title: Transepidermal water loss measurement during infancy can predict the subsequent development of atopic dermatitis regardless of filaggrin mutations.
abstract: BACKGROUND
  Atopic dermatitis (AD) is characterized by skin barrier dysfunction. Few studies have used noninvasive techniques to measure epidermis function in asymptomatic neonates.
  
  
  METHODS
  Data of 116 infants from our previous randomized controlled study were analyzed. Skin barrier function was measured through transepidermal water loss (TEWL), stratum corneum hydration (SCH), and pH. The association between skin barrier function and time to AD development was evaluated. Patients were classified with high or low TEWL, and SCH and pH were assessed. The survival function of the time to AD development and hazard ratios were estimated. Allergic sensitization to egg white and ovomucoid at 32 weeks was assessed.
  
  
  RESULTS
  Regardless of a filaggrin mutation, TEWL (optimal cutoff, 6.5 g/m(2)/h) of the forehead within the first week of life showed a lower p-value than TEWL of the leg, and the SCH and pH measurements. Baseline TEWL of the forehead was not different between groups, except for the mean gestational age, and it was not affected by humidity. We found a significant difference in the cumulative AD incidence between the high and low TEWL groups for the forehead only (p < 0.05). The probability without AD was lower in the high TEWL group than in the low TEWL group. For only the high TEWL group, AD development decreased significantly with daily emollient use. The high TEWL group exhibited a higher rate of sensitization to ovomucoid (p = 0.07).
  
  
  CONCLUSIONS
  TEWL of the forehead during the first week of life is associated with AD development.
authors.affiliation: Department of Pediatrics, Jikei University Katsushika Medical Center, Tokyo, Japan; Division of Allergy, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan. Electronic address: horimukai-k@ncchd.go.jp.
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: Shigenori
authors.initials: S
authors.lastname: Kabashima
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: Department of Dermatology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Sasaki
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: Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan.
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Saito
authors.affiliation: Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Matsumoto
authors.affiliation: Division of Allergy, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Ohya
mesh_terms: D003681:Dehydration; D003876:Dermatitis, Atopic / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D004198:Disease Susceptibility; D005260:Female; D000091344:Filaggrin Proteins; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007381:Intermediate Filament Proteins / Q000235:genetics*; D053208:Kaplan-Meier Estimate; D008297:Male; D009154:Mutation; D011336:Probability; D012189:Retrospective Studies; D012307:Risk Factors; D012867:Skin / Q000276:immunology / Q000503:physiopathology*
chemical_list: C000717249:FLG protein, human; D000091344:Filaggrin Proteins; D007381:Intermediate Filament Proteins
keywords: Atopic; Dermatitis; Infant; Predictive value of tests; Transepidermal water loss