Moisturisers from birth in at‐risk infants of atopic dermatitis – a pragmatic randomised controlled trial

Abstract

Background: Atopic dermatitis (AD) is a common, chronic dermatosis, with onset of disease often manifesting in early infancy. Past studies evaluating the early use of moisturisers in the prevention of AD had mixed results. Objectives:To compare the incidence of moderate or severe AD and total incidence of AD in a cohort of 'at-risk' infants treated with moisturisers from the first 2 weeks of life, to a similar group without moisturisers. Methods:We performed a single-centre, prospective, parallel-group, randomised study in infants with at least 2 first-degree relatives with atopy. Subjects were randomised into either a treatment group with moisturisers or a control group without moisturisers. Participants were assessed at 2, 6, and 12 months for AD and if present, the severity was assessed using SCORAD index. We also compared the overall incidence of AD, trans-epidermal water loss (TEWL), stratum corneum (SC) hydration, pH, and incidence of food and environmental sensitisation and allergies between both groups. Genotyping for loss-offunctions mutations in the FLG gene was conducted.Results: A total of 200 subjects were recruited, with 100 subjects in each arm. There was no significant difference in incidence of moderate or severe AD, and total incidence of AD at 12 months between the treatment and control groups. There was a lower mean SCORAD in the treatment group than in the control group, but no significant difference in TEWL, SC hydration, and skin pH. No significant side-effects were reported. Conclusions:The early use of moisturisers in 'atrisk' infants does not reduce the incidence of moderate-to-severe AD and overall incidence of AD in infancy.

Systematic review and network meta‐analysis of different types of emollient for the prevention of atopic dermatitis in infants

“…Six studies 17,21–25 reported the incidence of adverse events (AEs) after interventions (Table 2). We did not perform data synthesis due to variations in categories, such as skin infections, slippages and irritant contact dermatitis.…”

“…We retrieved 802 relevant studies from the initial literature search and only 10 RCTs 12,[17][18][19][20][21][22][23][24][25] were determined to meet our selection criteria after screening the titles, abstracts and full texts. Moreover, we also identified one eligible study 26 from a previous meta-analysis.…”

“…Moreover, we also identified one eligible study 26 from a previous meta-analysis. Finally, 11 eligible studies 12,[17][18][19][20][21][22][23][24][25][26] with 3483 subjects were included in our network metaanalysis. The detailed process of study selection is shown in Figure 1.…”

“…All eligible studies 12,[17][18][19][20][21][22][23][24][25][26] used appropriate methods to generate the random sequence, but one study 20 did not report the detailed information on the concealing allocation process. Two studies 18,26 were rated as high risk in performance bias and detection bias because blinding of participants, personnel and outcome assessment were not conducted.…”

“…13 As a simple, inexpensive and widely available strategy, regular application of emollients has been found to help alleviate clinical symptoms in AD patients, delay flares and reduce the dosage of topical corticosteroids. [14][15][16] Several studies 12,[17][18][19][20][21][22][23][24][25][26] have also investigated the prophylactic effect of the early emollient application on the development of AD in infants; however, the early application of emollients for the prevention of AD is currently being debated. [27][28][29][30] More importantly, a recent study reported that different types of emollient cream exhibit diverse physiological effects on the skin barrier in AD subjects.…”