Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention

Abstract

BackgroundAtopic dermatitis (atopic eczema) is a chronic inflammatory skin disease that has reached epidemic proportions in children worldwide and is increasing in prevalence. Because of the significant socioeconomic effect of atopic dermatitis and its effect on the quality of life of children and families, there have been decades of research focused on disease prevention, with limited success. Recent advances in cutaneous biology suggest skin barrier defects might be key initiators of atopic dermatitis and possibly allergic sensitization.ObjectiveOur objective was to test whether skin barrier enhancement from birth represents a feasible strategy for reducing the incidence of atopic dermatitis in high-risk neonates.MethodsWe performed a randomized controlled trial in the United States and United Kingdom of 124 neonates at high risk for atopic dermatitis. Parents in the intervention arm were instructed to apply full-body emollient therapy at least once per day starting within 3 weeks of birth. Parents in the control arm were asked to use no emollients. The primary feasibility outcome was the percentage of families willing to be randomized. The primary clinical outcome was the cumulative incidence of atopic dermatitis at 6 months, as assessed by a trained investigator.ResultsForty-two percent of eligible families agreed to be randomized into the trial. All participating families in the intervention arm found the intervention acceptable. A statistically significant protective effect was found with the use of daily emollient on the cumulative incidence of atopic dermatitis with a relative risk reduction of 50% (relative risk, 0.50; 95% CI, 0.28-0.9; P = .017). There were no emollient-related adverse events and no differences in adverse events between groups.ConclusionThe results of this trial demonstrate that emollient therapy from birth represents a feasible, safe, and effective approach for atopic dermatitis prevention. If confirmed in larger trials, emollient therapy from birth would be a simple and low-cost intervention that could reduce the global burden of allergic diseases.

Prebiotic‐supplemented partially hydrolysed cow's milk formula for the prevention of eczema in high‐risk infants: a randomized controlled trial

“…Recent insights indicate that the primary abnormality in eczema is a skin barrier defect. Allergic sensitization is a secondary phenomenon which increases the severity and longevity of atopic disorders 28. Thus, interventions that reduce sensitization and/or induce tolerance may be more important for long‐term outcomes.…”

A new topical panthenol-containing emollient: skin-moisturizing effect following single and prolonged usage in healthy adults, and tolerability in healthy infants

“…Clinical studies showed that the daily use of emollients prevents AD or reduces flare-ups (45,46). Recently, an expert panel reached consensus that the use of appropriate emollients at all post-inflammatory AD stages has the potential to maintain skin hydration with reduced acute exacerbations of AD (1).…”

Atopic eczema

“…16 Building on this observation, recent clinical trials have produced evidence to suggest that intensive emollient use from soon after birth, aimed to enhance the skin barrier, reduces the incidence of eczema by ∼50% in high-risk infants (defined as those with a first-degree relative having atopic disease). 17 However, the authors emphasise that larger trials are required before this approach can be recommended for routine clinical practice.…”