Systematic review and network meta‐analysis of different types of emollient for the prevention of atopic dermatitis in infants

Abstract

Prophylactic application of emollients has been an effective strategy against infant atopic dermatitis (AD); however, the difference of different emollients is unknown. We performed this network meta‐analysis to compare different emollients in preventing infant AD. A systematic search was performed in PubMed, EMBASE and Cochrane library to identify relevant studies from their inception through 28 February, 2022. We evaluated the quality of eligible studies using the Cochrane risk of bias assessment tool. Data analysis was performed using STATA 14.0. Eleven studies were included for data analysis. Direct meta‐analysis suggested that early application of emollients effectively prevented AD development in high‐risk infants (risk ratio [RR], 0.64; 95% confidence interval [CI], 0.47 to 0.88). Network meta‐analysis suggested that emollient emulsion might the better option for preventing infant AD development, with a surface under the cumulative ranking curve (SUCRA) of 82.6% for all populations, 78.0% for high‐risk populations and 79.2% for populations with food sensitization. Moreover, subjects receiving emollients more frequently experienced adverse events. Overall, early application of emollients is an effective strategy for preventing AD development in high‐risk infants and emollient emulsion may be the optimal type. Future study with well‐designed and large scale are warranted to validate our findings.

Should Emollients Be Recommended for the Prevention of Atopic Dermatitis?—New Evidence and Current State of Knowledge

“…This conclusion did not apply to neonates with risk factors of AD development, among whom such an intervention decreases disease incidence. The meta-analyses emphasized the complications and negative aspects of emollient use, such as the increased risk of skin infectious diseases among neonates treated with emollients [42][43][44][45][46][47].…”

“…The emollient types used in the intervention groups differed and included formulas such as creams, oils, gels, balms, and emulsions. The systemic review and metaanalysis by Junqin Liang et al [45] showed that emollient emulsion might be the superior option for preventing AD development in infants. Emollients may contain lipids that are nonphysiological, including petrolatum or lanolin, or physiological, which mimic lipids naturally present in the stratum corneum such as ceramides and cholesterol.…”

Skin‐centered strategies in food allergy prevention

“…Different pair-wise meta-analyses took into account all these studies and finally did not find that emollient application prevents either sensitization to food allergen or FA. 50,56,57 The heterogeneity of the studies that have been included in these meta-analyses (I 2 = 41%, 57 40%, 56 and 66% 50 ) forces to consider them with precaution.…”

Progress in Dermatology and Venereology in 2023 as reflected in the Journal of the European Academy of Dermatology and Venereology

“…Overall atopic dermatitis occurred less frequently when emollients were used for prevention (RR 0.64, CI 0.47-0.88; p < 0.001). 11 Some patients with atopic dermatitis when treated with Dupilumab develop facial erythema. This phenomenon was studied in 162 patients with severe atopic dermatitis under Dupilumab treatment; 137 had facial erythema before Dupi treatment, 121 improved, seven got worse and six out of 25 patients developed new facial erythema under Dupilumab.…”

“…In a systematic review and network meta‐analysis, the effect of primary prevention with emollients was studied in 11 double‐blind controlled randomized studies in a total of 3483 patients. Overall atopic dermatitis occurred less frequently when emollients were used for prevention (RR 0.64, CI 0.47–0.88; p < 0.001) 11 …”