Study: Daily emollient for infants could reduce atopic dermatitis incidence

Study: Daily emollient for infants could reduce atopic dermatitis incidence | Image credit: stock.adobe.com.

According to results from a randomized clinical trial that evaluated emollient intervention in infants not selected for risk of atopic dermatitis (AD), daily emollient application before the age of 9 weeks reduced incidence of AD at the age of 24 months.¹

According to the study authors led by Eric Simpson, MD, MCR, from the Department of Dermatology at Oregon Health & Science University in Portland, AD imposes a global health burden for children and can be a risk factor for developing food allergy and asthma.^1,2

READ MORE: Atopic dermatitis phenotypes and allergic disease development in children²

Those who develop AD early in life can carry a risk of developing allergic comorbidities, sleep disturbances, behavioral changes, and mental health disorders and can experience bullying or stigma associated with AD.¹

"The objective of this current study, the Community-based Assessment of Skin Care, Eczema, and Allergies (CASCADE trial), was to determine whether once-daily, full-body emollient initiated within the first 9 weeks of life can reduce the cumulative incidence of AD in a community-based population not selected for risk," wrote Simpson and investigators.

The trial was a randomized, decentralized pragmatic clinical trial that featured 1247 infant-parent dyads from 25 community-based pediatric and family medicine clinics that are members of 4 statewide practice-based research networks.

Dyads were broken up into one of 2 groups: a daily, full-body emollient application daily moisturizer group that started by 9 weeks of age or a control group that did not use emollient. Physician-diagnosed AD recorded in medical records by 24 months of age was the primary outcome of the study.

"In the primary analysis, the risk of diagnosed AD by age [of] 2 years in the intervention was compared with the control groups under an intention-to-treat assumption and missing outcomes were imputed using multiple imputation," wrote the study authors. "The relative risk (RR) was estimated using a generalized linear model with a binomial distribution and log link and reported P values from a 2-sided Wald test at the .05 level of significance. Risk differences [RDs] are presented using the margins and mimrgns commands in Stata version 18 (StataCorp)."

Of the 1247 infants included in the trial, 44.3% were girls. The mean (SD) age at random assignment was 23.9 (16.3) days. At the 24-month mark, the cumulative incidence of AD was 36.1% (SE, 2.1) in the daily moisturizer group and 43.0% (SE, 2.1) in the control group, with an RR of 0.84 (95% CI, 0.73-0.97; P = .02). The effect magnitude was larger in the population not at high risk of AD (RR, 0.75; 95% CI, 0.60-0.90; P = .01).

A weaker intervention effect was observed for those who had a first-degree blood relative with atopic disease compared with children with a lower risk, though the interaction was not statistically significant. Additionally, protective effect of emollient was modified by a dog in the house, as a stronger effect of protection was observed of the intervention in a subset of families (RD, −14.2; 95% CI, −23.2 to –4.6) than in those without any pets (RD, 0.3; 95% CI, −9.6 to 10.3).

Skin infections, a secondary outcome, occurred at lower rates in the daily moisturizer group compared with the control group (19.8% vs 21.1%; RR, 0.94; 95% CI, 0.74-1.20) with no statistical difference between groups.

Findings suggested that routine use of emollients for AD prevention could be an approach for families, as 64% of participants reported using emollients before study enrollment.

"This suggests that routine emollient use is part of infant skin care routines for many households in the US. The composition of the emollient likely makes a difference in efficacy, as differences have been observed in skin barrier assessments between ceramide and non–ceramide-containing moisturizers," wrote the authors.

Overall, results demonstrated that full-body emollient application that began in the first 2 months of life reduced the risk of AD development, particularly in those with a family history of AD and those who had a dog in the house.

The investigative team concluded by writing that "further work will be needed on the cost-effectiveness of this approach and implementation strategies" and that "the effect of this approach on allergic comorbidities is also a high priority for future work."

References

1. Simpson EL, Michaels LC, Ramsey K, et al. Emollients to prevent pediatric eczema: a randomized clinical trial. JAMA Dermatol. Published online July 23, 2025. doi:10.1001/jamadermatol.2025.2357
2. Fitch J. Atopic dermatitis phenotypes and allergic disease development in children. July 25, 2025. Accessed July 28, 2025. https://www.contemporarypediatrics.com/view/atopic-dermatitis-phenotypes-and-allergic-disease-development-in-children