Pediatric Dermatology Division, Pediatric Department, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Neonatology Division, Pediatric Department, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
J Eur Acad Dermatol Venereol. 2022 Jan;36(1):76-83. doi: 10.1111/jdv.17675. Epub 2021 Sep 30.
Enhancing the skin barrier in high-risk neonates by daily use of emollients during infancy might prevent atopic dermatitis (AD); however, there have been no studies on this topic in a country with a tropical climate. Climate may affect the results of the use of emollients in neonates for AD prevention and possible adverse cutaneous eruptions.
To test the hypothesis that emollients used during infancy can prevent AD in high-risk neonates in a country with a tropical climate and to evaluate other possible adverse cutaneous eruptions in this population.
This was a randomized controlled study in a tertiary care hospital with a 6 months' duration. Eligible neonates were randomly assigned to receive either emollient and skincare advice (emollient group) or skincare advice only (control group). The intervention was started within 3 weeks of birth.
The emollient group showed a significant reduction in the cumulative incidence of AD at 6 months (relative risk, 0.39; 95% CI 0.24-0.64; P < 0.001). The emollient group started to develop AD later and had a lower severity of AD than the control group (P < 0.001). Compared to moderate adherence, low adherence to emollient application was associated with a lower number of patients with AD (P = 0.008). Potentially emollient-related cutaneous eruptions, such as miliaria, and suspected cutaneous infections, such as impetigo, were more frequent in the emollient group. Exposure to passive smoking showed a significant difference in the development of AD compared to non-smoking exposure, both during pregnancy and after the child's birth (P < 0.001).
This study suggests that, in a tropical climate, emollient applied to the skin of at-risk neonates on an 'as needed' basis (depending on environmental factors, level of skin dryness), rather than on a 'daily basis', can provide a substantial benefit for AD prevention.
在婴儿期每天使用保湿剂增强高危新生儿的皮肤屏障功能可能预防特应性皮炎（AD）；然而，在热带气候国家，尚未对此进行研究。气候可能会影响保湿剂在预防新生儿 AD 及可能出现的不良皮肤反应中的使用效果。
检验以下假说，即在热带气候国家，在婴儿期使用保湿剂可预防高危新生儿 AD，并评估该人群中其他可能出现的不良皮肤反应。
这是一项在三级保健医院进行的、为期 6 个月的随机对照研究。符合条件的新生儿被随机分配至接受保湿剂和皮肤护理建议（保湿剂组）或仅接受皮肤护理建议（对照组）。干预措施于出生后 3 周内开始。
与对照组相比，保湿剂组在 6 个月时 AD 的累积发病率显著降低（相对风险，0.39；95%CI 0.24-0.64；P<0.001）。保湿剂组开始出现 AD 的时间较晚，且 AD 的严重程度低于对照组（P<0.001）。与低依从性相比，低依从性与较少的 AD 患者有关（P=0.008）。与保湿剂相关的潜在皮肤反应，如痱子，以及疑似皮肤感染，如脓疱疮，在保湿剂组中更为常见。与非吸烟暴露相比，怀孕期间和孩子出生后被动吸烟对 AD 的发生有显著影响（P<0.001）。
本研究表明，在热带气候条件下，根据环境因素和皮肤干燥程度按需而非每日给高危新生儿皮肤使用保湿剂，可能对预防 AD 有显著益处。
