DISCUSSION
Understanding potentially modifiable environmental risk factors for AD may allow for exposure reduction, mitigation of disease and/or prevention.8 Management of AD hinges on effective treatment and control for the well-being of the child and the family, while paying attention to psycho-social and comorbidity issues.6-9,12-14 Important aspects of AD treatment include parental education, avoidance of triggering factors, and daily application of moisturizers.5,8
A defective epidermal skin barrier permits the entry of allergens and loss of moisture.35,8 A better understanding of the neonatal skin barrier development in reaching a physiological pH and in gaining thickness is crucial in order to encourage parents to use moisturizers from birth, especially for those infants at risk for AD.15,23-26 Ongoing recognition of the central role a defective skin barrier plays in AD, supports the daily and ongoing use of moisturizers as an important part of treatment, prevention, and maintenance of AD.5,23,24,28
The need for medical treatments such as TCS and/or topical calcineurin Inhibitors (TCI) and/or phosphodiesterase 4 inhibitors depends on the severity of the AD condition; these treatments should be used in combination with moisturizers.38
The choice of moisturizer is dependent on individual preference, should be safe, effective, inexpensive, free of additives, fragrances, perfumes, sensitizing agents, and should be comfortable to use.39
Head-to-head trials between specific moisturizers are few in number, and are often underpowered, which may explain the lack of superior outcomes of one moisturizer compared to another. 39
A Cochrane review on moisturizer use in AD identified 77 relevant studies published to December 2015, with 6603 participants; most patients had mild-to-moderate AD.40
The authors concluded that moisturizer use in AD showed beneficial effects, prolonging time to flare, and reducing the number of flares and the amount of TCS needed to achieve similar reduction in AD severity. Moreover, combining active treatment with moisturizer showed better results than with active treatment alone.40 Topical natural oils, such as coconut, and sunflower seed oil are frequently chosen to combat dryness and to reduce the use of topical steroids.41 A moisturizer that contains sunflower oil distillate demonstrated clinical efficacy and safety when applied in pediatric patients with AD.34,35 Additionally, the moisturizer exhibited a TCS-sparing effect while improving skin condition.36,37
Limitations
The cause of AD is poorly understood, although genetic predisposition and environmental triggers appear to be critical to its pathogenesis. Further research is needed to better ascertain the various etiologic contributors to AD development in order to improve understanding of the condition, and to develop effective preventative and therapeutic treatments that may be initiated from birth. Although more studies are needed, daily moisturizer use from birth onwards appears to improve clinical outcomes for atopy-prone infants.
A defective epidermal skin barrier permits the entry of allergens and loss of moisture.35,8 A better understanding of the neonatal skin barrier development in reaching a physiological pH and in gaining thickness is crucial in order to encourage parents to use moisturizers from birth, especially for those infants at risk for AD.15,23-26 Ongoing recognition of the central role a defective skin barrier plays in AD, supports the daily and ongoing use of moisturizers as an important part of treatment, prevention, and maintenance of AD.5,23,24,28
The need for medical treatments such as TCS and/or topical calcineurin Inhibitors (TCI) and/or phosphodiesterase 4 inhibitors depends on the severity of the AD condition; these treatments should be used in combination with moisturizers.38
The choice of moisturizer is dependent on individual preference, should be safe, effective, inexpensive, free of additives, fragrances, perfumes, sensitizing agents, and should be comfortable to use.39
Head-to-head trials between specific moisturizers are few in number, and are often underpowered, which may explain the lack of superior outcomes of one moisturizer compared to another. 39
A Cochrane review on moisturizer use in AD identified 77 relevant studies published to December 2015, with 6603 participants; most patients had mild-to-moderate AD.40
The authors concluded that moisturizer use in AD showed beneficial effects, prolonging time to flare, and reducing the number of flares and the amount of TCS needed to achieve similar reduction in AD severity. Moreover, combining active treatment with moisturizer showed better results than with active treatment alone.40 Topical natural oils, such as coconut, and sunflower seed oil are frequently chosen to combat dryness and to reduce the use of topical steroids.41 A moisturizer that contains sunflower oil distillate demonstrated clinical efficacy and safety when applied in pediatric patients with AD.34,35 Additionally, the moisturizer exhibited a TCS-sparing effect while improving skin condition.36,37
Limitations
The cause of AD is poorly understood, although genetic predisposition and environmental triggers appear to be critical to its pathogenesis. Further research is needed to better ascertain the various etiologic contributors to AD development in order to improve understanding of the condition, and to develop effective preventative and therapeutic treatments that may be initiated from birth. Although more studies are needed, daily moisturizer use from birth onwards appears to improve clinical outcomes for atopy-prone infants.
CONCLUSION
AD is a chronic, relapsing skin disease, which impacts not only
the child, but also the family unit, impacting both financial burden
and emotional effects. Prevention and management of AD
hinge on parental education, preventive measures, treatment,
and control to improve the well-being of the child and of the
family. A defective epidermal skin barrier in AD may benefit
from daily moisturizer use, which should start after birth, especially
in those infants at risk for AD. Sunflower oil distillate, as a
component in a moisturizer, has exhibited clinical efficacy and
safety when used in pediatric patients with AD.
DISCLOSURES
The authors disclosed receipt of the following financial support
for the research, authorship, and/or publication of this article:
This work was supported by an unrestricted educational grant
from Laboratories Expanscience.
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10.1007/s11882-014-0433-9. 10. Xu S, Immaneni S, Hazen GB, Silverberg JL, Paller AS, Lio PA. Cost-effectiveness of prophylactic moisturization for atopic dermatitis. JAMA Pediatr. 2017;171(2):e163909. doi: 10.1001/jamapediatrics.2016.3909. Epub 2017 Feb 6.
11. Filanovsky MG, Pootongkam S, Tamburro JE, Smith MC, Ganocy SJ, Nedorost ST. The financial and emotional impact of atopic dermatitis on children and their families. J Pediatr. 2016;169:284–90. doi: 10.1016/j.jpeds.2015.10.077.
12. Blome C, Radtke MA, Eissing L, Augustin M. Quality of life in patients with atopic dermatitis: disease burden, measurement, and treatment benefit. Am
2. Eichenfield LF, Ellis CN, Mancini AJ, Paller AS, Simpson EL. Atopic dermatitis: epidemiology and pathogenesis update. Semin Cutan Med Surg. 2012;31(3Suppl):S3–S5. doi: 10.1016/j.sder.2012.07.002.
3. Lyons JJ, Milner JD, Stone KD. Atopic dermatitis in children: clinical features, pathophysiology and treatment. Immunol Allergy Clin North Am. 2015;35(1):161–83. doi:10.1016/j.iac.2014.09.008.
4. Li JC, Fishbein A, Singam V, Patek KR, Zee PC, Attarian H, et al. Sleep disturbance and sleep-related impairment in adults with atopic dermatitis: A cross-sectional study. Dermatitis. 2018;29(5):270-277. doi: 10.1097/ DER.0000000000000401
5. Bieber T. Atopic dermatitis. N Engl J Med. 2008;358(14):1483–94. doi:10.1056/NEJMra074081
6. Strom MA, Fishbein AB, Paller AS, Silverberg JI. Association between atopic dermatitis and attention deficit hyperactivity disorder in U.S. children and adults. Br J Dermtaol. 2016;175(5):920–29. doi: 10.1111/bjd.14697.
7. Cork MJ, Danby SG, Vasilopoulos Y, Hadgraft J, Lane ME, Moustafa M, et al. Epidermal barrier dysfunction in atopic dermatitis. J Invest Dermatol. 2009;129(8):1892–908.
8. Kantor R, Silverberg JI. Environmental risk factors and their role in the management of atopic dermatitis. Expert Rev Clinical Immunol. 2017;15–26. https://doi.org/10.1080/1744666X.2016.1212660.
9. Agrawal R, Woodfolk JA. Skin barrier defects in atopic dermatitis. Curr Allergy Asthma Rep. 2014 May;14(5):433–9. doi:
10.1007/s11882-014-0433-9. 10. Xu S, Immaneni S, Hazen GB, Silverberg JL, Paller AS, Lio PA. Cost-effectiveness of prophylactic moisturization for atopic dermatitis. JAMA Pediatr. 2017;171(2):e163909. doi: 10.1001/jamapediatrics.2016.3909. Epub 2017 Feb 6.
11. Filanovsky MG, Pootongkam S, Tamburro JE, Smith MC, Ganocy SJ, Nedorost ST. The financial and emotional impact of atopic dermatitis on children and their families. J Pediatr. 2016;169:284–90. doi: 10.1016/j.jpeds.2015.10.077.
12. Blome C, Radtke MA, Eissing L, Augustin M. Quality of life in patients with atopic dermatitis: disease burden, measurement, and treatment benefit. Am
