UNSTRUCTURED
Eczema is a common and taxing condition, with an estimated prevalence of 10.7% among pediatric patients in the United States and cost of 5 billion USD annually.1 Eczema has a known association with food allergies, with both conditions most commonly developing during the first year of life. The cost of care and the daily attention required to treat both eczema and food allergy represent significant burdens to individuals and families. Without a global standard for neonatal or infant skin care, and with few emollient studies performed in term infants, this Cochrane review2 provides a much-needed assessment of the evidence for use of emollients and other interventions to prevent eczema, as well as their effects on development of food allergy.
This systematic review assessed 33 randomized controlled trials (n=25,827), all of which studied term (>37 weeks) infants (<12 months) without pre-existing diagnosis of eczema, food allergy, or other skin condition. The review concludes that skin care interventions do not change the risk of developing eczema by the age of one to two years (risk ratio (RR) 1.03, 95% confidence interval (CI) 0.81-1.31, 7 trials, n=3075), nor do they reduce the time needed to develop eczema (hazard ratio 0.86, 95% CI 0.65-1.14, 9 trials, n=3349, but were associated with a higher number of skin infections (RR 1.34, 95% CI 1.02-1.77, 6 trials, n=2728). These were all reported with moderate-certainty evidence.
There was limited evidence concerning the impact of skin care interventions on IgE-mediated food allergies (RR 2.53, 95% CI 0.99-6.47, 1 trial, n=996) or sensitization to food allergens at 1-2 years (RR 0.86, 95% CI 0.28-2.69, 2 trials, n=1055); the few trials that investigated these outcomes produced broad confidence intervals that failed to achieve statistical significance.
Further work is warranted to identify the effects of different skin care interventions on the prevention of eczema and their effects on food allergy. There are currently a number of ongoing clinical trials to assess the use of skin care interventions on the prevention of atopic dermatitis and food allergy, and one trial that recently concluded that there is no evidence that the use of daily emollients reduces the risk of eczema by the age of two years in high-risk patients (patients with first-degree relatives with a history of eczema, asthma, or allergic rhinitis).3
Incidence of dry skin and eczema have increased, especially since the onset of the coronavirus pandemic. With an enhanced emphasis on frequent hand-washing, hand hygiene has also become an increasingly popular topic amongst individuals and families.4 In recent years prior to the pandemic, an increase in the incidence of eczema in the pediatric population was reported, most prominently among infants.5 With this in mind, it is important for clinicians to familiarize themselves with treatment regimens that are supported by data, preferably from large systematic reviews like those performed by the Cochrane Review Groups. By understanding the information from numerous studies simultaneously, meta-analyses, such as the one summarized here, enable physicians to apply evidence to clinical practice and make sound recommendations to patients.
From the Cochrane Library: Skin care interventions in infants for preventing eczema and food allergy (Preprint)
