Pam Harrison

December 12, 2014

For infants at high risk for atopic dermatitis, the daily application of a common moisturizer leads to fewer skin problems, including eczema, by 32 weeks of age, a new study indicates.

Skin "consists of a constructive barrier, a chemical barrier, and an immunological barrier; we used moisturizer to enhance the constructive barrier," said Kumiko Morita, MD, from the National Center for Child Health and Development in Tokyo.

"We found that the cumulative incidence of atopic dermatitis and eczema at 32 weeks was lower in infants in the intervention group than in the control group," she told Medscape Medical News.

She presented the study results at the World Allergy Organization International Scientific Conference and Congress of the Brazilian Association of Allergy and Immunology in Rio de Janeiro. They were also recently published in the Journal of Allergy and Clinical Immunology.

The 118 infants in the study had a parent or sibling with atopic dermatitis, so were considered to be at high risk for the development of atopic dermatitis or eczema. Half the infants were randomized to receive daily moisturizer; the other half received nothing.

The product used in the study was an emulsion-type moisturizer from Shiseido that is popular in Japan and can be readily purchased in drug stores.

All infants were examined by the same blinded dermatologist during scheduled visits and at 4, 12, 24, and 32 weeks of life.

The condition was determined to be atopic dermatitis if eczematous symptoms lasted more than 4 weeks, and was determined to be eczema if symptoms lasted more than 2 weeks, in accordance with modified Hanifin and Rajka criteria.

Less Dermatitis, Eczema

During the first 32 weeks of life, fewer children in the moisturizer group than in the control group developed atopic dermatitis or eczema (19 vs 28; P = .012).

"These findings support our hypothesis that the daily application of a moisturizer prevents the development of atopic dermatitis or eczema during the first 32 weeks of life," said Dr. Morita.

Serum levels of allergen-specific IgE — determined with a high-sensitivity allergen microarray of diamond-like carbon-coated chips — were used to evaluate the infants for the presence of allergic sensitization.

Levels of IgE antibody against egg white were used to determine the rate of allergic sensitization in the infants, which was similar in the moisturizer and control groups.

However, in a post hoc analysis, the rate of allergic sensitization was significantly higher in infants with skin lesions, including those caused by atopic dermatitis or eczema, than in infants without lesions (odds ratio, 2.86).

In a study published in the same issue of the Journal of Allergy and Clinical Immunology (2014;134:818-823), researchers report that the daily use of a moisturizer from birth enhanced the skin barrier and helped prevent atopic dermatitis.

In the randomized controlled trial, 124 neonates at high risk for atopic dermatitis were assessed.

Parents in the intervention group were instructed to start applying moisturizer all over their infant's body on a daily basis in the first 3 weeks after birth. Parents in the control group were asked not to use a moisturizer.

At 6 months, there was a relative risk reduction of 50% in the cumulative incidence of atopic dermatitis in the moisturizer group, compared with the control group (P = .017). There was no difference in adverse events between the two groups.

The researchers conclude that applying a moisturizer from birth is "a feasible, safe, and effective approach" for the prevention of atopic dermatitis. If the benefit is confirmed in larger trials, this simple low-cost intervention could reduce the global burden of allergic disease.

There was no commercial funding for this study. Dr. Morita has disclosed no relevant financial relationships. Coauthor Kenta Horimukai, MD, from the National Center for Child Health and Development, reports receiving research support from the Ministry of Health, Labour and Welfare in Japan.

World Allergy Organization International Scientific Conference (WISC) and Congress of the Brazilian Association of Allergy and Immunology: Abstract 1035. Presented December 7, 2014.

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