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Dynamic trends in skin barrier function from birth to age 6 months and infantile atopic dermatitis: A Chinese

Ying Ye^1,2, Piaoping Zhao², Limin Dou²

¹Department of Clinical Epidemiology Children's Hospital of Fudan University & National Children Medical Center Shanghai China.

Clinical and Translational Allergy

|July 15, 2021

Insights

Higher transepidermal water loss (TEWL) in early infancy is linked to an increased risk of developing atopic dermatitis (AD). These findings highlight the importance of monitoring skin barrier function in newborns to predict and potentially prevent infant eczema.

Area of Science:

Neonatal dermatology
Infant skin physiology
Epidemiology of allergic diseases

Background:

Infant skin barrier development is crucial and may influence the onset of skin disorders.
Atopic dermatitis (AD) is a common infant skin condition with multifactorial origins.
Understanding early skin barrier dynamics is key to identifying risk factors for AD.

Purpose of the Study:

To investigate the dynamic trends of key skin barrier parameters in early infancy.
To assess the association between these dynamic trends and the risk of developing infant atopic dermatitis (AD).
To identify specific skin barrier parameters indicative of future AD risk.

Main Methods:

Prospective cohort study (NCT02889081) of 418 term infants.
Measurement of transepidermal water loss (TEWL), stratum corneum hydration (SCH), skin pH, and sebum content at multiple sites and time points (birth, 42 days, 6 months).
Statistical analysis including variance analyses and discrete time survival analysis, adjusting for covariates, to determine associations with AD at 1 year.

Main Results:

Skin barrier parameters showed nonlinear trends post-birth: TEWL and SCH increased, while skin pH and sebum content decreased.
Higher cheek transepidermal water loss (TEWL) at birth and 42 days significantly correlated with increased risk of AD.
No significant associations were found between stratum corneum hydration (SCH), skin pH, or sebum content and AD risk in early life.

Conclusions:

Infant skin barrier functions exhibit dynamic, nonlinear changes in the first six months post-birth.
Elevated transepidermal water loss (TEWL) in early infancy is a significant predictor of developing atopic dermatitis (AD).
Monitoring early postnatal TEWL may aid in identifying infants at higher risk for early-onset AD.

Read full analysis

Abstract

Background:

Skin barrier functions develop after birth and may be related to skin disorders in infants. We aimed to assess associations between dynamic trends of four skin barrier functional parameters in early life with infant atopic dermatitis (AD).

Methods:

Based on the prospective cohort MKNFOAD (NCT02889081), we examined transepidermal water loss (TEWL), stratum corneum hydration (SCH), skin pH, and sebum content at five anatomical sites (cheek, forehead, forearm, abdomen, and lower leg) in 418 term infants at birth, 42 days, and 6 months. Trend differences by sex and association with AD at age 1 year were tested using variance analyses. Associations of the parameters with AD risk were tested using discrete time survival analysis, adjusting extensive covariates including parental history of allergy, infant's sex, birth weight (kg), and delivery mode. Odds ratios (ORs) and 95% confidence interval (CIs) were reported.

Results:

Overall TEWL and SCH appeared trends of increase while skin surface pH and sebum content showed trends of decrease within the first six postnatal months. Sex differences were significant for sebum content only (p < 0.001). After adjustment for parental and children covariates, cheek TEWL at birth (OR = 1.26, 95% CI 1.00-1.57, p = 0.045) and 42 days (OR = 1.52, 95% CI 1.17-1.97, p = 0.002) were significantly associated with increased AD risk. Associations were not observed between SCH, skin pH, and sebum content at birth or 42 days with AD.

Conclusions:

Skin barrier functions of Chinese term infants varied nonlinearly after birth. Higher postnatal TEWL levels in early life indicate higher risk of early-onset AD.

Keywords:

TEWL atopic dermatitis birth cohort prospective skin barrier

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