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Predicting skin barrier dysfunction and atopic dermatitis in early infancy

Published online: September 27, 2019

Skin barrier dysfunction, measured by trans epidermal water loss, is associated with dry skin and has been found to precede atopic dermatitis. Dry skin is a cardinal sign, as well as an important diagnostic criterion, for atopic dermatitis, which in turn is associated with the development of food allergy, asthma and allergic rhinitis. Identifying predictive factors for skin barrier dysfunction and atopic dermatitis may therefore be important in order to select infants for potential primary prevention strategies.

Rehbinder and colleagues aimed to identify early-life predictive factors of dry skin, high transepidermal water loss and atopic dermatitis at 3 months of age, and to determine if dry skin or high transepidermal water loss at 3 months predicted atopic dermatitis at 6 months of age.
The study presented in the The Journal of Allergy and Clinical Immunology: In Practice included 1150 mother-child pairs recruited antenatally in the Preventing Atopic Dermatitis and Allergies in children (PreventADALL) prospective general population-based birth cohort study. Dry skin, transepidermal water loss and eczema were assessed at 3- and 6 months investigations. As a proxy for atopic dermatitis, eczema was defined as the presence of eczematous lesions verified by a physician, while high transepidermal water loss was defined as transepidermal water loss above the 90th percentile. Potential predictive factors were recorded from electronic questionnaires at 18- and 34-week pregnancy and from obstetric charts.

The authors found that increased paternal age and gestational age at birth was predictive of dry skin at 3 months of age, while maternal allergic disease, male sex and birth during the winter season were predictive for high transepidermal water loss. For atopic dermatitis at 3 months of age, the predictors were elective caesarean section, at least one sibling, and maternal allergic disease. Infants who at 3 months of age had dry skin independent of location, presented with eczema twice as often at 6 months of age compared to infants with unaffected skin at 3 months of age. Recognizing these early-life predictors for atopic dermatitis may help in targeting infants for primary prevention of atopic dermatitis and possibly other allergic diseases.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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