Atopic dermatitis (AD) is a prolonged deteriorating provocative skin disease that most often presents during early childhood. The clinical presence of dry skin, a fundamental feature of AD, is indicative of a diminished skin barrier and associates with elevated measures of transepidermal water loss (TEWL).

The purpose of a new study published in The Journal of Allergy and Clinical Immunology was to identify parental, prenatal and perinatal predictive factors of dry skin, high transepidermal water loss (TEWL) and AD at 3 months of age, and to determine whether dry skin or high TEWL at 3 months can predict AD at 6 months. Dry skin is linked with increased TEWL, which has been found to pave the way to AD in childhood.

This study included 1150 mother-child pairs from the Preventing Atopic Dermatitis and Allergies in children (Prevent ADALL) prospective birth cohort study. Dry skin, TEWL and eczema were assessed at 3 and 6 months investigations. Eczema, used as a proxy for AD, was defined as the presence of eczematous lesions, excluding differential diagnoses to AD. High TEWL was defined as TEWL > 90th percentile, equaling 11.3 g/m2/h. Potential predictive factors were recorded from electronic questionnaires at 18- and 34-week pregnancy and obstetric charts.

It was found that significant predictive factors for dry skin at 3 months were delivery > 38 gestational weeks and paternal age > 37 years; for high TEWL – male sex, birth during winter season and maternal allergic disease; and for eczema – elective caesarean section, multiparity and maternal allergic diseases. Moreover, dry skin without eczema at 3 months was predictive for eczema at 6 months, while high TEWL at 3 months was not.

Identifying prognostic factors for AD early in life, including the existence of dry skin, may help targeting infants for primary prevention of AD.

Thus, it was concluded that in early infancy, distinct parental and pregnancy-related factors were predictive of dry skin, high TEWL and AD. While dry skin at 3 months of age was predictive of AD, three months later.

Source: J Allergy Clin Immunol Pract. 2020 Feb;8(2):664-673.e5.