Early emollient bathing closely associated with Atopic Dermatitis risk

Recent research has focused on the role of the skin barrier in the pathogenesis of Atopic dermatitis (AD), a chronic inflammatory skin condition, and the use of emollients has been considered a potential preventive measure. However, a new study published in Pediatric Allergy and Immunology challenges this notion, revealing a surprising link between early emollient bathing and a higher risk of AD development in the first two years of life.

The "Babies After SCOPE: Evaluating the Longitudinal Impact Using Neurological and Nutritional Endpoints" Birth Cohort study, which enrolled 2183 infants, aimed to assess the relationship between emollient bathing at 2 months and the trajectory of AD during the first two years of life. The study collected data on early skincare practices, skin barrier function, parental history of atopy (genetic predisposition to allergic diseases), and AD outcomes to perform a comprehensive analysis while adjusting for potential confounding variables.

The results of the study were surprising and somewhat concerning for parents and healthcare professionals alike. Among the 1505 children with available AD status data at 6, 12, and 24 months, the prevalence of AD was found to be 18.6% at 6 months, 15.2% at 12 months, and 16.5% at 24 months.

The statistical analysis revealed a strong association between emollient bathing at 2 months and an increased risk of AD development. The odds of AD at any point in the first two years of life were significantly higher among infants who had received emollient baths at 2 months, even after adjusting for confounding variables (odds ratio (OR): 2.41, 95% confidence interval (CI): 1.56 to 3.72, p < .001).

Further analysis delved deeper into the impact of different emollient practices. Infants who had both emollient baths and frequent emollient application at 2 months had even higher odds of AD at 6, 12, and 24 months compared to those who had neither (OR at 6 months: 1.74, 95% CI: 1.18–2.58, p = .038; OR at 12 months: 2.59, 95% CI: 1.69–3.94, p < .001; OR at 24 months: 1.87, 95% CI: 1.21–2.90, p = .009).

Reference:

O’Connor, C., Livingstone, V., O’B Hourihane, J., Irvine, A. D., Boylan, G., & Murray, D. (2023). Early emollient bathing is associated with subsequent atopic dermatitis in an unselected birth cohort study. In Pediatric Allergy and Immunology (Vol. 34, Issue 7). Wiley. https://doi.org/10.1111/pai.13998