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A Community-based Assessment of Skin Care, Allergies, and Eczema (CASCADE): an atopic dermatitis primary prevention
Brian Eichner1, Le Ann C Michaels2, Kelsey Branca2
1Duke Primary Care Research Consortium, Duke University, Durham, NC, USA.
Insights
Daily emollient use in infants may prevent atopic dermatitis (AD). This study investigated if lipid-rich emollients reduce AD risk in the general infant population, offering potential changes to routine infant skincare guidance.
Area of Science:
- Dermatology
- Pediatrics
- Preventative Medicine
Background:
- Atopic dermatitis (AD) is a prevalent chronic infant skin condition.
- Skin barrier dysfunction is a key factor in AD development.
- Early intervention with emollients may prevent AD in high-risk infants.
Purpose of the Study:
- To evaluate the effectiveness of daily lipid-rich emollient application in preventing physician-diagnosed AD in the general infant population.
- To assess secondary outcomes including caregiver-reported AD measures and other atopic disease development.
- To conduct a pragmatic, randomized, physician-blinded trial in a primary care setting.
Main Methods:
- Recruitment of infant-parent dyads from primary care practices across multiple research networks.
- Randomization of 1250 infants into daily emollient intervention or control groups.
- 24-month follow-up using chart review and surveys, with intention-to-treat analysis.
Main Results:
- Primary outcome: cumulative incidence of physician-diagnosed AD.
- Secondary outcomes: caregiver-reported AD severity and other atopic disease incidence.
- Data analysis based on intention-to-treat principles for generalizability.
Conclusions:
- Atopic dermatitis significantly impacts infant quality of life and is linked to other atopic conditions.
- Widespread use of lipid-rich emollients could potentially decrease AD prevalence in infants.
- The pragmatic trial design is expected to yield generalizable findings for routine infant skincare recommendations.
Background:
Atopic dermatitis (AD) is a common, chronic skin disorder often beginning in infancy. Skin barrier dysfunction early in life serves as a central event in the pathogenesis of AD. In infants at high risk of developing AD, preventative application of lipid-rich emollients may reduce the risk of developing AD. This study aims to measure the effectiveness of this intervention in a population not selected for risk via a pragmatic, randomized, physician-blinded trial in the primary care setting.
Methods:
Infant-parent dyads are recruited from a primary care practice participating through one of four practice-based research networks in Oregon, Colorado, Wisconsin, and North Carolina. Eligible dyads are randomized to the intervention (daily use of lipid-rich emollient) or the control (no emollient) group (n = 625 infants in each) and are followed for 24 months. The primary outcome is the cumulative incidence of physician-diagnosed AD and secondary outcomes include caregiver-reported measures of AD and development of other atopic diseases. Data collection occurs via chart review and surveys, with no study visits required. Data will be analyzed utilizing intention-to-treat principles.
Discussion:
AD is a common skin condition in infants that affects quality of life and is associated with the development of other atopic diseases. If a safe intervention, such as application of lipid-rich emollients, in the general population effectively decreases AD prevalence, this could alter the guidance given by providers regarding routine skin care of infants. Because of the pragmatic design, we anticipate that this trial will yield generalizable results.
Trial Registration:
ClinicalTrials.gov: NCT03409367. Registered on 11 February 2018.
