Early Emollient Application Helps Prevent Infant Atopic Dermatitis

The early application of emollients could be a useful and viable strategy in preventing atopic dermatitis in infants.

A team, led by Junqin Liang, Department of Dermatology and Venereology, People's Hospital of Xinjiang Uygur Autonomous Region, compared different emollients for effectiveness in preventing infant atopic dermatitis.

The Theory

While prophylactic application of emollients is effective treatment strategy preventing infant atopic dermatitis, the difference of difference emollients is not yet known.

“As a simple, inexpensive and widely available strategy, regular application of emollients has been found to help alleviate clinical symptoms in [atopic dermatitis] patients, delay flares and reduce the dosage of topical corticosteroids,” the authors wrote. “However, the early application of emollients for the prevention of [atopic dermatitis] is currently being debated.”

In the network meta-analysis, the investigators performed a systematic search to identify studies utilizing emollients for preventing infant atopic dermatitis from inception to February 2022. The studies were evaluated using the Cochrane risk of bias assessment tool.

Participants in the studies were infants who did not have atopic dermatitis at the point of recruitment, regardless of baseline risk. The experimental group of the studies must include participants who received emollients and the control group receiving standard care, including no treatment or similar adjuvant skin interventions in the experimental group.

Finally, the studies must report the development of atopic dermatitis after the intervention and were designed as randomized controlled trials.

Studies were excluded if non-skin interventions, including prebiotics or probiotics were used for all subjects in both the experimental and control groups.

Three Types of Emollients

Overall, they identified 11 studies for the final analysis involving cream, emulsion, and mixed type emollients.

The results show mixed emollients were significantly effective in preventing infant atopic dermatitis development compared to standard care (RR, 0.60; 95% CrI, 0.38-0.97). However, there was no statistical difference for the remaining comparisons.

However, the relative efficacy did not significantly differ between the 3 types of emollients in the high-risk population.

The direct meta-analysis showed early application of emollients was an effective strategy in preventing atopic dermatitis in high-risk infants (RR, 0.64; 95% CI, 0.47-0.88).

The network meta-analysis also showed emollient emulsion could be a viable option to prevent infant atopic dermatitis development (surface under the cumulative ranking curve (SUCRA), 82.6% for all populations, 78.0% for high-risk populations, and 79.2% for populations with food sensitization).

Finally, because of limited data the comparative safety of different types of emollients was not quantitatively evaluated.

“Overall, early application of emollients is an effective strategy for preventing [atopic dermatitis] development in high-risk infants and emollient emulsion may be the optimal type,” the authors wrote. “Future study with well-designed and large scale are warranted to validate our findings.”

The study, “Systematic review and network meta- analysis of different types of emollient for the prevention of atopic dermatitis in infants,” was published online by the European Academy of Dermatology and Venerology.