Attenuation of Atopic Dermatitis in Newborns, Infants, and Children With Prescription Treatment and Ceramide-Containing Skin Care: A Systematic Literature Review and Consensus
March 2024 | Volume 23 | Issue 3 | 152 | Copyright © March 2024
Published online February 14, 2024
Lawrence A. Schachner MD FAAD FAAPa, Anneke Andriessen PhDb, Latanya Benjamin MD FAAD FAAP,c, Mercedes E. Gonzalez MD FAADd, Leon Kircik MD FAADe, Peter Lio MD FAADf, Giuseppe Micali MDg
aDermatology and Pediatrics, Pediatric Dermatology, University of Miami School of Medicine, Miami, FL
bRadboud Academy; Radboud UMC, Nijmegen and Andriessen Consultants, Malden, The Netherlands
cDepartment of Women’s and Children’s Health, Florida Atlantic University, Boca Raton, FL
dDr. Phillip Frost Department of Dermatology and Cutaneous Surgery at the University of Miami Miller School of Medicine Miami, FL
eIcahn School of Medicine at Mount Sinai, New York, NY; Indiana University Medical Center, Indianapolis, IN; Physicians Skin Care, PLLC, Louisville, KY; DermResearch, PLLC, Louisville, KY
fNorthwestern University Feinberg School of Medicine, Chicago, IL
gDermatology Clinic, University of Catania, Catania, Italy
Abstract
Background: Atopic dermatitis (AD) typically starts in infancy and early childhood. The chronic skin disorder is associated with recurrent flares, pruritus, and genetic predisposition. Daily use of moisturizers that contain lipids, such as ceramides, reduces the rate of AD flares and the need for topical steroid treatment. We aimed to provide insights on AD attenuation to tailor AD prescription therapy, skin care, and maintenance treatment to improve pediatric patients with AD and families.
Methods: A panel of 6 pediatric dermatologists and dermatologists who treat neonates, infants, and children developed a consensus paper on AD attenuation for pediatric patients. The modified Delphi process comprised a face-to-face panel meeting and online follow-up to discuss the systematic literature search results and draw from clinical experience and opinion of the panel to adopt and agree on 5 statements.
Results: Understanding the functional properties of newborn and infant skin, discussing skincare product use with parents, and recommending tailored prescription and skincare routines can improve newborn, infant, and children's skin health. Studies on the prophylactic application of moisturizers initiated in early infancy suggest moisturizers may delay rather than prevent AD, especially in high-risk populations and when used continuously. Increasingly there is evidence that moisturizer application reduces the severity of AD and extends the time to flares, which may help attenuate the atopic march. The protective effect of skin care for AD has been observed in studies where its daily use is ongoing; these beneficial effects may be lost in less than 1year after cessation. It is therefore important to emphasize that skin care should be routinely used when counseling patients and caregivers.
Conclusion: Healthcare providers can improve patient outcomes in atopic-prone infants and children by providing instructions regarding the daily benefits of applying skin care with gentle cleansers and moisturizers. Using gentle cleansers and moisturizers containing barrier lipids from birth onward may delay AD occurrence and mitigate severity in predisposed infants.
J Drugs Dermatol. 2024;23(3):152-159 doi:10.36849/JDD.7894
INTRODUCTION
Atopic dermatitis (AD) is a common recurrent cutaneous disorder associated with pruritus and genetic predisposition that typically begins in infancy and early childhood.
1 It is unclear if AD is a single disease entity or a spectrum of diseases with a shared phenotype.
1-5 Certain clinical features are highly characteristic of AD, such as morphology, anatomic distribution, marked pruritus, relapsing course and or seasonal variation, associated xerosis, and a personal or family history of atopy.
1-5 Maintaining a healthy skin barrier starting early in life, using daily and ongoing skin care with a gentle cleanser and a lipid-containing moisturizer has been shown to reduce the number of flares and reduce AD severity.
6-8 However, evidence on interventions to prevent AD in pediatric patients is conflicting.
This consensus paper aims to provide insights into the literature about AD attenuation in newborns, infants, and children. We further explore gentle cleansers and moisturizers, particularly ceramide-containing skin care, offering insights into their specific role in attenuating AD as monotherapy or as an adjunct to AD treatment for the pediatric population.
