Application of moisturizer to neonates prevents development of atopic dermatitis.
Horimukai, Kenta MD a,*; Morita, Kumiko MD a,*; Narita, Masami MD, PhD a; Kondo, Mai MD a; Kitazawa, Hiroshi MD, PhD a; Nozaki, Makoto MD b; Shigematsu, Yukiko MD b; Yoshida, Kazue MD, PhD b; Niizeki, Hironori MD, PhD b; Motomura, Ken-ichiro MD c; Sago, Haruhiko MD, PhD c; Takimoto, Tetsuya MD, PhD d; Inoue, Eisuke PhD d; Kamemura, Norio PhD e; Kido, Hiroshi MD, PhD e; Hisatsune, Junzo PhD f; Sugai, Motoyuki DDS, PhD f; Murota, Hiroyuki MD, PhD g; Katayama, Ichiro MD, PhD g; Sasaki, Takashi PhD h; Amagai, Masayuki MD, PhD h; Morita, Hideaki MD, PhD i; Matsuda, Akio PhD i; Matsumoto, Kenji MD, PhD i; Saito, Hirohisa MD, PhD i,*; Ohya, Yukihiro MD, PhD a,*
[Miscellaneous Article]
Journal of Allergy & Clinical Immunology.
134(4):824-830e6, October 2014.
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Background: Recent studies have suggested that epidermal barrier dysfunction contributes to the development of atopic dermatitis (AD) and other allergic diseases.
Objective: We performed a prospective, randomized controlled trial to investigate whether protecting the skin barrier with a moisturizer during the neonatal period prevents development of AD and allergic sensitization.
Methods: An emulsion-type moisturizer was applied daily during the first 32 weeks of life to 59 of 118 neonates at high risk for AD (based on having a parent or sibling with AD) who were enrolled in this study. The onset of AD (eczematous symptoms lasting >4 weeks) and eczema (lasting >2 weeks) was assessed by a dermatology specialist on the basis of the modified Hanifin and Rajka criteria. The primary outcome was the cumulative incidence of AD plus eczema (AD/eczema) at week 32 of life. A secondary outcome, allergic sensitization, was evaluated based on serum levels of allergen-specific IgE determined by using a high-sensitivity allergen microarray of diamond-like carbon-coated chips.
Results: Approximately 32% fewer neonates who received the moisturizer had AD/eczema by week 32 than control subjects (P = .012, log-rank test). We did not show a statistically significant effect of emollient on allergic sensitization based on the level of IgE antibody against egg white at 0.34 kUA/L CAP-FEIA equivalents. However, the sensitization rate was significantly higher in infants who had AD/eczema than in those who did not (odds ratio, 2.86; 95% CI, 1.22-6.73).
Conclusion: Daily application of moisturizer during the first 32 weeks of life reduces the risk of AD/eczema in infants. Allergic sensitization during this time period is associated with the presence of eczematous skin but not with moisturizer use.
(C) 2014Elsevier, Inc.