Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention

Eric Simpson, Joanne R. Chalmers, Jon Hanifin, Kim S. Thomas, Michael J. Cork, W. H Irwin McLean, Sara J. Brown, Zunqiu Chen, Yiyi Chen, Hywel C. Williams

Research output: Contribution to journalArticle

343 Citations (Scopus)

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. Conclusion 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.

Original languageEnglish (US)
Pages (from-to)818-823
Number of pages6
JournalJournal of Allergy and Clinical Immunology
Volume134
Issue number4
DOIs
StatePublished - Oct 1 2014

Fingerprint

Emollients
Atopic Dermatitis
Parturition
Skin
Incidence
Parents
Newborn Infant
Risk Reduction Behavior
Skin Tests
Skin Diseases
Therapeutics
Randomized Controlled Trials
Quality of Life
Research Personnel
Costs and Cost Analysis

Keywords

  • Atopic dermatitis
  • eczema
  • emollients
  • prevention
  • skin barrier

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Medicine(all)

Cite this

Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention. / Simpson, Eric; Chalmers, Joanne R.; Hanifin, Jon; Thomas, Kim S.; Cork, Michael J.; McLean, W. H Irwin; Brown, Sara J.; Chen, Zunqiu; Chen, Yiyi; Williams, Hywel C.

In: Journal of Allergy and Clinical Immunology, Vol. 134, No. 4, 01.10.2014, p. 818-823.

Research output: Contribution to journalArticle

Simpson, Eric ; Chalmers, Joanne R. ; Hanifin, Jon ; Thomas, Kim S. ; Cork, Michael J. ; McLean, W. H Irwin ; Brown, Sara J. ; Chen, Zunqiu ; Chen, Yiyi ; Williams, Hywel C. / Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention. In: Journal of Allergy and Clinical Immunology. 2014 ; Vol. 134, No. 4. pp. 818-823.
@article{ea04810a3d914649adc7d2e8d06bc31e,
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. Conclusion 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.",
keywords = "Atopic dermatitis, eczema, emollients, prevention, skin barrier",
author = "Eric Simpson and Chalmers, {Joanne R.} and Jon Hanifin and Thomas, {Kim S.} and Cork, {Michael J.} and McLean, {W. H Irwin} and Brown, {Sara J.} and Zunqiu Chen and Yiyi Chen and Williams, {Hywel C.}",
year = "2014",
month = "10",
day = "1",
doi = "10.1016/j.jaci.2014.08.005",
language = "English (US)",
volume = "134",
pages = "818--823",
journal = "Journal of Allergy and Clinical Immunology",
issn = "0091-6749",
publisher = "Mosby Inc.",
number = "4",

}

TY - JOUR

T1 - Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention

AU - Simpson, Eric

AU - Chalmers, Joanne R.

AU - Hanifin, Jon

AU - Thomas, Kim S.

AU - Cork, Michael J.

AU - McLean, W. H Irwin

AU - Brown, Sara J.

AU - Chen, Zunqiu

AU - Chen, Yiyi

AU - Williams, Hywel C.

PY - 2014/10/1

Y1 - 2014/10/1

N2 - 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. Conclusion 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.

AB - 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. Conclusion 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.

KW - Atopic dermatitis

KW - eczema

KW - emollients

KW - prevention

KW - skin barrier

UR - http://www.scopus.com/inward/record.url?scp=84908092166&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84908092166&partnerID=8YFLogxK

U2 - 10.1016/j.jaci.2014.08.005

DO - 10.1016/j.jaci.2014.08.005

M3 - Article

C2 - 25282563

AN - SCOPUS:84908092166

VL - 134

SP - 818

EP - 823

JO - Journal of Allergy and Clinical Immunology

JF - Journal of Allergy and Clinical Immunology

SN - 0091-6749

IS - 4

ER -