title: Application of moisturizer to neonates prevents development of atopic dermatitis.
abstract: BACKGROUND
  Recent studies have suggested that epidermal barrier dysfunction contributes to the development of atopic dermatitis (AD) and other allergic diseases.
  
  
  OBJECTIVE
  We performed a prospective, randomized controlled trial to investigate whether protecting the skin barrier with a moisturizer during the neonatal period prevents development of AD and allergic sensitization.
  
  
  METHODS
  An emulsion-type moisturizer was applied daily during the first 32 weeks of life to 59 of 118 neonates at high risk for AD (based on having a parent or sibling with AD) who were enrolled in this study. The onset of AD (eczematous symptoms lasting >4 weeks) and eczema (lasting >2 weeks) was assessed by a dermatology specialist on the basis of the modified Hanifin and Rajka criteria. The primary outcome was the cumulative incidence of AD plus eczema (AD/eczema) at week 32 of life. A secondary outcome, allergic sensitization, was evaluated based on serum levels of allergen-specific IgE determined by using a high-sensitivity allergen microarray of diamond-like carbon-coated chips.
  
  
  RESULTS
  Approximately 32% fewer neonates who received the moisturizer had AD/eczema by week 32 than control subjects (P = .012, log-rank test). We did not show a statistically significant effect of emollient on allergic sensitization based on the level of IgE antibody against egg white at 0.34 kUA/L CAP-FEIA equivalents. However, the sensitization rate was significantly higher in infants who had AD/eczema than in those who did not (odds ratio, 2.86; 95% CI, 1.22-6.73).
  
  
  CONCLUSIONS
  Daily application of moisturizer during the first 32 weeks of life reduces the risk of AD/eczema in infants. Allergic sensitization during this time period is associated with the presence of eczematous skin but not with moisturizer use.
authors.affiliation: Division of Allergy, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Kenta
authors.initials: K
authors.lastname: Horimukai
authors.affiliation: Division of Allergy, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Kumiko
authors.initials: K
authors.lastname: Morita
authors.affiliation: Division of Allergy, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Masami
authors.initials: M
authors.lastname: Narita
authors.affiliation: Division of Allergy, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Mai
authors.initials: M
authors.lastname: Kondo
authors.affiliation: Division of Allergy, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kitazawa
authors.affiliation: Division of Dermatology, Department of Surgical Subspecialties, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Nozaki
authors.affiliation: Division of Dermatology, Department of Surgical Subspecialties, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Shigematsu
authors.affiliation: Division of Dermatology, Department of Surgical Subspecialties, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Kazue
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Division of Dermatology, Department of Surgical Subspecialties, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Hironori
authors.initials: H
authors.lastname: Niizeki
authors.affiliation: Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Ken-Ichiro
authors.initials: K
authors.lastname: Motomura
authors.affiliation: Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Sago
authors.affiliation: Clinical Research Center, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Takimoto
authors.affiliation: Clinical Research Center, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Eisuke
authors.initials: E
authors.lastname: Inoue
authors.affiliation: Division of Enzyme Chemistry, Institute for Enzyme Research, Tokushima University, Tokushima, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Kamemura
authors.affiliation: Division of Enzyme Chemistry, Institute for Enzyme Research, Tokushima University, Tokushima, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kido
authors.affiliation: Department of Bacteriology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Junzo
authors.initials: J
authors.lastname: Hisatsune
authors.affiliation: Department of Bacteriology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Motoyuki
authors.initials: M
authors.lastname: Sugai
authors.affiliation: Department of Dermatology, Course of Integrated Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Murota
authors.affiliation: Department of Dermatology, Course of Integrated Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Katayama
authors.affiliation: Department of Dermatology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Sasaki
authors.affiliation: Department of Dermatology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Amagai
authors.affiliation: Department of Allergy and Immunology, National Research Institute for Child Health and Development, Tokyo, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Morita
authors.affiliation: Department of Allergy and Immunology, National Research Institute for Child Health and Development, Tokyo, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Matsuda
authors.affiliation: Department of Allergy and Immunology, National Research Institute for Child Health and Development, Tokyo, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Matsumoto
authors.affiliation: Department of Allergy and Immunology, National Research Institute for Child Health and Development, Tokyo, Japan. Electronic address: saito-hr@ncchd.go.jp.
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Saito
authors.affiliation: Division of Allergy, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan. Electronic address: ohya-y@ncchd.go.jp.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Ohya
mesh_terms: D000328:Adult; D000485:Allergens / Q000276:immunology; D003876:Dermatitis, Atopic / Q000276:immunology / Q000517:prevention & control*; D021181:Egg Hypersensitivity / Q000276:immunology / Q000517:prevention & control*; D004527:Egg Proteins / Q000276:immunology; D004655:Emulsions / Q000008:administration & dosage* / Q000009:adverse effects; D004817:Epidermis / Q000187:drug effects* / Q000276:immunology / Q000473:pathology; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007231:Infant, Newborn; D007564:Japan; D008297:Male; D046228:Microarray Analysis; D012306:Risk
chemical_list: D000485:Allergens; D004527:Egg Proteins; D004655:Emulsions; D007073:Immunoglobulin E
keywords: Atopic dermatitis; IgE; allergic sensitization; atopy; food allergy; randomized controlled trial