We have an epidemic of eczema (also known as atopic dermatitis) throughout the world, particularly in Western Europe and the United States. People with eczema have very severe itching associated with red, cracked, and sometimes infected skin lesions. Eczema in childhood often precedes the development of other allergic disorders like food allergies, asthma, and seasonal allergies. It reduces quality of life by a lot, leads to missed school and work days, and costs the healthcare system billions of dollars each year.
Because eczema is an allergic disease, most studies have focused on avoiding potential allergens (things like pollen, pet dander, and dust mites). The results of those studies have mostly been disappointing and inconsistent, and until now there is no single accepted prevention strategy. Treating eczema mostly relies on steroids, but we know that long-term steroid creams can lead to thinning of the skin and increased risk of infections. Recent advances in our understanding of skin biology suggest that it is actually a problem in the barrier function of the skin that may be the first event leading to eczema. The idea is that if the skin cannot guard against potential allergens, it will lead to an immune reaction and development of a rash. The inflamed skin obviously cannot protect well against other allergens in the environment leading to more reactions and a vicious circle. Scratching further damages the skin’s barrier function, worsening the problem. Moisturizers are a safe and effective method of improving skin barrier function, and may represent a way to prevent eczema from developing in high risk individuals.
That was the basis for a recent study done in 124 babies in the United Kingdom. Participants were selected based on having a strong family history of eczema. We know that eczema also has a genetic link, and children with a mother, father, brother, or sister affected are more likely to develop it themselves. They controlled for things like type of delivery (cesarean versus natural birth), gender, and birthweight. The babies were then randomized to either an intervention group with daily, scheduled moisturizing with either an oil, cream, or ointment, or a control group where they moisturized as needed without a specific schedule. Researchers then followed the families for six months to see who developed eczema.
In the intervention group, cream was the preferred moisturizer (about 70% of families chose it) followed by oil (20%) and ointments like Vaseline or Aquaphor (10%). This makes sense because creams are less messy and easier to apply. About 85% of parents in the intervention group reported using the moisturizer at least five days per week, and the majority used it every day, as instructed. Daily moisturizer use significantly reduced the risk of developing eczema at six months with 43% of the control group developing the disease versus 22% in the intensive moisturizing group. That translates to 50% less risk! No particular moisturizer was better than the others as long as it was used consistently. The intensive moisturizing regimen was very well tolerated and no important side effects were reported.
The researchers concluded that intensive moisturizing improves skin hydration and reduces skin absorption of the potential allergens that can lead to early skin inflammation important in the development of eczema. This was the largest and best designed study on the topic and provides good evidence that families with a strong history of eczema should consider intensive moisturizing for their new babies during the first year or two of life. It may save them a lot of headaches and trips to the dermatologist down the line!