Well-moisturized infants less likely to develop eczema

Parents who apply moisturizer to their newborns may be able to protect them from developing eczema, a group of American and British researchers report in a new study.

Even if eczema eventually develops, a delay of months or years may mean the skin condition will be less severe than it would have been without moisturizing. “The earlier the age of onset, the more severe the disease,” says Eric Simpson, a clinician at Oregon Health and Science University in Portland, Oregon, who co-led the study with Hywel Williams at the University of Nottingham in the UK.

Simpson presented the findings on May 11 at the annual meeting of the Society for Investigative Dermatology in Raleigh, North Carolina.

Moisturizers provide a barrier over eczema-prone skin, to keep in water and keep out allergens and irritants. They reduce the number of flares. Simpson and Williams wondered whether moisturizers could prevent the very first flare: in short, prevent eczema from ever starting. “All previous strategies to prevent eczema have been performed in the allergy arena,” Simpson says. “Not feeding the mother certain foods. Not feeding children certain foods. Delaying the age at which children are exposed to foods. House dust mite removal.”

But first, the question was whether parents would agree to be part of a randomized trial that required some subjects not to moisturize their children at all. The researchers planned a provisional trial—and the parents of 124 babies signed up. Half applied moisturizer to their babies for six months; the other half did not.

At the end of the trial, the researchers studied physical properties of the babies’ skin and noted whether they had developed eczema. Twenty-two percent of babies in the moisturized group had eczema, compared to 43% of those in the control group. “These results were statistically significant, and showed this approach has great promise,” Simpson says. He says, though, that the study should be repeated in a larger cohort of babies.

Choosing the right moisturizer matters. Simpson says that even though 70% of parents say they moisturize their children, they may be using products that are alkaline or contain fragrances or detergents, which could cause or worsen eczema.

Martin Steinhoff, a professor in residence of dermatology at the University of California, San Francisco, agrees. "Not all moisturizers defined by the cosmetics industry are moisturizers by a dermatological definition," he says. "They should be ointments or fatty creams or Cetaphil Restoraderm, or have ingredients such as urea or ceramides. Most lotions or creams cannot moisturize because the water content is too high; they wash off lipids from the skin."

But you don’t have to overspend to get a good moisturizer. “There are about fifty new moisturizers that are expensive or say ‘for eczema’ or ‘hypoallergenic,’ but none of them have shown any benefit over Vaseline—plain old petrolatum,” Simpson says. He would like to see a study comparing the benefits of common moisturizers, especially for babies. “Otherwise, it’s hard to figure out which to go with.” He plans to pick a single moisturizer to use in a larger-scale trial, with 500 or more participants, which will produce results that carry more statistical weight and follow children longer than 6 months. He will conduct this trial sometime in the next few years. Interested in taking part, or finding out the results of the study? Keep current by following my blog.

[Comment by Steinhoff added 6/7/2012]