Early initiation of short‐term emollient use for the prevention of atopic dermatitis in high‐risk infants—The STOP‐AD randomised controlled trial. Issue 4 (8th September 2022)

• Record Type: Journal Article
• Authors: Ní Chaoimh, Carol; Lad, Dhanis; Nico, Claudio; Puppels, Gerwin J.; Wong, X. F. Colin C.; Common, John E.; Murray, Deirdre M.; Irvine, Alan D.; Hourihane, Jonathan O'Brien
• Is Part Of: Allergy. Volume 78:Issue 4(2023)
• Page Start: 984
• Page End: 994
• Publication Date: 2022-09-08
• Subjects: atopic dermatitis -- emollient -- prevention -- randomized controlled trial -- skin barrier; Allergy -- Periodicals; 616.97
• DOI: 10.1111/all.15491
• Languages: English
• ISSNs: 0105-4538

Abstract

Abstract: Background: Protecting the skin barrier in early infancy may prevent atopic dermatitis (AD). We investigated if daily emollient use from birth to 2 months reduced AD incidence in high‐risk infants at 12 months. Methods: This was a single‐center, two‐armed, investigator‐blinded, randomized controlled clinical trial (NCT03871998). Term infants identified as high risk for AD (parental history of AD, asthma or allergic rhinitis) were recruited within 4 days of birth and randomised 1:1 to either twice‐daily emollient application for the first 8 weeks of life (intervention group), using an emollient specifically formulated for very dry, AD‐prone skin, or to standard routine skin care (control group). The primary outcome was cumulative AD incidence at 12 months. AD <6 months was diagnosed based on clinical presence of AD. The UK Working Party Diagnostic Criteria were applied when diagnosing AD between 6 and 12 months. Results: Three hundred twenty‐one were randomised (161 intervention and 160 control), with 61 withdrawals (41 intervention, 20 control). The cumulative incidence of AD at 12 months was 32.8% in the intervention group vs. 46.4% in the control group, p = 0.036 [Relative risk (95%CI): 0.707 (0.516, 0.965)]. One infant in the intervention group was withdrawn from the study following development of a rash that had a potential relationship with the emollient. There was no significant difference in the incidence of skin infections between the intervention and control groups during the intervention period (5.0% vs. 5.7%, p > 0.05). Conclusions: This study has demonstrated that early initiation of daily specialized emollient use until 2 months reduces the incidence of AD in the first year of life in high‐risk infants. Abstract : This randomized controlled trial investigates if daily emollient use from birth to 2 months can reduce the incidence of AD in high‐risk infants. The cumulative incidence of AD at 12 months is 32.8% in the intervention group vs. 46.4% in the control group. A short‐term intervention involving early initiation (within 4 days of birth) of daily specialized emollient use until 8 weeks is associated with an approximately 50% and 29% lower risk of cumulative AD at 6 and 12 months, respectively.Abbreviations: AD, atopic dermatitis; CI, confidence interval; mo, month; wks, weeks