Predicting skin barrier dysfunction and atopic dermatitis in early infancy

Abstract Background Dry skin, associated with increased transepidermal water loss (TEWL), is 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 (PreventADALL) prospective birth cohort study, we included 1150 mother-child pairs. Dry skin, TEWL and eczema were assessed at 3- and 6 months 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, equalling 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 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, (ORadjusted: 1.92, 95% CI: 1.21-3.05, p=0.005), while 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 three months later.