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

Simpson, Eric L.; Chalmers, Joanne R.; Hanifin, Jon M.; Thomas, Kim S.; Cork, Michael J.; Irwin McLean, W.H.; Brown, Sara J.; Chen, Zunqiu; Chen, Yiyi; Williams, Hywel C.

Authors

Eric L. Simpson

Joanne R. Chalmers

Jon M. Hanifin

Michael J. Cork

W.H. Irwin McLean

Sara J. Brown

Zunqiu Chen

Yiyi Chen

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HYWEL WILLIAMS HYWEL.WILLIAMS@NOTTINGHAM.AC.UK
Professor of Dermato-Epidemiology



Abstract

Atopic 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.

Objective

Our 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.

Methods

We 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.

Results

Forty-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.

Conclusion

The 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.

Citation

Simpson, E. L., Chalmers, J. R., Hanifin, J. M., Thomas, K. S., Cork, M. J., Irwin McLean, W., …Williams, H. C. (2014). Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention. Journal of Allergy and Clinical Immunology, 134(4), 818-823. https://doi.org/10.1016/j.jaci.2014.08.005

Journal Article Type Article
Acceptance Date Aug 1, 2014
Online Publication Date Oct 1, 2014
Publication Date Oct 1, 2014
Deposit Date Sep 17, 2018
Publicly Available Date Mar 28, 2024
Journal Journal of Allergy and Clinical Immunology
Electronic ISSN 1097-6825
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 134
Issue 4
Pages 818-823
DOI https://doi.org/10.1016/j.jaci.2014.08.005
Keywords Atopic dermatitis; Eczema; Skin barrier; Prevention; Emollients
Public URL https://nottingham-repository.worktribe.com/output/1105340
Publisher URL https://www.sciencedirect.com/science/article/pii/S009167491401118X?via%3Dihub
PMID 25282563