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12th January 2023
Early prophylactic emollient use (EU) among high-risk infants, prevents the development of atopic eczema (AE) and emollient emulsions are likely to be the most effective, according to the findings of a network meta-analysis by Chinese researchers.
Atopic eczema is a chronic, inflammatory disorder of the skin and which affects between 0.9% and 22.5% of children aged 6 to 7. It is characterised by a persistent skin dryness, erythema and pruritus, leading to an impaired in quality of life. While the precise cause remains to be determined, a feature of the disease is a defective epidermal barrier that enables greater water loss through the skin leading to dryness.
However, this can be remedied to a large extent through EU, which alleviates the clinical symptoms and reduces the need for anti-inflammatory agents such as topical corticosteroids. In recent years, it has been suggested that early emollient use to high-risk infants, i.e., those with a family history of the disease or other atopic conditions such as asthma or hay fever, might prevent the subsequent development of AE.
The evidence to support this is equivocal, with one meta-analysis finding that use of emollients made no difference, whereas another concluded that prophylactic emollient use, initiated in early infancy may prevent AE, especially in high-risk populations and when used continuously. A further consideration and which might account for the observed discrepancies in the meta-analyses, is the type of emollient used. In fact, there is some data to show that different emollient creams have different effects on the skin and only certain types have the ability to improve the skin’s barrier and protect against irritants that trigger eczema.
With some uncertainty over whether early EU could prevent the development of AE, in the present study, the Chinese researchers undertook a network meta-analysis to address both whether the early application of emollients in infancy could prevent the later development of AE and which types of emollients were most effective. They used the surface under the cumulative ranking area curve (SUCRA) which to rank the different types of emollients, which could be either emulsions, creams or mixed formulations (e.g., creams, gels) and where a higher SUCRA value indicated a greater preventive efficacy.
Early emollient use and the development of atopic eczema
A total of 11 trials with 3,483 subjects were included in the network meta-analysis. Overall, the results showed that the development of AE was significantly lower after early emollient application (Risk Ratio, RR = 0.75, 95% CI 0.57 – 0.99, p = 0.001). In addition, this risk was also significantly lower, when the analysis was restricted to high-risk infants (RR = 0.64, 95% CI 0.47 – 0.88).
When examining the different types of emollients, the SUCRA values were highest for emollient emulsions, with values of 82.6% for all populations and 78.0% for high-risk populations.
The authors concluded that the early application of emollients is an effective strategy for preventing AE development in high-risk infants and that an emollient emulsion may be the optimal type of formulation.
Liang J et al. Systematic review and network meta-analysis of different types of emollient for the prevention of atopic dermatitis in infants. J Eur Acad Dermatol Venereol 2022