In order to prevent eczema children, we first need to discuss atopic dermatitis (eczema) first. Atopic dermatitis affects 17-24% of the pediatric population and 4-7% of adults. It develops in the first 6 months in about half the children and by 5 years of age in 85% of the cases. Only about half of affected children outgrow it by adulthood. A disrupted skin barrier plays a key role in disease initiation. Skin barrier defects open the door for allergic sensitization and contribute to atopic dermatitis and the entire atopic march (allergic rhinitis, asthma). Ongoing efforts are aimed at interventions to prevent eczema and impede the onset of allergies and asthma.
Skin barrier abnormalities leads to allergy penetration through a compromised barrier which leads to an increased immune response, antigen stimulation and initiation of skin disease. This leads to an increased IgE production in the circulation, which leads to exacerbation of eczema through the skin, but it also spreads beyond the skin to initiate other allergic diseases such as food allergy, asthma and allergic rhinitis.
Possible interventions to prevent eczema are focusing on improving the skin barrier with moisturizers. Avoiding the first step of allergic sensitization can avert other allergy disorders. An initial small study suggested that petrolatum can be used for primary eczema prevention. Other studies have shown that moisturizers significantly reduce rates of atopic dermatitis development. A study done in high risk babies showed that Cetaphil cream usage from birth showed a 50% reduction in incidence of atopic dermatitis. Early data shows that early moisturizing leads to altered skin microbes and pH levels in high-risk newborns. Future studies that will compare various moisturizers to prevent eczema in high risk infants are warranted.
In addition to moisturizing, other interventions were studied. Attempts to alter the microbial profile with probiotics gave mixed results. Dietary allergen avoidance during pregnancy or lactation is not recommended. Other factors (vaccines, allergen avoidance and breast feeding) in preventing eczema is still controversial. Previous studies have demonstrated the anti-inflammatory properties and beneficial effects of fish oil supplementation during pregnancy.
Topical steroids and calcineurin inhibitors (Elidel, Protopic) are not currently recommended as a primary prevention in high-risk non-affected infants. In terms of secondary prevention (children who already have eczema), there is limited data. The Early Treatment of Atopic Child study showed beneficial effects of using Zyrtec in 1-to 2 year olds with eczema in preventing asthma, however more studies are needed. There is promise that Dupilumab, an IL-4 receptor monoclonal antibody, can reverse the allergy immune response and prevent the atopic march in the future.
In conclusion, usage of emollients in high risk infants (before eczema develops) might help prevent eczema, but the development of eczema usually begins at a very early age which may require early systemic intervention (eg dupilumab) to effectively treat the disease and prevent the atopic march.