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

AD was observed in 11% of the infants in the skin intervention group, 9% in the food intervention group, 5% in the combined intervention group, and 8% in the control group (risk difference of 3.1%, 95% CI, -0.3 to 6.5 for the skin intervention and risk difference of 1.0%, 95% CI, -2.1 to 4.1 for the food intervention, in favor of the control group). The authors concluded that "neither skin emollients nor early complementary feeding reduced development of AD at 12 months."  

While the results of the large-scale trials41,42 may appear nonconfirmatory, it should be noted that using other moisturizer formulations may have produced a different effect.  

CONCLUSION

Discussing and recommending optimized skincare products and routines to parents can help attenuate AD in newborn and infant skin. Healthcare providers can improve patient outcomes by providing instruction regarding the benefits of applying clinically tested therapeutic moisturizers daily to improve skin barrier function and help delay, reduce, or maybe prevent AD.23 The protective effect of skin care for AD has been observed in studies where its daily use is ongoing;34 these beneficial effects may be lost less than 1 year after cessation.20 It is therefore important to emphasize that skin care should be routinely used, during and between flares, when counseling patients and caregivers.26

DISCLOSURES

CeraVe International supported the research for this work. The authors, LS, AA, LB, MG, LK, PL, GM, received fees for attending the meeting. The authors reviewed the manuscript and agreed with the final version and have no conflict of interest with the content of the manuscript. 

REFERENCES

  1. Brunner PM, Emerson RO, Tipton C, et al. Nonlesional atopic dermatitis skin shares similar T-cell clones with lesional tissues. Allergy. 2017;72(12):2017-2025. doi:10.1111/all.13223 
  2. Unger B, Garcet S, Gonzalez J, et al. An integrated model of atopic dermatitis biomarkers highlights the systemic nature of the disease. J Invest Dermatol. 2017;137:603-613. doi:10.1016/j.jid.2016.09.037 
  3. Lloyd-Lavery A, Solman L, Grindlay DJC, Rogers NK, Thomas KS, Harman KE. What's new in atopic eczema? An analysis of systematic reviews published in 2016. Part 2: epidemiology, aetiology and risk factors. Clin Exp Dermatol. 2016;2019(44):363-369. doi:10.1111/ced.13853 
  4. Pavel AB, Zhou L, Diaz A, et al. The proteomic skin profile of moderate-to-severe atopic dermatitis patients shows an inflammatory signature. J Am Acad Dermatol. 2020;82(3):690- 699. doi:10.1016/j.jaad.2019.10.039 
  5. Biagini Myers JM, Sherenian MG, Baatyrbek Kyzy A, et al. Events in normal skin promote early-life atopic dermatitis - The MPAACH Cohort. J Allergy Clin Immunol Pract. 2020;8(7):2285-2293.e6. doi:10.1016/j.jaip.2020.03.048 
  6. Boralevi F, Saint Aroman M, Delarue A, et al. Long-term emollient therapy improves xerosis in children with atopic dermatitis. J Eur Acad Dermatol Venereol. 2014;28(11):1456-1462. doi:10.1111/jdv.12314 
  7. Weber TM, Samarin F, Babcock MJ, Filbry A, Rippke F. Steroid-free over-the-counter eczema skin care formulations reduce risk of flare, prolong time to flare, and reduce eczema symptoms in pediatric participants with atopic dermatitis. J Drugs Dermatol. 2015;14(5):478-485. 
  8. Ma L, Li P, Tang J, et al. Prolonging time to flare in pediatric atopic dermatitis: A randomized, investigator-blinded, controlled, multicenter clinical study of a ceramide-containing moisturizer. Adv Ther. 2017;34(12):2601-2611. doi:10.1007/s12325-017-0640-6 
  9. Smith Begolka W, Elston DM, Beutner KR. American Academy of Dermatology evidence-based guideline development process: responding to new challenges and establishing transparency. J Am Acad Dermatol. 2011;64(6):e105-e112. doi:10.1016/j.jaad.2010.10.029 
  10. Draelos ZD. The effect of ceramide-containing skin care products on eczema resolution duration. Cutis. 2008;81(1):87-91. 
  11. McClanahan D, Wong A, Kezic S, et al. A randomized controlled trial of an emollient with ceramide and filaggrin-associated amino acids for the primary prevention of atopic dermatitis in high-risk infants. J Eur Acad Dermatol Venereol. 2019;33(11):2087-2094. doi:10.1111/ jdv.15786 
  12. Horimukai K, Morita K, Narita M, et al. Application of moisturizer to neonates prevents development of atopic dermatitis. J Allergy Clin Immunol. 2014;134(4):824-830.e6. doi:10.1016/j.jaci.2014.07.060
  13. Simpson EL, Chalmers JR, Hanifin JM, et al. Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention. J Allergy Clin Immunol. 2014;134(4):818- 823. doi:10.1016/j.jaci.2014.08.005 
  14. Lynde CW, Andriessen A, Barankin B, et al. Moisturizers and ceramide-containing moisturizers may offer concomitant therapy with benefits. J Clin Aesthet Dermatol. 2014;7(3):18-26. 
  15. Basu MN, Mortz CG, Jensen TK, Barington T, Halken S. Natural moisturizing factors in children with and without eczema: associations with lifestyle and genetic factors. J Eur Acad Dermatol Venereol. 2022;36(2):255-262. doi:10.1111/jdv.17787 
  16. Perrett KP, Peters RL. Emollients for prevention of atopic dermatitis in infancy. Lancet. 2020;395(10228):923-924. doi:10.1016/S0140-6736(19)33174-5 
  17. Pavel AB, Renert-Yuval Y, Wu J, et al. Tape strips from early-onset pediatric atopic dermatitis highlight disease abnormalities in nonlesional skin. Allergy. 2021;76(1):314-325. doi:10.1111/ all.14490 
  18. Flohr C, England K, Radulovic S, et al. Filaggrin loss-of-function mutations are associated with early-onset eczema, eczema severity and transepidermal water loss at 3 months of age. Br J Dermatol. 2010;163(6):1333-1336. doi:10.1111/j.1365-2133.2010.10068.x 
  19. Hoyer A, Rehbinder EM, Fardig M, et al. Filaggrin mutations in relation to skin barrier and atopic dermatitis in early infancy. Br J Dermatol. 2022;186(3):544-552. doi:10.1111/bjd.20831 
  20. Danby SG, Andrew PV, Kay LJ, et al. Enhancement of stratum corneum lipid structure improves skin barrier function and protects against irritation in adults with dry, eczema-prone skin. Br J Dermatol. 2022;186(5):875-886. doi:10.1111/bjd.20955 
  21. Rawlings AV. Molecular basis for stratum corneum maturation and moisturization. Br J Dermatol. 2014;171(Suppl 3):19-28. doi:10.1111/bjd.13303 
  22. Wollenberg A, Barbarot S, Bieber T, et al. Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I. J Eur Acad Dermatol Venereol. 2018;32(5):657-682. doi:10.1111/jdv.14891 
  23. Hebert AA, Rippke F, Weber TM, Nicol NH. Efficacy of non-prescription moisturizers for atopic dermatitis: an updated review of clinical evidence. Am J Clin Dermatol. 2020;21(5):641-655. doi:10.1007/s40257-020-00529-9 
  24. Eichenfield LF, Tom WL, Berger TG, et al. Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014;71(1):116-132. doi:10.1016/j.jaad.2014.03.023 
  25. Wollenberg A, Barbarot S, Bieber T, et al. Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part II. J Eur Acad Dermatol Venereol. 2018;32(6):850-878. doi:10.1111/jdv.14888 
  26. Lansang P, Lara-Corrales I, Bergman JN, et al. Approach to the assessment and management of pediatric patients with atopic dermatitis: a consensus document. Section IV: Consensus statements on the assessment and management of pediatric atopic dermatitis. J Cutan Med Surg. 2019;23(5_suppl):32S-39S. doi:10.1177/1203475419882654 
  27. LePoidevin LM, Lee DE, Shi VY. A comparison of international management guidelines for atopic dermatitis. Pediatr Dermatol. 2019;36:36-65. doi:10.1111/pde.13678 
  28. Danby SG, Andrew PV, Brown K, Chittock J, Kay LJ, Cork MJ. An investigation of the skin barrier restoring effects of a cream and lotion containing ceramides in a multivesicular emulsion in people with dry, eczema-prone, skin: The RESTORE Study Phase 1. Dermatol Ther (Heidelb). 2020;10(5):1031-1041. doi:10.1007/s13555-020-00426-3 
  29. van Zuuren EJ, Fedorowicz Z, Christensen R, Lavrijsen A, Arents BWM. Emollients and moisturisers for eczema. Cochrane Database Syst Rev. 2017;2(2):CD012119. doi:10.1002/14651858.CD012119.pub2 
  30. Gayraud F, Sayag M, Jourdan E. Efficacy and tolerance assessment of a new type of dermocosmetic in infants and children with moderate atopic dermatitis. J Cosmet Dermatol. 2015;14(2):107-112. doi:10.1111/jocd.12145 
  31. Angelova-Fischer I, Rippke F, Richter D, et al. Stand-alone emollient treatment reduces flares after discontinuation of topical steroid treatment in atopic dermatitis: a double-blind, randomized, vehicle-controlled, left-right comparison study. Acta Derm Venereol. 2018;98(5):517-523. doi:10.2340/00015555-2882 
  32. Angelova-Fischer I, Neufang G, Jung K, Fischer TW, Zillikens D. A randomized, investigator-blinded efficacy assessment study of stand-alone emollient use in mild to moderately severe atopic dermatitis flares. J Eur Acad Dermatol Venereol. 2014;28(Suppl 3): 9-15. doi:10.1111/ jdv.12479 
  33. Schachner L, Andriessen A, Benjamin L, et al. The importance of skin care for neonates and infants: an algorithm. J Drugs Dermatol. 2021;20(11):1195-1205. doi:10.36849/jdd.6219 
  34. Zhong Y, Samuel M, van Bever H, Tham EH. Emollients in infancy to prevent atopic dermatitis: A systematic review and meta-analysis. Allergy. 2022;77(6):1685-1699. doi:10.1111/all.15116 
  35. Ballardini N, Kull I, Söderhall C, Lilja G, Wickman M, Wahlgren CF. Eczema severity in preadolescent children and its relation to sex, filaggrin mutations, asthma, rhinitis, aggravating factors and topical treatment: a report from the BAMSE birth cohort. Br J Dermatol. 2013;168(3):588-594. doi:10.1111/bjd.12196 
  36. Ricci G, Patrizi A, Baldi E, Menna G, Tabanelli M, Masi M. Long-term follow-up of atopic dermatitis: retrospective analysis of related risk factors and association with concomitant allergic diseases. J Am Acad Dermatol. 2006;55(5):765-771. doi:10.1016/j.jaad.2006.04.064 
  37. Garmhaussen D, Hagemann T, Bieber T, et al. Characterization of different courses of atopic dermatitis in adolescent and adult patients. Allergy. 2013;68:498-506. doi:10.1111/all.12112 
  38. Rystedt I. Prognostic factors in atopic dermatitis. Acta Derm Venereol. 1985;65:206-213. 
  39. Chaoimh CN, Lad D, Nico C, et al. Early initiation of short-term emollient use for the prevention of atopic dermatitis in high-risk infants-The STOP-AD randomised controlled trial. Allergy. 2022;10.1111/all.15491. doi:10.1111/all.15491 
  40. Lowe AJ, Su JC, Allen KJ, et al. A randomized trial of a barrier lipid replacement strategy for the prevention of atopic dermatitis and allergic sensitization: the PEBBLES pilot study. Br J Dermatol. 2018;178(1):e19-e21. doi:10.1111/bjd.15747 
  41. Chalmers JR, Haines RH, Bradshaw LE, et al. Daily emollient during infancy for prevention of eczema: the BEEP randomised controlled trial. Lancet. 2020;395(10228):962-972. doi:10.1016/ S0140-6736(19)32984-8 
  42. Skjerven HO, Rehbinder EM, Vettukattil R, et al. Skin emollient and early complementary feeding to prevent infant atopic dermatitis (PreventADALL): a factorial, multicentre, cluster-randomised trial. Lancet. 2020;395(10228):951-961. doi:10.1016/S0140-6736(19)32983-6 

AUTHOR CORRESPONDENCE

Anneke Andriessen PhD anneke.a@tiscali.nl
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