title: Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Dermatology, Oregon Health & Science University, Portland, Ore. Electronic address: simpsone@ohsu.edu.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Simpson
authors.affiliation: Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Joanne R
authors.initials: JR
authors.lastname: Chalmers
authors.affiliation: Department of Dermatology, Oregon Health & Science University, Portland, Ore.
authors.forename: Jon M
authors.initials: JM
authors.lastname: Hanifin
authors.affiliation: Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Kim S
authors.initials: KS
authors.lastname: Thomas
authors.affiliation: Dermatology Research, Department of Infection and Immunity, University of Sheffield, Sheffield, United Kingdom.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Cork
authors.affiliation: Dermatology & Genetic Medicine, University of Dundee, Dundee, United Kingdom.
authors.forename: W H Irwin
authors.initials: WH
authors.lastname: McLean
authors.affiliation: Dermatology & Genetic Medicine, University of Dundee, Dundee, United Kingdom.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Brown
authors.affiliation: Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland, Ore.
authors.forename: Zunqiu
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Public Health & Preventive Medicine, Oregon Health & Science University, Portland, Ore.
authors.forename: Yiyi
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Hywel C
authors.initials: HC
authors.lastname: Williams
mesh_terms: D003876:Dermatitis, Atopic / Q000276:immunology / Q000517:prevention & control*; D004643:Emollients / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D012306:Risk; D012867:Skin / Q000187:drug effects* / Q000276:immunology / Q000473:pathology; D016896:Treatment Outcome; D006113:United Kingdom; D014481:United States
chemical_list: D004643:Emollients
keywords: Atopic dermatitis; eczema; emollients; prevention; skin barrier