infancy might delay rather than prevent AD (moderate certainty), especially in high-risk populations and when used continuously.
Daily use of emollient therapy from birth to enhance skin barrier function may significantly delay the onset of AD in high-risk infants.11-13,23,26 However, there is some evidence that this treatment may delay rather than prevent AD. Even in the absence of active disease, the chronic nature of AD requires ongoing basic care to maintain the skin barrier.23,26
A systematic review and meta-analysis by Zhong et al investigated the efficacy and safety of prophylactic emollients initiated during the first 6 weeks of infancy to prevent AD and food allergies.34 The review identified randomized controlled trials published between January 2000 and July 2020 that evaluated the effect of prophylactic emollients within the first 6 weeks of life vs no treatment on AD development by 2 years of age. There was no significant reduction in AD development (RR 0.84, 95% CI, 0.64 to 1.10) compared to the control group in the 10 studies that fulfilled the inclusion criteria. However, prophylactic moisturizers exhibited an improved skin condition (RR 0.75, 95% CI, 0.62 to 1.11) in infants at high risk for AD development (n = 8 studies). A significant benefit (RR 0.59, 95% CI, 0.43 to 0.81) was also identified in studies (n = 6) in which emollients were used continuously until AD assessment; however, this effect was not observed if treatment had been interrupted prior to that time. The authors concluded that the application of emollients initiated during the first 6 weeks of infancy --- particularly in high-risk populations and with continuous use may delay rather than prevent AD.
Statement 4
Moisturizer use benefits young AD patients, reducing the severity and extending the time to flares. This could help prevent or attenuate the atopic march.
An inhibited barrier function in AD may result in periodic flare-ups of erythematous and pruritic lesions; therefore, delaying or preventing flares is key in managing this disease. AD treatment guidelines recommend daily treatment of atopic skin with moisturizers to prevent flares and maintain a flare-free state.24,26,27 Van Zuuren et al conducted a systematic review of randomized controlled trials that enrolled people with AD.29 The review included 77 studies (N=6603; age 4 months to 84 years [mean 18.6 years]; mean treatment duration, 6.7 weeks). When all moisturizers were compared to vehicle, placebo, or no moisturizer, they were found to produce fewer flares (6 studies, n=607; RR 0.33, 95% CI, 0.17 to 0.62; moderate-quality evidence) and lower investigator-assessed disease severity scores (12 studies, n=1281; SMD -1.04, 95% CI,-1.57 to -0.51; high-quality evidence).
In addition, moisturizer combined with active topical treatment was more effective in reducing flares (1 study, n=105; RR 0.43, 95% CI, 0.20 to 0.93; low-quality evidence) and in lowering investigator-assessed disease severity (3 studies, n=192; SMD-0.87, 95% CI, -1.17 to -0.57; moderate-quality evidence) than the active treatment alone. The authors concluded that most moisturizers produce some beneficial effects, prolong time to and decrease the number of flares, and reduce the number of topical steroids needed to diminish eczema severity.
