Daily Moisturizing of Infants May Prevent Eczema

October 22, 2014

Daily Moisturizing of Infants May Prevent Eczema

  1. David J. Amrol, MD

Encouraging results from two small randomized studies of high-risk infants

  1. David J. Amrol, MD

Abnormal skin barrier function is thought to be central in the pathophysiology of atopic dermatitis (AD). Filaggrin is required for normal barrier function, and loss-of-function mutations are a major risk factor for severe eczema and other allergic diseases. Daily emollient therapy is a cornerstone of treatment, but moisturizers have not been studied in the prevention of AD.

In a pilot study, 124 newborns in the U.S. and U.K. were randomized to daily emollient therapy or usual infant skin care started by age 3 weeks. All infants were at high risk for AD, with at least one atopic first-degree relative. Parents in the U.S. were allowed to choose among sunflower oil, Cetaphil cream, or Aquaphor Healing Ointment. After 6 months, 43% of infants in the control group versus 22% in the emollient group had physician-diagnosed AD (relative risk reduction, 50%).

In a separate Japanese study, 118 high-risk infants were randomized to daily treatment with an emulsion-type emollient or usual skin care (petroleum jelly was allowed in both groups) starting the first week of life. By 32 weeks, AD developed in 47% of infants in the control group versus 32% in the emollient group.

Comment

Most studies examining interventions for AD have focused on allergen avoidance or probiotics, and their results have been disappointing. Although the two studies cited here were small and of short duration, their findings are encouraging. Daily emollient therapy for newborns is safe and inexpensive, and can be pleasant for parents and newborns. While we await results of ongoing larger and longer-duration studies, I will recommend this therapy for high-risk newborns.

Editor Disclosures at Time of Publication

  • Disclosures for David J. Amrol, MD at time of publication Equity Abbott; AbbieVie; Express Scripts; Johnson and Johnson; Novartis; Pfizer; United Health Leadership positions in professional societies Allergy Society of South Carolina (Past President)

Citation(s):

Reader Comments (1)

Joram Seggev, MD Physician, Allergy/Immunology, Las Vegas, NV

Until now we have known that aggressive skin hydration and emollients are crucial for the management of atopic dermatitis. Reduction in prevalence of AD with simple measures would have an impact of many babies and their parents.

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