Emollients in Infancy: Can We Prevent Atopic Dermatitis?

Atopic dermatitis (AD) remains one of the most common chronic inflammatory skin conditions of childhood, often preceding the development of food allergies (FA) and other atopic disorders. In recent years, prophylactic emollient use in early infancy has emerged as a potential strategy to strengthen the skin barrier and prevent AD onset. But does the evidence support this approach?

A recent systematic review and meta-analysis evaluated randomized controlled trials published between January 2000 and July 2020, focusing on infants started on emollients within the first 6 weeks of life. The analysis included 10 trials with follow-up for AD development within the first two years.

Overall, early emollient use did not significantly reduce AD incidence (RR 0.84, 95% CI 0.64–1.10). However, subgroup analyses offered important insights. In high-risk infants—those with a family history of atopy—prophylactic emollients showed a more pronounced benefit (RR 0.75, 95% CI 0.62–1.11). Similarly, continuous use until the point of AD assessment yielded significant protection (RR 0.59, 95% CI 0.43–0.81), while treatment cessation prior to assessment nullified the benefit. No protective effect was seen for FA prevention.

The findings suggest that early, sustained emollient application may delay or reduce AD onset, particularly in genetically predisposed infants. However, the absence of benefit in the general population and the possibility that emollients may only delay rather than prevent disease warrant cautious interpretation. Future trials with longer follow-up and standardized emollient regimens are needed before routine recommendation can be made.