function and eczema risk

Principal Investigator(s): Dr Zarif Jabbar-Lopez, Dr Carsten Flohr (London)
Type of Study: Pilot randomised controlled trial and observational
Recruiting? no

Funding Body: NIHR
Start Date: 01-Oct-2017
Projected End Date:



Atopic eczema is a common, sometimes debilitating chronic skin disease that affects up to 20% of children. Given its prevalence, even a small relative risk reduction could result in a significant reduction in disease burden. Epidemiological studies have implicated hard water in the risk of infants developing eczema and experimental data suggest that this may, in part, be due to an interaction between hard water and soap. The aim of this investigation is to comprehensively examine the effect of hard versus soft water on skin barrier function, skin barrier constituents, the skin microbiome and eczema risk in early life. The hypothesis that exposure to hard water (high calcium carbonate) increases the risk of eczema in newborn children will be tested in a pilot clinical trial by investigating whether installation of a water-softening device around the time of birth in high-risk children living in hard water areas reduces the risk of skin barrier breakdown and eczema.

Lay Summary

Eczema is a common skin problem that affects up to a fifth of children. While eczema does run in families, there appears to be more to it than just genetics. Eczema tends to develop in the first 2 years of life and it is thought that the things that come into contact with a child’s skin during these early years might be important in determining whether they go on to have eczema. Studies looking at the patterns of eczema in various parts of the world have identified a link between living in a hard water area and having eczema. This may be due to the water hardness itself or water hardness may be a proxy for something else. To test this further are planning a pilot clinical trial to see whether installing water softeners in the homes of newborn babies reduces their risk of developing eczema.

Summary of Findings

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