Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention - 02/10/14
, Joanne R. Chalmers, PhD b, Jon M. Hanifin, MD a, Kim S. Thomas, PhD b, Michael J. Cork, PhD, FRCP c, W.H. Irwin McLean, FRSE, FMedSci d, Sara J. Brown, MRCP, MD d, Zunqiu Chen, MS e, Yiyi Chen, PhD f, Hywel C. Williams, DSc, FMedSci bAbstract |
Background |
Atopic dermatitis (atopic eczema) is a chronic inflammatory skin disease that has reached epidemic proportions in children worldwide and is increasing in prevalence. Because of the significant socioeconomic effect of atopic dermatitis and its effect on the quality of life of children and families, there have been decades of research focused on disease prevention, with limited success. Recent advances in cutaneous biology suggest skin barrier defects might be key initiators of atopic dermatitis and possibly allergic sensitization.
Objective |
Our objective was to test whether skin barrier enhancement from birth represents a feasible strategy for reducing the incidence of atopic dermatitis in high-risk neonates.
Methods |
We performed a randomized controlled trial in the United States and United Kingdom of 124 neonates at high risk for atopic dermatitis. Parents in the intervention arm were instructed to apply full-body emollient therapy at least once per day starting within 3 weeks of birth. Parents in the control arm were asked to use no emollients. The primary feasibility outcome was the percentage of families willing to be randomized. The primary clinical outcome was the cumulative incidence of atopic dermatitis at 6 months, as assessed by a trained investigator.
Results |
Forty-two percent of eligible families agreed to be randomized into the trial. All participating families in the intervention arm found the intervention acceptable. A statistically significant protective effect was found with the use of daily emollient on the cumulative incidence of atopic dermatitis with a relative risk reduction of 50% (relative risk, 0.50; 95% CI, 0.28-0.9; P = .017). There were no emollient-related adverse events and no differences in adverse events between groups.
Conclusion |
The results of this trial demonstrate that emollient therapy from birth represents a feasible, safe, and effective approach for atopic dermatitis prevention. If confirmed in larger trials, emollient therapy from birth would be a simple and low-cost intervention that could reduce the global burden of allergic diseases.
Le texte complet de cet article est disponible en PDF.Key words : Atopic dermatitis, eczema, skin barrier, prevention, emollients
Plan
| This report presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (RP-PG-0407-10177). The views expressed in this report are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health. United States–based contributions were made possible with funding from a Mentored Patient-oriented Research Career Development Award from the National Institute of Arthritis and Musculoskeletal and Skin Diseases at the National Institutes of Health (5K23AR057486). Support was also obtained from the Oregon Clinical and Translational Research Institute (OCTRI) and grant number 5 KL2 RR024141-04 from the National Center for Research Resources (NCRR; 5 KL2 RR024141-04), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Research in the McLean laboratory is funded by the Wellcome Trust (Programme Grant 092530/Z/10/Z and Strategic Award 098439/Z/12/Z). S.J.B. holds a Wellcome Trust Intermediate Clinical Fellowship WT086398MA. |
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| Disclosure of potential conflict of interest: This study was funded by the National Institute for Health Research (RPPG-0407-10177). M. J. Cork has received compensation from Almirall Pharmaceuticals for membership on their advisory board; has received or has grants pending from Almirall Pharmaceuticals; and has received payment for delivering lectures, as well as compensation for travel and other meeting-related expenses, from Almirall, Astellas Pharma, and Steifel (a GlaxoSmithKline company). W. H. I. McLean's institution has received funding from the Wellcome Trust (WT086398MA), as has that of S. J. Brown, who also received an honorarium for speaking at the AAAAI annual meeting in 2012 and 2013. The rest of the authors declare that they have no relevant conflicts of interest. |
Vol 134 - N° 4
P. 818-823 - octobre 2014 Retour au numéro
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