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Predicting Skin Barrier Dysfunction and Atopic Dermatitis in Early Infancy

Journal article
Authors E. M. Rehbinder
K. M. Advocaat Endre
K. C. Lødrup Carlsen
A. Asarnoj
K. E. Stensby Bains
T. L. Berents
K. H. Carlsen
H. K. Gudmundsdóttir
G. Haugen
G. Hedlin
I. Kreyberg
L. S. Nordhagen
B. Nordlund
C. M. Saunders
L. Sandvik
H. O. Skjerven
C. Söderhäll
A. C. Staff
R. Vettukattil
M. R. Værnesbranden
L. Landrø
M. H. Carlsen
O. C. Lødrup Carlsen
P. A. Granlund
B. Granum
S. Götberg
K. Hilde
C. M. Jonassen
U. C. Nygaard
K. Rudi
I. Skrindo
K. Sjøborg
S. G. Tedner
Johanna Wiik
A. J. Winger
group study
Published in Journal of Allergy and Clinical Immunology: In Practice
Volume 8
Issue 2
Pages 664-673.e5
ISSN 2213-2198
Publication year 2020
Published at Institute of Clinical Sciences, Department of Obstetrics and Gynecology
Pages 664-673.e5
Language en
Keywords Allergic diseases, Atopic dermatitis, Atopy, Dry skin, Eczema, Skin barrier, TEWL, Xerosis
Subject categories Dermatology and Venereal Diseases, Allergology


Background: Dry skin is associated with increased transepidermal water loss (TEWL), which has been 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 prospective birth cohort study, we included 1150 mother-child pairs. Dry skin, TEWL, and eczema were assessed at 3- and 6-month 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, equaling 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 < .05) for dry skin at 3 months were delivery >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 (adjusted odds ratio: 1.92, 95% confidence interval: 1.21-3.05; P = .005), whereas 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 3 months later. © 2019 American Academy of Allergy, Asthma & Immunology

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