High-risk neonates can be prevented from atopic dermatitis (AD) during infancy by daily use of emollients which enhances the skin barrier. But climate may affect the results and possibly cause adverse cutaneous eruptions. Concerning this, their effects must be evaluated in a tropical climate. 

A study investigated whether emollients used during infancy can prevent AD in high-risk neonates in a country with a tropical climate and also evaluated other possible adverse cutaneous eruptions in the population of interest.

This randomized controlled study was carried out in a tertiary care hospital in a 6 months duration, with eligible neonates randomized to receive either emollient and skin-care advice (emollient group) or skin-care advice only (control group). The intervention was initiated within 3 weeks of the birth of the enrolled neonates.

The researchers observed-

• A significant reduction in the cumulative incidence of AD at 6 months in the emollient group.
• Development of AD was observed later in the emollient group which was lower in severity than the control group.
• Low adherence to the emollient application was observed to be associated with a lower number of patients with AD, than moderate adherence.
• The emollient group showed the more frequent occurrence of potentially emollient-related cutaneous eruptions, like miliaria, and suspected cutaneous infections (like impetigo).
• Exposure to passive smoking, both during pregnancy and after the childs birth, was associated with a significant difference in the development of AD.

Thus it was concluded that emollient application to the skin of at-risk neonates, in a tropical climate, should follow the "as needed" recommendation (depending on environmental factors, level of skin dryness), rather than applying it on a "daily basis". This would render a substantial benefit for AD prevention.

Source:  J Eur Acad Dermatol Venereol. 2021 Sep 21. doi: 10.1111/jdv.17675. Epub ahead of print. PMID: 34545646.