It is now possible to prevent atopic dermatitis in at-risk children

  • 15min
  • May. 2022
  • Supported by
    • La Roche-Posay

One clear risk factor: heredity5


The leading risk factor for AD in children is the existence of the condition in either one or both parents7:

  • If one parent has it: 20%-30% of children develop AD.7
  • If both parents have it: 40%-50% of children develop AD.7
  • The risk appears to be greater when the mother has the condition.7

Conversely, only 10% of children with atopic dermatitis have parents with no atopic symptoms.7



The root of atopic dermatitis: a skin barrier dysfunction


A skin barrier dysfunction is now recognised as being central to the onset and progression of AD.4

It is the result of a defect in the skin barrier’s structure, due to mutations in the gene coding filaggrin (FLG), a key protein in barrier formation.1,4,5

Moreover, children who are carriers of this mutation experience increased transepidermal water loss (TWL). Skin dryness often leads to the inflammation of skin prone to atopic dermatitis.4

Furthermore, the presence of TWL anomalies on the second day of life are predictive of the subsequent development of clinically symptomatic AD, particularly if they are observed in children with these mutations.6

In addition to this defect in the skin barrier’s structure, there is also a modification in the skin microbiota, with an overexpression of Staphyloccus aureus.1,8

This modification of the skin structure, combined with the increase in TWL and bacterial colonisation, allows microorganisms and allergens to penetrate the epidermis and stimulate the immune system. Consequently, the immune system reacts excessively to what it considers an attack, leading to an inflammatory response.3



Strengthening the skin barrier: an opportunity to prevent atopic dermatitis


In the absence of a cure for AD, early primary prevention is a major goal.5

Besides drug-based therapies, basic care of patients with AD relies on the use of emollients. It was therefore logical to examine the role that the latter could play in strengthening the skin barrier of newborns with a high risk of atopic dermatitis (due to a parent or sibling having the condition).2,4,7


Skin barrier protection might prevent atopic dermatitis development2



Emollients: clinically-proven effectiveness in the primary prevention of atopic dermatitis


Two major studies, published in 2014, were conducted in newborns at risk for atopic dermatitis.

Horimukai et al:1,4

  • A randomised, double-blind, controlled, parallel-group study in 118 newborns having a family history of atopic dermatitis
  • Intervention group (n=59): daily application of an emollient for the first 32 days of the newborn’s life
  • Results :
    • Increased hydration of the stratum corneum at 12 weeks in the intervention group
    • A significant decrease of 32% in the risk of atopic dermatitis in the intervention group (HR: 0.48; 95% CI: 0.27-0.86)
Simpson et al:2
  • A multi-centric, multinational, randomised, double-blind, controlled, parallel-group study in 124 newborns at risk for atopic dermatitis
  • Intervention group (n=54): daily application of an emollient to the entire body (except the head) starting at no later than 3 weeks and continuing until the infant reached 6 months of age
  • Results :
    • A 50% decrease in the relative risk of atopic dermatitis at 6 months of age (RR: 0.50; 95% CI: 0.28-0.90)

In addition to demonstrating the treatment’s effectiveness, the results also confirmed that tolerance was good.9

Moreover, the daily use of emollients in infants, from birth to 6 months of age, has been proven to be a cost-effective primary prevention strategy for at-risk newborns. This is especially relevant because atopic dermatitis represents a costly health condition and is associated with many comorbidities.6



Clear clinical implications


The early use of emollients in newborns at risk for atopic dermatitis is an effective strategy for the primary prevention of AD. Emollients help repair skin barrier function, thereby preventing water loss and keeping antigens from penetrating the body.1,5,7



A more detailed overview

How does an emollient work?

An emollient delivers lipids to the stratum corneum. This improves skin hydration by trapping water. It also helps prevent inflammation caused by external irritants.5
Some emollients have been clinically proven to rebalance the skin microbiota.10

Bibliography

  1. Grey K., Maguiness S. Atopic Dermatitis: Update for Pediatricians. Pediatr Ann. 2016;45(8) :e280-86.
  2. Simpson E.L., Chalmers J.R., Hanifin J.M., et al. Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention. J Allergy Clin Immunol. 2014;134:818-23.
  3. Ng J.P.X., Liew H.M., Ang B. Use of emollients in atopic dermatitis. JEADV 2015;29:854–57.
  4. Horimukai K., Morita K., Narita M., et al. Application of moisturizer to neonates prevents development of atopic dermatitis. J Allergy Clin Immunol. 2014;14(4):824-30.
  5. Chalmers J.R, Haines R.H., Mitchell E.J., et al. Effectiveness and cost-effectiveness of daily all-over-body application of emollient during the first year of life for preventing atopic eczema in high-risk children (The BEEP trial): protocol for a randomised controlled trial. Trials 2017;18:343.
  6. Xu S., Immaneni S., Hazen G.B., et al. Cost-effectiveness of Prophylactic Moisturization for Atopic Dermatitis. JAMA Pediatr. 2016;doi:10.1001/jamapediatrics.2016.3909.
  7. Oszukowska M., Michalak I., Gutfreund K., et al. Role of primary and secondary prevention in atopic Dermatitis. Postep Derm Allergol. 2015;XXXII(6):409–20.
  8. Powers C.E., Mcshane D.B., Gilligan P.H., et al. Microbiome and pediatric atopic dermatitis. J Dermatol. 2015;42:1137–42.
  9. Simpson E.L. Berry T.M., Brown P.A., et al. A Pilot Study of Emollient Therapy for the Primary Prevention of Atopic Dermatitis. J Am Acad Dermatol. 2010 October;63(4):587–93.
  10. Seite S., Zelenkova H., Martin R. Clinical efficacy of emollients in atopic dermatitis patients – relationship with the skin microbiota modification. Clin Cosmet Invest Dermatol. 2017;10:25–33.