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Moisturisers from birth in at-risk infants of atopic dermatitis - a pragmatic randomised controlled trial
Pamela Si Min Ng1, Lynette Wei Yi Wee2, Valerie Pui Yoong Ho2
1Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore.
Insights
Early moisturiser use in at-risk infants does not prevent atopic dermatitis (AD). This study found no significant difference in AD incidence between infants treated with moisturisers from birth and a control group.
Area of Science:
- Dermatology
- Pediatrics
- Allergy and Immunology
Background:
- Atopic dermatitis (AD) is a prevalent chronic skin condition often beginning in infancy.
- Previous research on early moisturiser use for AD prevention yielded inconclusive results.
Purpose of the Study:
- To evaluate the impact of early moisturiser application on AD incidence in high-risk infants.
- To compare moderate-to-severe AD and total AD incidence in infants using moisturisers from 2 weeks of age versus a control group.
Main Methods:
- A prospective, randomized controlled trial involving 200 infants with a family history of atopy.
- Infants were randomized to receive moisturiser treatment from 2 weeks of age or no moisturiser.
- Assessments at 2, 6, and 12 months included AD diagnosis, severity scoring (SCORAD), and skin barrier function tests (TEWL, hydration, pH).
Main Results:
- No significant difference was observed in the incidence of moderate-to-severe AD or total AD at 12 months between the groups.
- The moisturiser group showed a lower mean SCORAD, but skin barrier function (TEWL, hydration, pH) did not differ significantly.
- No adverse side effects were reported in the treatment group.
Conclusions:
- Routine early application of moisturisers does not appear to reduce the incidence of atopic dermatitis in infants at high risk.
- Further research may be needed to identify specific interventions for AD prevention in vulnerable infant populations.
Background:
Atopic dermatitis (AD) is a common, chronic dermatosis, with onset of disease often manifesting in early infancy. Past studies evaluating the early use of moisturisers in the prevention of AD had mixed results.
Objectives:
To compare the incidence of moderate or severe AD and total incidence of AD in a cohort of 'at-risk' infants treated with moisturisers from the first 2 weeks of life, to a similar group without moisturisers.
Methods:
We performed a single-centre, prospective, parallel-group, randomised study in infants with at least 2 first-degree relatives with atopy. Subjects were randomised into either a treatment group with moisturisers or a control group without moisturisers. Participants were assessed at 2, 6, and 12 months for AD and if present, the severity was assessed using SCORAD index. We also compared the overall incidence of AD, trans-epidermal water loss (TEWL), stratum corneum (SC) hydration, pH, and incidence of food and environmental sensitisation and allergies between both groups. Genotyping for loss-of-functions mutations in the FLG gene was conducted.
Results:
A total of 200 subjects were recruited, with 100 subjects in each arm. There was no significant difference in incidence of moderate or severe AD, and total incidence of AD at 12 months between the treatment and control groups. There was a lower mean SCORAD in the treatment group than in the control group, but no significant difference in TEWL, SC hydration, and skin pH. No significant side-effects were reported.
Conclusions:
The early use of moisturisers in 'at-risk' infants does not reduce the incidence of moderate-to-severe AD and overall incidence of AD in infancy.
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