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J Allergy Clin Immunol Pract. 2019 Sep 27. pii: S2213-2198(19)30792-5. doi: 10.1016/j.jaip.2019.09.014. [Epub ahead of print]

Predicting Skin Barrier Dysfunction and Atopic Dermatitis in Early Infancy.

Author information

1
Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Dermatology, Oslo University Hospital, Oslo, Norway. Electronic address: e.m.rehbinder@medisin.uio.no.
2
Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Dermatology, Oslo University Hospital, Oslo, Norway.
3
Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
4
Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
5
Department of Dermatology, Oslo University Hospital, Oslo, Norway.
6
Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway.
7
Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
8
Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Faculty of Health Studies, VID Specialized University, Oslo, Norway.
9
Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway.
10
Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
11
Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Obstetrics and Gynaecology, Østfold Hospital Trust, Kalnes, Norway.
12
Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
13
Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.
14
Department of Toxicology and Risk Assessment, Norwegian Institute of Public Health, Oslo, Norway.
15
Genetic Unit, Centre for Laboratory Medicine, Østfold Hospital Trust, Kalnes, Norway; Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway.
16
Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway.
17
Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway; Department of Ear, Nose and Throat, Akershus University Hospital, Lørenskog, Norway.
18
Department of Obstetrics and Gynaecology, Østfold Hospital Trust, Kalnes, Norway.
19
Department of Obstetrics and Gynaecology, Østfold Hospital Trust, Kalnes, Norway; Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden.

Abstract

BACKGROUND:

Dry skin is associated with increased transepidermal water loss (TEWL), which has been found to precede atopic dermatitis (AD) in childhood.

OBJECTIVE:

We aimed to identify parental, prenatal, and perinatal predictive factors of dry skin, high TEWL, and AD at 3 months of age, and to determine if dry skin or high TEWL at 3 months can predict AD at 6 months.

METHODS:

From the Preventing Atopic Dermatitis and Allergies in children prospective birth cohort study, we included 1150 mother-child pairs. Dry skin, TEWL, and eczema were assessed at 3- and 6-month 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.

RESULTS:

Significant predictive factors (P < .05) 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. Dry skin without eczema at 3 months was predictive for eczema at 6 months (adjusted odds ratio: 1.92, 95% confidence interval: 1.21-3.05; P = .005), whereas high TEWL at 3 months was not.

CONCLUSION:

In early infancy, distinct parental- and pregnancy-related factors were predictive for dry skin, high TEWL, and AD. Dry skin at 3 months of age was predictive for AD 3 months later.

KEYWORDS:

Allergic diseases; Atopic dermatitis; Atopy; Dry skin; Eczema; Skin barrier; TEWL; Xerosis

PMID:
31568931
DOI:
10.1016/j.jaip.2019.09.014

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