Strategies that may prevent eczema easy to implement, inexpensive
Sarah S.Asch, M.D., FAAD, FAAP and Sheilagh M.Maguiness, M.D., FAAD, FAAP
Focus on Subspecialties
Strategies to prevent atopic dermatitis (AD) are as numerous and multifaceted as the
Over the past decade, increasing evidence has demonstrated that AD, often called eczema,
is caused primarily by structural skin barrier problems. Thus, strategies surrounding
skin barrier repair are a hot topic. In addition, studies showing protective effects
of early food introduction and protective environmental exposures in the neonatal
period for other atopic diseases have piqued enthusiasm for prevention of AD.
Following is an evidence-based look at prevention strategies pediatricians can recommend
to patients and families.
Moisturizing the skin
AD is a common pediatric skin disease, affecting about 18% of children. It results
in dry, itchy and inflamed skin that can lead to significant impairment in quality
of life for patients and their families. Currently, there is no cure.
Moisturizing the skin regularly from the newborn period onward may prevent atopic
dermatitis and is under investigation (Chalmers JR, et al.Trials.2017;18:343.) Two small studies of 124 infants and 80 infants, respectively, showed
that daily or twice daily emollient use reduced the incidence of atopic dermatitis
in at-risk infants at six months (Simpson EL, et al. J Allergy Clin Immunol. 2014;134:818-823; Lowe AJ.Br J Dermatol.2018;178:e19-e21).
A cost analysis showed petroleum jelly was the most cost-effective for daily use on
a growing infant (Xu S, et al. JAMA Pediatr. 2017;171:e163909).
As with the Learning Early About Peanut Allergy study for prevention of peanut allergy
(Du Toit G, et al. J Allergy Clin Immunol. 2013;131:135-143), there is emerging evidence to support that optimization of the
skin barrier also may prevent food allergies later in childhood (Lowe AJ.Br J Dermatol.2018;178:e19-e21). So, given the safety and cost-effectiveness, this intervention
is very practical.
Benefits of early exposures
Similarly, the Protection Against Allergy Study in Rural Environments showed that
in those with allergic parents, prenatal dog or cat exposure and introduction of yogurt
in the first year of life appear to protect against early-persistent phenotypes of
atopic dermatitis (Roduit C et al. JAMA Pediatr. 2017;171:655-662).
The concept of a whole person, or even whole household, microbiome is emerging as
a target for modulating atopic and inflammatory disease. Synbiotics, specific combinations
of pre- and probiotics, are under study for prevention of atopic dermatitis but are
not ready for clinical prime time.
A common mantra for AD is avoiding the triggers of potential allergens or irritants.
While some children develop allergic contact dermatitis, most children experience
the irritation alone as a factor contributing to their eczema flares. For example,
in both atopic dermatitis and garden-variety diaper dermatitis, irritants in bathing
and moisturizing products, such as fragrance, alcohols, preservatives and lanolin
(commonly found in soaps, body washes, detergents, baby wipes, diaper creams and baby
lotions) can worsen the underlying eczema.
A small percentage of children can have allergic contact dermatitis (ACD). This occurs
when a person becomes allergic via repeated exposures to a chemical through their
skin. Neomycin and nickel are commonly recognized causes of ACD in children. Both
types of contact dermatitis are more common in children with underlying atopy, underscoring
the need to avoid these possible triggers. Use of hypoallergenic and fragrance-free
skin care products, particularly in early childhood, is recommended for children with
AD and sensitive skin.
The possibility that eczema and/or related diseases may be prevented is exciting.
Though the literature is still evolving, pediatricians can share evidence-based eczema-prevention
strategies with patients and families. All are simple and inexpensive with potential
for a big impact. A daily moisturizer to repair the skin barrier, early introduction
of foods such as yogurt and avoidance of potential triggers all may have a preventive
Drs. Asch and Maguiness are members of the AAP Section on Dermatology.