Transepidermal Water Loss in Newborns Associated with Clinical Atopic Dermatitis Signs

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The presence of transepidermal water loss (TEWL) at the anterior cubital fossa of newborn babies is associated with clinical signs of atopic dermatitis, according to recent findings, highlighting a method for clinicians to assess atopic dermatitis risk in this age group.¹

These data were the result of new research authored in part by Cristian Fidanzi, MD, from the unit of dermatology at the University of Pisa’s department of medical and oncology area in Pisa, Italy. Fidanzi et al. noted that there had been a lack of methods available to identify newborns with atopic dermatitis, also known as eczema.²

“This study aims to evaluate the predictive role of serological biomarkers, in correlation with the TEWL and hydration rate and with the development of (atopic dermatitis) at 12 months of age,” Fidanzi and colleagues wrote. “To achieve the goal of predicting the development of (atopic dermatitis), skin and serologic data were evaluated at birth.”

Background and Design

The investigators gathered 10-mL cord blood samples from subjects at birth. The subjects assessed in the study were a set of 40 consecutive full-term newborns who had been at a university hospital in Italy.

The research team implemented enzyme-linked immunosorbent assay kits to evaluate the newborns’ levels of serum cytokines, following the kit manufacturers’ instructions. They considered a wide variety of factors in their research, some of which included the existence of a family history of allergies such as allergic rhinoconjunctivitis or asthma.

The team also evaluated the newborns for inflammatory skin disorders like psoriasis or eczema, as well as the babies’ breast-feeding status, their method of delivery, and the parental utilization of ceramide-based emollients as well as cleansers. TEWL was evaluated by the investigators at the 1, 6, and 12-month marks following newborns’ births, with the team specifically looking at newborns’ anterior cubital fossa and the front of their knees through the use of the DermaLab TEWL Probe.

The research team assessed the babies’ cradle cap, levels of dryness, and eczematous lesions over the course of the necessary follow-up interactions during the study. The DermaLab Moisture Probes of this same cohort were also used to look at newborn levels of hydration.

An atopic dermatitis diagnosis was produced using the Hanifin-Rajka and UK Working Party criteria, specifically at the 6 and 12-month marks. The team did not include babies born prematurely, ones with major skin or systemic conditions observed at birth, and ones whose parents did not provide consent or were on systemic treatments.

Ceramide-based emollients as well as moisturizers were applied thanks to the investigators’ instructions once each day throughout their observation period for newborns who developed eczema symptoms.

Study Results

Overall, the 40 newborns evaluated by the team had been 68% male, with 16 having symptoms and signs of eczema and placed in the atopic dermatitis cohort. There were 24 who turned out not to have developed the skin disease and placed in the non-atopic dermatitis cohort.

Anterior cubital fossa TEWL values which were statistically significant at the 1, 6, and 12-month marks among those with the skin condition versus those without any clinical signs. The investigators concluded that there were statistically significant correlations between the TEWL assessed at the anterior part of newborns’ knees and their hydration rate seen at the anterior cubital fossa by their initial month of life.

The research team highlighted the fact that the quantification of cytokines showed that an evaluation of patients' cord blood serum levels of CCL17 and IL-31 could allow for additional insights into the identification of infants' susceptibility to eczema.

“Limitations of this study include its observational design, small number of individuals enrolled, restriction to a single institution, and a possible selection bias since parents with a history of atopy might have been more agreeable to enroll their children,” they wrote.

References

1. ^{D’Erme AM, Fidanzi C, Bevilacqua M, et al. Cord Blood Serum Levels of IL-31 and CCL17, Cutaneous Markers, and Development of Atopic Dermatitis. JAMA Dermatol. Published online September 11, 2024. doi:10.1001/jamadermatol.2024.3178.}
2. ^{Wollenberg A,Christen-Zäch S,Taieb A,et al; European Task Force on Atopic Dermatitis/EADV Eczema Task Force. ETFAD/EADV Eczema task force 2020 position paper on diagnosis and treatment of atopic dermatitis in adults and children. J Eur Acad Dermatol Venereol. 2020;34 (12):2717-2744. doi:10.1111/jdv.16892.}