Skin Care and Intervention

  • Yukihiro OhyaEmail author


Atopic dermatitis (AD) is a chronic inflammatory skin disorder and also recognized as one of the allergic diseases that has increased within a half century when rapid environmental and lifestyle changes have occurred as a background. Most randomized controlled trials (RCTs) for high-risk infants with an intention of allergen elimination failed to prevent the onset of AD. Although some RCTs that administered probiotics during both prenatal and postnatal periods showed preventive effects on AD, a meta-analysis showed that probiotics were not effective as a viable treatment of established AD. Now, skin barrier dysfunction is recognized as a key initiator to progress AD, and the hypothesis that improving the properties of skin barrier early in life by applying emollients might prevent or delay the onset of AD was verified by two independent RCTs. One was a multicenter RCT carried out in the United States (USA) and United Kingdom (UK) applying emollients from birth to 6 months resulting in 50% reduction of the onset of AD. The other was a single-center RCT carried out in Japan applying an emollient from birth to 8 months resulting in 34% reduction of the onset. Skin care seems to be important not only for the prevention and treatment of AD but also for prevention of food allergy and other allergic diseases. In the future, larger-scale RCTs are expected to confirm preventive effect of skin care with emollients on AD and other allergic diseases in later life.


Emollients Food allergy Prevention RCT Skin care 


  1. 1.
    Arshad SH, Matthews S, Gant C, Hide DW. Effect of allergen avoidance on development of allergic disorders in infancy. Lancet. 1992;339(8808):1493–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Horak F Jr, Matthews S, Ihorst G, Arshad SH, Frischer T, Kuehr J, et al. Effect of mite-impermeable mattress encasings and an educational package on the development of allergies in a multinational randomized, controlled birth-cohort study -- 24 months results of the Study of Prevention of Allergy in Children in Europe. Clin Exp Allergy. 2004;34:1220. doi: 10.1111/j.1365-2222.2004.02024.x.CrossRefPubMedGoogle Scholar
  3. 3.
    Woodcock A, Lowe LA, Murray CS, Simpson BM, Pipis SD, Kissen P, et al. Early life environmental control: effect on symptoms, sensitization, and lung function at age 3 years. Am J Respir Crit Care Med. 2004;170:433–9. doi: 10.1164/rccm.200401-083OC.CrossRefPubMedGoogle Scholar
  4. 4.
    Chan-Yeung M, Ferguson A, Watson W, Dimich-Ward H, Rousseau R, Lilley M, et al. The Canadian Childhood Asthma Primary Prevention Study: outcomes at 7 years of age. J Allergy Clin Immunol. 2005;116:49–55. doi: 10.1016/j.jaci.2005.03.029.CrossRefPubMedGoogle Scholar
  5. 5.
    Kramer MS, Kakuma R. Cochrane Database of Systematic Reviews 2012, 9:CD000133.Google Scholar
  6. 6.
    Snijders BEP, Thijs C, van Ree R, van den Brandt PA. Age at first introduction of cow milk products and other food products in relation to infant atopic manifestations in the first 2 years of life: the KOALA birth cohort study. Pediatrics. 2008;122:e115–22.CrossRefPubMedGoogle Scholar
  7. 7.
    Koplin JJ, Osborne NJ, Wake M, Martin PE, Gurrin LC, Robinson MN, et al. Can early introduction of egg prevent egg allergy in infants? A population-based study. J Allergy Clin Immunol. 2010;126:807–13. doi: 10.1016/j.jaci.2010.07.028.CrossRefPubMedGoogle Scholar
  8. 8.
    Du Toit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, et al. Randomized trial of peanut consumption in infants at risk peanut allergy. N Engl J Med. 2015;372:803–13. doi: 10.1056/NEJMoa1414850.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Ierodiakonou D, Garcia-Larsen V, Logan A, Groome A, Cunha S, Chivinge J, et al. Timing of allergenic food introduction to the infant diet and risk of allergic or autoimmune disease: a systematic review and meta-analysis. JAMA. 2016;316:1181–19. doi: 10.1001/jama.2016.12623.CrossRefPubMedGoogle Scholar
  10. 10.
    Natsume O, Kabashima S, Nakazato J, Yamamoto-Hanada K, Narita M, Kondo M, et al. Two-step egg introduction for prevention of egg allergy in high-risk infants with eczema(PETIT): a randomized double-blind placebo controlled trial. Lancet. 2017;389(10066):276–86. doi: 10.1016/S0140-6736(16)31418-0.CrossRefPubMedGoogle Scholar
  11. 11.
    Kalliomäki M, Salminen S, Arvilommi H, Kero P, Koskinen P, Isolauri E. Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial. Lancet. 2001;357(9262):1076–9. doi: 10.1016/S0140-6736(00)04259-8.CrossRefPubMedGoogle Scholar
  12. 12.
    Kalliomäki M, Salminen S, Poussa T, Arvilommi H, Isolauri E. Probiotics and prevention of atopic disease: 4-year follow-up of a randomised placebo-controlled trial. Lancet. 2003;361(9372):1869–71. doi: 10.1016/S0140-6736(03)13490-3.CrossRefPubMedGoogle Scholar
  13. 13.
    Panduru M, Panduru NM, Salavastru CM, Tiplica GS. Probiotics and primary prevention of atopic dermatitis: a meta-analysis of randomized controlled studies. J Eur Acad Dermatol Venereol. 2015;29:232–42. doi: 10.1111/jdv.12496.CrossRefPubMedGoogle Scholar
  14. 14.
    Tang ML. Probiotics and prebiotics: immunological and clinical effects in allergic disease. Nestle Nutr Workshop Ser Pediatr Program. 2009;64:219–51. doi: 10.1159/000235793.CrossRefPubMedGoogle Scholar
  15. 15.
    van der Aa LB, Heymans HSA, van Aalderen WMC, Sprikkelman AB. Probiotics and prebiotics in atopic dermatitis: review of the theoretical background and clinical evidence. Pediatr Allergy Immunol. 2010;21:e355–67. doi: 10.1111/j.1399-3038.2009.00915.x.CrossRefPubMedGoogle Scholar
  16. 16.
    Lee J, Seto D, Bielory L. Meta-analysis of clinical trials of probiotics for prevention and treatment of pediatric atopic dermatitis. J Allergy Clin Immunol. 2008;121:116–121.e11. doi: 10.1016/j.jaci.2007.10.043.CrossRefPubMedGoogle Scholar
  17. 17.
    Odhiambo JA, Williams HC, Clayton TO, Robertson CF, Asher MI. ISAAC Phase Three Study Group. Global variations in prevalence of eczema symptoms in children from ISAAC phase three. J Allergy Clin Immunol. 2009;124:1251–8.e23. doi: 10.1016/j.jaci.2009.10.009.CrossRefPubMedGoogle Scholar
  18. 18.
    Williams H, Stewart A, von Mutius E, Cookson W, Anderson HR, International Study of Asthma and Allergies in Childhood (ISAAC) Phase One and Three Study Groups. Is eczema really on the increase worldwide? J Allergy Clin Immunol. 2008;121:947–54.e15. doi: 10.1016/j.jaci.2007.11.004.CrossRefPubMedGoogle Scholar
  19. 19.
    Boguniewicz M, Leung DY. Atopic dermatitis: a disease of altered skin barrier and immune dysregulation. Immunol Rev. 2011;242:233–46. doi: 10.1111/j.1600-065X.2011.01027.x.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Leung DY. New insights into atopic dermatitis: role of skin barrier and immune dysregulation. Allergol Int. 2013;62:151–61. doi: 10.2332/allergolint.13-RAI-0564.CrossRefPubMedGoogle Scholar
  21. 21.
    Brown SJ, McLean WH. One remarkable molecule: Filaggrin. J Invest Dermatol. 2012;132(3 Pt 2):751–62. doi: 10.1038/jid.2011.393.CrossRefPubMedGoogle Scholar
  22. 22.
    Loden M. Role of topical emollients and moisturizers in the treatment of dry skin barrier disorders. Am J Clin Dermatol. 2003;4:771–88.CrossRefPubMedGoogle Scholar
  23. 23.
    Wigger-Alberti W, Elsner P. Petrolatum prevents irritation in a human cumulative exposure model in vivo. Dermatology. 1997;194:247–50.CrossRefPubMedGoogle Scholar
  24. 24.
    Ghali FE. Improved clinical outcomes with moisturization in dermatologic disease. Cutis. 2005;76(6 suppl):13–8.PubMedGoogle Scholar
  25. 25.
    Simpson EL, Berry TM, Brown PA, Hanifin JM. A pilot study of emollient therapy for the primary prevention of atopic dermatitis. J Am Acad Dermatol. 2010;63:587–93. doi: 10.1016/j.jaad.2009.11.011.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Simpson EL, Chalmers JR, Hanifin JM, Thomas KS, Cork MJ, McLean WH, et al. Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention. J Allergy Clin Immunol. 2014;134(4):818–23. doi: 10.1016/j.jaci.2014.08.005.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Horimukai K, Morita K, Narita M, Kondo M, Kitazawa H, Nozaki M, et al. Application of moisturizer to neonates prevents development of atopic dermatitis. J Allergy Clin Immunol. 2014;134:824–830.e6. doi: 10.1016/j.jaci.2014.07.060.CrossRefPubMedGoogle Scholar
  28. 28.
    Blume-Peytavi U, Cork M, Faergemann J, Szczapa J, Vanaclocha F, Gelmetti C. Bathing and cleansing in newborns from day 1 to first year of life: recommendations from a European round table meeting. J Eur Acad Dermatol Venereol. 2009;23:751–9. doi: 10.1111/j.1468-3083.2009.03140.x.CrossRefPubMedGoogle Scholar
  29. 29.
    Suzuki K, Hiyoshi M, Tada H, Bando M, Ichioka T, Kamemura N, et al. Allergen diagnosis microarray with high-density immobilization capacity using diamond-like carbon-coated chips for profiling allergen-specific IgE and other immunoglobulins. Anal Chim Acta. 2011;706:321–7. doi: 10.1016/j.aca.2011.08.034.CrossRefPubMedGoogle Scholar
  30. 30.
    Eichenfield LF, Tom WL, Berger TG, Krol A, Paller AS, Schwarzenberger K, et al. Guidelines of care for the management of atopic dermatitis Section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014;71:116–32. CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Nelson HS. New perspectives on epidermal barrier dysfunction in atopic dermatitis: gene–environment interactions. J Allergy Clin Immunol. 2006;118:3–21. doi: 10.1016/j.jaci.2006.04.042.CrossRefGoogle Scholar
  32. 32.
    Not available.Google Scholar
  33. 33.
    Flohr C, Perkin M, Logan K, Marrs T, Radulovic S, Campbell LE, et al. Atopic dermatitis and disease severity are the main risk factors for food sensitization in exclusively breastfed infants. J Invest Dermatol. 2014;134(2):345–50. doi: 10.1038/jid.2013.298.CrossRefPubMedGoogle Scholar
  34. 34.
    Saunes M, Øien T, Dotterud CK, Romundstad PR, Storrø O, Holmen TL, et al. Early eczema and the risk of childhood asthma: a prospective, population-based study. BMC Pediatr. 2012;12:168. doi: 10.1186/1471-2431-12-168.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Amat F, Saint-Pierre P, Bourrat E, Nemni A, Couderc R, Boutmy-Deslandes E, et al. Early-onset atopic dermatitis in children: which are the phenotypes at risk of asthma? Results from the ORCA cohort. PLoS One. 2015;10(6):e0131369. doi: 10.1371/journal.pone.0131369.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Almqvist C, Li Q, Britton WJ, Kemp AS, Xuan W, Tovey ER, Marks GB, et al. Early predictors for developing allergic disease and asthma: examining separate steps in the 'allergic march'. Clin Exp Allergy. 2007;37(9):1296–302.CrossRefPubMedGoogle Scholar
  37. 37.
    Tsakok T, Marrs T, Mohsin M, Baron S, du Toit G, Till S, et al. Does atopic dermatitis cause food allergy? A systematic review. J Allergy Clin Immunol. 2016;137(4):1071–8. doi: 10.1016/j.jaci.2015.10.049.CrossRefPubMedGoogle Scholar
  38. 38.
    Yoshida K, Kubo A, Fujita H, Yokouchi M, Ishii K, Kawasaki H, et al. Distinct behavior of human Langerhans cells and inflammatory dendritic epidermal cells at tight junctions in patients with atopic dermatitis. J Allergy Clin Immunol. 2014;134(4):856–64. doi: 10.1016/j.jaci.2014.08.001.CrossRefPubMedGoogle Scholar
  39. 39.
    Yokouchi M, Kubo A, Kawasaki H, Yoshida K, Ishii K, Furuse M, et al. Epidermal tight junction barrier function is altered by skin inflammation, but not by filaggrin-deficient stratum corneum. J Dermatol Sci. 2015;77(1):28–36. doi: 10.1016/j.jdermsci.2014.11.007.CrossRefPubMedGoogle Scholar
  40. 40.
    Kawasaki H, Nagao K, Kubo A, Hata T, Shimizu A, Mizuno H, et al. Altered stratum corneum barrier and enhanced percutaneous immune responses in filaggrin-null mice. J Allergy Clin Immunol. 2012;129(6):1538–46.e6. doi: 10.1016/j.jaci.2012.01.068.CrossRefPubMedGoogle Scholar
  41. 41.
    Amano W, Nakajima S, Kunugi H, Numata Y, Kitoh A, Egawa G, et al. The Janus kinase inhibitor JTE-052 improves skin barrier function through suppressing signal transducer and activator of transcription 3 signaling. J Allergy Clin Immunol. 2015;136(3):667–677.e7. doi: 10.1016/j.jaci.2015.03.051.CrossRefPubMedGoogle Scholar
  42. 42.
    Egawa G, Kabashima K. Multifactorial skin barrier deficiency and atopic dermatitis: essential topics to prevent the atopic march. J Allergy Clin Immunol. 2016;138(2):350–358.e1. doi: 10.1016/j.jaci.2016.06.002.CrossRefPubMedGoogle Scholar
  43. 43.
    Fukuie T, Nomura I, Horimukai K, Manki A, Masuko I, Futamura M, et al. Proactive treatment appears to decrease serum immunoglobulin-E levels in patients with severe atopic dermatitis. Br J Dermatol. 2010;163:1127–9. doi: 10.1111/j.1365-2133.2010.09904.x.CrossRefPubMedGoogle Scholar
  44. 44.
    Fukuie T, Hirakawa S, Narita M, Nomura I, Matsumoto K, et al. Potential preventive effects of proactive therapy on sensitization in moderate to severe childhood atopic dermatitis: a randomized, investigator-blinded, controlled study. J Dermatol. 2016;43:1283–92. doi: 10.1111/1346-8138.13408.CrossRefPubMedGoogle Scholar
  45. 45.
    Horimukai K, Morita K, Narita M, Kondo M, Kabashima S, Inoue E, et al. Transepidermal water loss measurement during infancy can predict the subsequent development of atopic dermatitis regardless of filaggrin mutations. Allergol Int. 2016;65:103–8. doi: 10.1016/j.alit.2015.09.004.CrossRefPubMedGoogle Scholar
  46. 46.
    Shoda T, Futamura M, Yang L, Yamamoto-Hanada K, Narita M, Saito H, et al. Timing of eczema onset and risk of food allergy at 3 years of age: a hospital-based prospective birth cohort study. J Dermatol Sci. 2016;84(2):144–8. doi: 10.1016/j.jdermsci.2016.08.003.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.Division of Allergy, Department of Medical SubspecialtiesNational Center for Child Health and DevelopmentTokyoJapan

Personalised recommendations