ABSTRACT
Without a global standard for neonatal or infant skin care, and with few emollient studies performed in term infants, Kelleher et al’s Cochrane review [2] provides a much-needed assessment of the evidence for emollients and other interventions to prevent eczema, as well as their effects on the development of food allergy. Outcomes Comparison Relative risk (RR) or hazard ratio (HR) (CI) Number of studies and participants in the pooled analysis Quality of evidence Development of eczema by 1-2 years Skin care interventions vs standard carea RR=1.03 (CI 0.81-1.31) 7 trials, 3075 participants Moderate Time needed to develop eczema Skin care interventions vs standard care HR=0.86 (CI 0.65-1.14) 9 trials, 3349 participants Moderate Development of skin infections Skin care interventions vs standard care RR=1.34 (CI 1.02-1.77) 6 trialsb, 2728 participants Moderate IgEc-mediated food allergies at 1-2 years Skin care interventions vs standard care RR=2.53 (CI 0.99-6.47) 1 trial, 996 participants Very low Sensitization to food allergens at 1-2 years Skin care interventions vs standard care RR=0.86 (CI 0.28-2.69) 2 trials, 1055 participants Very low aStandard care is defined as no skin care or care as usual. bWhile 2 out of the 6 studies in the pooled analysis slightly favored skin care interventions (not statistically significant), the pooled data suggested an increased risk of skin infection with emollients. There are currently a number of ongoing clinical trials assessing skin care interventions for the prevention of atopic dermatitis and food allergy;one trial recently concluded there is no evidence that the use of daily emollients reduces the risk of eczema by the age of 2 years in high-risk patients (patients with first-degree relatives with a history of eczema, asthma, or allergic rhinitis) [3].