Early Use of Short-term Emollients Linked With Reduced Incidence of AD in High-risk Infants

Early initiation of daily specialized emollient use until 2 months was associated with a reduced incidence of atopic dermatitis (AD) development among high-risk infants, according to study findings published in Allergy.

With onset typically occurring in infancy, the pathogenesis of AD has been indicated to include impaired skin barrier function, along with cutaneous immune dysregulation and microbial disturbances.

“Supporting this is the consistent evidence that loss-of-function mutations in the filaggrin gene (FLG), resulting in measurable skin barrier defects, plays a central role in the inherited risk of AD,” explained the study authors.

Daily emollient use, which researchers described as the “cornerstone of AD management,” has notablly shown promise as a preventive mechanism against AD development, which affects up to one-fifth of children globally. However, clinical investigations regarding its preventive efficacy have generated conflicting findings.

In seeking to further explore whether protection of the skin barrier in early infancy can prevent AD, they conducted a single-center, 2-armed, investigator-blinded, randomized controlled clinical trial (NCT03871998) to assess if daily emollient use from birth to 2 months reduced AD incidence in high-risk infants at 12 months.

“Term infants identified as high risk for AD (parental history of AD, asthma or allergic rhinitis) were recruited within 4 days of birth and randomized (1:1) to either twice-daily emollient application for the first 8 weeks of life (intervention group), using an emollient specifically formulated for very dry, AD-prone skin, or to standard routine skin care (control group),” explained the study authors.

The primary outcome assessed was cumulative AD incidence at 12 months, in which AD at less than 6 months was diagnosed based on clinical presence of AD and the UK Working Party Diagnostic Criteria was applied when diagnosing AD between 6 and 12 months.

A total of 321 infants were randomized (intervention, n = 161; control, n = 160), with 61 withdrawals (intervention, n = 41; control, n = 20). Overall, the cumulative incidence of AD at 12 months was 32.8% in the intervention group vs 46.4% in the control group (relative risk, 0.707; 95% CI, 0.516-0.965; P = .036).

One infant in the intervention group was withdrawn from the study following development of a rash that had a potential relationship with the emollient. No significant difference in the incidence of skin infections was observed between the intervention and control groups during the intervention period (5.0% vs 5.7%; P > .05).

Researchers concluded that while the mechanisms behind the preventive effects of daily emollient use on AD development remains unclear, analysis of microbiome diversity and inflammatory biomarkers in a subgroup of this study is ongoing and may provide further information.

“While several recent studies do not support a protective effect of emollient use in infancy, future studies should examine the use of more complex emollients directed at enhancing the skin barrier in various populations and ethnicities, while identifying a treatment window that is both effective and acceptable to parents,” they added.

Reference

Chaoimh CN, Lad D, Nico C, et al. Early initiation of short-term emollient use for the prevention of atopic dermatitis in high-risk infants—The STOP-AD randomised controlled trial. Allergy. Published online August 22, 2022. doi:10.1111/all.15491