Daily emollient during infancy for prevention of eczema: the BEEP randomised controlled trial
RCT (n=1394 newborns in UK) found no evidence that daily emollient during first year of life prevents eczema in high-risk children and some evidence to suggest an increased risk of skin infections, thus daily emollients should not be used to try and prevent eczema in the newborn.
Source:
The Lancet
SPS commentary:
In this trial, term newborns with a family history of atopic disease were randomly assigned to application of emollient daily (either Diprobase cream or DoubleBase gel) for the first year plus standard skin-care advice (emollient group) or standard skin-care advice only (control group).
Also published along this study in Lancet is a Norwegian RCT (PreventADALL trial; n=2397 newborns) which found neither early skin emollients nor early complementary feeding reduced development of atopic dermatitis by age 12 months.
According to a commentary, the absence of a preventive effect on atopic dermatitis might be associated with the type, frequency of application, and timing of commencement of emollient. It notes that following promising results of a trend to reduced atopic dermatitis and food sensitisation at age 12 months from a pilot study using a ceramide-dominant emollient with a slightly acidic pH, twice daily from birth, a large RCT in high-risk infants, Prevention of Eczema by a Barrier Lipid Equilibrium Strategy (PEBBLES), is underway to confirm these findings including food allergy endpoints. It adds however that even if the results show a reduction in these atopic outcomes, lessons from PreventADALL suggest this intensive twice daily emollient regimen, not to mention the high cost of this complex formulation, could affect its potential viability as a population-based preventive strategy. It alludes to an ongoing prospective individual patient data meta-analysis that will provide additional evidence on any association between use of emollients during the first year of life and reduction in atopic dermatitis, food allergy, and associated health outcomes. It suggests that at this stage, emollients should not be recommended for the primary prevention of atopic dermatitis in infants.