Now researchers have identified the best emollients to help prevent the skin condition.
Infants who are at high risk of atopic dermatitis are significantly less likely to develop the condition if they are moisturised in early life, and new research suggests emollient emulsion is best.
The meta-analysis included 11 randomised controlled trials and 3500 infants without atopic dermatitis at baseline, and compared the effectiveness of creams, emulsions or mixed types of emollients with standard care in preventing its development.
Researchers found that infants were 25% less likely overall to develop the skin condition if they had an early application of emollients.
Mixed emollients appeared to be the most effective, leading to a 40% reduction in atopic dermatitis incidence compared to usual care.
In high-risk infants, early emollient use led to a 36% reduction in the incidence.
A further analysis ranked the effectiveness of different types of moisturisers, with emollient emulsion coming out on top, followed by mixed emollients and emollient creams.
While adverse events were more common among infants using an emollient, there was not enough data to determine whether one type was worse than another.
Routine moisturiser use was important to stop the fragile skin barrier from drying out and cracking, leading to inflammation, said Clinical Associate Professor Kurt Gebauer, a dermatologist at Fremantle Dermatology in Perth.
“If someone asks how to stop their kid from getting eczema, an active thing they can do is to coat them with a very thick moisturiser twice daily. Because the first thing that happens is we dry out and crack, and when we crack that causes inflammation,” he said.
“Moisturiser is a vehicle for prevention and protection, not a vehicle to fix. Once you’ve got a kid with an itchy red rash, putting moisturiser on them is going to sting and irritate.
“Moisturising routinely as a preventative is something that needs to be done from day one.”
Professor Gebauer said he recommended his patients use whatever moisturiser they have at home, and if they needed to buy one to choose a simple, unscented moisturiser such as Sorbolene, QV, Cetaphil or CeraVe.
Plant-based moisturisers were best avoided as they contained industrial preservatives, he said.
“They have a huge number of preservatives which you don’t need, and putting strong preservatives on when the skin barrier is broken is not a good idea.”
Professor Gebauer said parents should avoid over-washing and overheating children.
“We have a habit of over-washing, over-cleansing and over-scrubbing, and breaking down the natural moisturisers that do exist. Then we over-heat kids and put them in synthetic materials like one-piece nylon jumpsuits.”
Professor Gebauer said depending on the climate, patients may need to use a lotion in summer and a thicker cream in winter.
Authors of the meta-analysis said impairment of the epidermal barrier at birth usually preceded the development of atopic dermatitis, and previous research had shown that improving skin hydration and skin barrier function could help relieve symptoms.
“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,” they wrote.
The use of emollients on infants early in life to prevent atopic dermatitis was currently under debate, they said.
“More importantly, a recent study reported that different types of emollient cream exhibit diverse physiological effects on the skin barrier in AD subjects,” they said.
The researchers said poorly managed atopic dermatitis affected quality of life, and people with the condition were more likely to develop food allergies, asthma and allergic rhinitis.
“As a result, it is critically important to clarify the possible mechanisms of AD to develop a more precise and effective preventive and treatment strategy.”
Journal of the European Academy of Dermatology and Venereology 2022, online 23 November
