背景:在普通人群随机对照PreventADALL试验中,频繁的润肤浴添加剂从2周龄没有防止特应性皮炎,而整个婴儿期对皮肤屏障功能的影响尚未建立。
目的:这项探索性亚研究的主要目的是评估矿物油浴对婴儿期经皮水分流失(TEWL)和皮肤干燥的影响,其次探讨聚丝团蛋白(FLG)突变是否改变了这种作用。
方法:总共2153名婴儿随机接受皮肤干预(SI)(n=995)(油浴4次/周,从2周到8个月)或无皮肤干预(NSI)(n=1158),在3、6和/或12月龄时进行TEWL测量。其中1683名婴儿也有可用的FLG突变状态。通过混合效应回归模型评估皮肤干预对TEWL和婴儿期皮肤干燥的影响。背景特征和协议依从性是从电子问卷中收集的,出生记录和每周日记。
结果:在生命的第一年,与NSI组相比,SI的TEWL(95%CI)平均高0.42g/m2/h(0.13-0.70,p=0.004)。3个月时水平明显较高,(8.6(8.3-9.0)对7.6(7.3-7.9)),但在6个月和12个月时相似。与SI组相比,在3个月时(59%对51%)和6个月时(63%对53%),在12个月大的时候,差异不再显著。3个月时,FLG突变携带者的TEWL与SI组的TEWL相似。在生命的第一年没有发现皮肤干预和FLG突变之间的相互作用。
结论:与对照组相比,从2周龄开始频繁进行油浴的婴儿在整个婴儿期的皮肤屏障功能降低,主要归因于3月龄时TEWL较高,而接受皮肤干预的婴儿在3个月和6个月时皮肤干燥程度较低。
BACKGROUND: In the general population randomized controlled
trial PreventADALL, frequent emollient bath additives from 2 weeks of age did not prevent atopic dermatitis, while the effect on skin barrier function throughout infancy is not established.
OBJECTIVE: The primary aim of this exploratory substudy was to assess the effect of mineral-based oil baths on transepidermal water loss (TEWL) and dry skin through infancy, and secondarily to explore if filaggrin (FLG) mutations modified the effect.
METHODS: Overall, 2153 infants were included and randomized to either the \'Skin intervention\' (SI) group (n = 995) (oil bath 4 times weekly from 2 weeks through 8 months) or \'No skin intervention\' (NSI) group (n = 1158), with TEWL measurements at 3, 6 and/or 12 months of age. Information on FLG mutation status was available for 1683 of these infants. Effects of the skin intervention on TEWL and dry skin through infancy were assessed by mixed-effects regression modelling. Background characteristics and protocol adherence were collected from electronic questionnaires, birth records and weekly diaries.
RESULTS: The TEWL (95% confidence interval) was on average 0.42 g m-2 h-1 (0.13-0.70, P = 0.004) higher in the SI group compared with the NSI group through the first year of life, with significantly higher levels at 3 months [8.6 (8.3-9.0) vs. 7.6 (7.3-7.9)], but similar at 6 and 12 months. Dry skin was observed significantly more often in the NSI group compared with the SI group at 3 months (59% vs. 51%) and at 6 months of age (63% vs. 53%), while at 12 months of age, the difference was no longer significant. At 3 months, the TEWL of FLG mutation carriers was similar to the TEWL in the SI group. No interaction between SI and FLG mutation was found in the first year of life.
CONCLUSIONS: Infants given frequent oil baths from 2 weeks of age had reduced skin barrier function through infancy compared with controls, largely attributed to higher TEWL at 3 months of age, while the skin at 3 and 6 months appeared less dry in infants subjected to the skin intervention.
Atopic dermatitis (AD) affects approximately 20% of children in industrialized countries. AD causes dry, itchy skin and can increase the chance of infections. This
study was a substudy of the large Scandinavian PreventADALL
trial, including 2394 infants, recruited from the general population between 2014 and 2016. Children in this
trial were allocated randomly to receive either a skin intervention, food intervention, combined intervention, or no intervention. Children were examined at 3, 6 and 12 months of age. The examinations involved an investigation of the skin, to evaluate dry skin and skin barrier function by transepidermal water loss (TEWL) in the outer layers of the skin (higher TEWL suggests decreased skin barrier function). The skin intervention consisted of oil baths at least 4 times per week from 2 weeks of age through 8 months of age, and have previously not been shown to prevent AD by 1 and 3 years of age. We aimed to investigate whether frequent oil baths had any effect on TEWL and dry skin. We found that the skin intervention increased TEWL in the first year of life, especially at 3 months of age. Dry skin was less common in the skin intervention groups compared with the groups with no skin intervention. Infants with mutations in the gene coding for a skin barrier protein, called filaggrin, were associated with increased TEWL; however, in the skin intervention group, TEWL was similar among the infants with or without filaggrin mutations. Our findings suggest that oil baths several times per week from early infancy transiently decreases skin barrier function.