Emollient use alters skin barrier and microbes in infants at risk for developing atopic dermatitis

Glatz, Martin; Jo, Jay‐Hyun; Kennedy, Elizabeth A.; Polley, Eric C.; Segre, Julia A.; Simpson, Eric L.; Kong, Heidi H.

doi:10.1371/journal.pone.0192443

Cited by 98 publications

(96 citation statements)

References 57 publications

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“…The lack of an effect on the microbiome is in contrast to recent findings that emollient therapy appears to diversify the microbiome in infants . It is possible that different emollients have varying effects on the microbiome.…”

Section: Discussioncontrasting

confidence: 71%

A randomized controlled trial of an emollient with ceramide and filaggrin‐associated amino acids for the primary prevention of atopic dermatitis in high‐risk infants

McClanahan

Wong

Kežić

et al. 2019

Acad Dermatol Venereol

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Background Skin barrier dysfunction may precede infantile development of clinical atopic dermatitis (AD). Early‐life emollient therapy to enhance barrier function may prevent or modify AD development in high‐risk infants. Objectives (a) To determine whether daily full‐body application of an emollient with ceramide and amino acids (study emollient) can reduce the cumulative AD incidence compared to standard skin care at 1 year of age. (b) To evaluate the study emollient's effect on skin barrier function, natural moisturizing factor and the microbiome using non‐invasive biophysical and biochemical techniques. Methods We performed a single‐centre, investigator‐blinded, randomized controlled trial enrolling infants at high risk for AD development determined by family history. The intervention was full‐body once‐daily application of the study emollient. The control arm was asked to not apply full‐body emollient regularly and only use an emollient of their choice for dry skin. The primary outcome was the cumulative incidence of AD diagnosed at 12 months by a blinded investigator. Results Less than half the target sample size was enrolled (n = 100, goal sample was 208) with 28% lost to follow‐up. Across all clinical end points, a numerical trend was observed in favour of the intervention, although not statistically significant likely due to lack of power from under‐enrolment. AD was diagnosed in 13.2% vs. 25.0% at 12 months (P = 0.204) and 19.4% vs. 31.0% at 2 years (P = 0.296) in intervention vs. control groups, respectively. There were no significant differences between groups in skin barrier or microbiome assessments. While there were no serious adverse events, there were more cases of reported contact dermatitis in the intervention vs. control arms, 9.3% vs. 4.3%, respectively; however, these events were not related to the study emollient and most mild in severity. Conclusion The observed trends suggest a protective effect of daily study emollient therapy compared to control.

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Section: Discussioncontrasting

confidence: 71%

A randomized controlled trial of an emollient with ceramide and filaggrin‐associated amino acids for the primary prevention of atopic dermatitis in high‐risk infants

McClanahan

Wong

Kežić

et al. 2019

Acad Dermatol Venereol

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“…Treatment with an acidic compared with a neutral cream inhibited the occurrence of atopic dermatitis‐like skin lesions and respiratory allergy in filaggrin‐deficient murine atopic dermatitis models . An emollient with a pH of 4.8 altered skin barrier and microbes in infants at risk for developing atopic dermatitis . Skin care products adjusted to pH 4 have been used successfully in acne skin .…”

Section: Reducing Skin Ph As a Therapeutic Tool In Wound Healing Skimentioning

confidence: 99%

pH in nature, humans and skin

Proksch

2018

The Journal of Dermatology

325

239

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The pH plays an important physiological role in nature and humans. pH varies from 1 to 8 in human organs with tight regulation in blood and epithelia of barrier organs. The physiological pH of the stratum corneum is 4.1-5.8 and several mechanisms contribute to its formation: filaggrin degradation, fatty acid content, sodium-hydrogen exchanger (NHE1) activation and melanosome release. First, the acidic pH of the stratum corneum was considered to present an antimicrobial barrier preventing colonization (e.g. by Staphylococcus aureus and Malassezia). Later on, it was found that the pH influences skin barrier function, lipid synthesis and aggregation, epidermal differentiation and desquamation. Enzymes of ceramide metabolism (e.g. β-glucocerebrosidase or acid sphingomyelinase) as well as proteases (e.g. chymotryptic enzyme or cathepsin D linked to epidermal differentiation and desquamation) are regulated by the pH. Experimental disruption of the physical barrier leads to an increase of pH, returning to normal levels only after many hours. Inflammatory skin diseases and diseases with an involvement of the epidermis exhibit a disturbed skin barrier and an increased pH. This is known for atopic dermatitis, irritant contact dermatitis, ichthyosis, rosacea and acne, but also for aged and dry skin. Normalizing the pH by acidification through topical treatment helps to establish a physiological microbiota, to repair skin barrier, to induce epidermal differentiation and to reduce inflammation.

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“…30 Although initial proposed mechanisms for the beneficial effect of emollients focused on barrier repair and decreased TEWL, recent preliminary data showed that early emolliation leads to an altered skin microbiome and skin pH in high-risk newborns. 95 Given our results showing increases in AMP levels, innate immune gene expression, and barrier characteristics, we offer a possible explanation for the preventive effect of emollients, which potentially alter the innate and adaptive immune profiles in axes relevant to protection against infections, [96][97][98][99][100] AMPs, and barrier profile, ultimately changing the natural history of AD development in high-risk newborns.…”

Section: Discussionmentioning

confidence: 69%

Petrolatum: Barrier repair and antimicrobial responses underlying this “inert” moisturizer

Czarnowicki

Malajian

Khattri

et al. 2016

Journal of Allergy and Clinical Immunology

126

103

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Emollient use alters skin barrier and microbes in infants at risk for developing atopic dermatitis

Cited by 98 publications

References 57 publications

A randomized controlled trial of an emollient with ceramide and filaggrin‐associated amino acids for the primary prevention of atopic dermatitis in high‐risk infants

A randomized controlled trial of an emollient with ceramide and filaggrin‐associated amino acids for the primary prevention of atopic dermatitis in high‐risk infants

pH in nature, humans and skin

Petrolatum: Barrier repair and antimicrobial responses underlying this “inert” moisturizer

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