Effects of Early Emollient Use in Children at High Risk of Atopic Dermatitis: A German Pilot Study

Inken Harder; Dora Stölzl; Nicole Sander; Jan Hartmann; Elke Rodriguez; Carsten Mazur; Sebastian Kerzel; Michael Kabesch; Denise Küster; Jochen Schmitt; Regina Fölster-Holst; Sascha Gerdes; Hila Emmert; Stephan Weidinger

doi:10.2340/actadv.v103.5671

Authors

Inken Harder Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel https://orcid.org/0000-0002-3079-0440
Dora Stölzl Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
Nicole Sander Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany https://orcid.org/0000-0001-9084-7069
Jan Hartmann 1Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
Elke Rodriguez Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
Carsten Mazur Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
Sebastian Kerzel Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO), Clinic St. Hedwig, Regensburg, Germany
Michael Kabesch Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO), Clinic St. Hedwig, Regensburg, Germany
Denise Küster Center of Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
Jochen Schmitt Center of Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
Regina Fölster-Holst Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
Sascha Gerdes Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
Hila Emmert Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
Stephan Weidinger Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany https://orcid.org/0000-0003-3944-252X

DOI:

https://doi.org/10.2340/actadv.v103.5671

Keywords:

atopic dermatitis, early emollient, skin barrier, skin physiology

Abstract

Several small studies have indicated that daily emollient use from birth might delay, suppress or prevent atopic dermatitis (AD). Two larger trials did not confirm this; however, a recent smaller study indicated a protective effect if daily emollient use is used in the first 2 months of life. Further research is needed to evaluate the effect of emollient use on development of AD. The current study randomly assigned 50 newborns who were at high risk of developing AD (1:1) to receive general infant skin-care advice (control group), or skin-care advice plus emollient with advice to apply emollient at least once daily until 1 year of age (intervention group). Repeated skin examinations, skin physiology measurements and skin microbiome profiling were performed. Of the children in the intervention and control groups, 28% and 24%, respectively, developed AD (adjusted Relative Risk (RR) 1.19, p = 0.65, adjusted risk difference 0.05). Skin pH decreased and transepidermal water loss and stratum corneum hydration increased over time in both groups with no significant differences. In the intervention group skin microbiome alpha diversity increased earlier, and the abundance of Streptococcus and Staphylococcus species were significantly reduced at month 1. Daily early emollient use in children with high risk of AD was safe, but it did not significantly reduce the risk of developing AD or impact skin physiology development.

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