Daily Application of Emollients Reduces the Risk of Atopic Dermatitis at 2 Years of Age

Does daily application of an emollient reduce the likelihood that children will be diagnosed with atopic dermatitis at 2 years of age?

Daily application of an emollient during the first 2 years of life, especially in children at low risk and those with a dog in the home, significantly reduces the likelihood of atopic dermatitis at 2 years of age. Whether this merely delays the diagnosis or prevents it or whether daily application has any effect on later diagnoses linked to atopic dermatitis, such as allergies and asthma, is unknown. (Level of Evidence = 1b–)

Results of previous trials on the prevention of atopic dermatitis have largely come from high-risk populations and have had mixed results. The researchers identified infants aged 0 to 8 weeks in primary care clinics and excluded those who were very premature, had immunodeficiency, or had a previous eczema diagnosis. Of the 1,847 infants who were screened, 1,247 were included in the study, which speaks well for generalizability. Infant-parent dyads were randomized to daily application of an emollient or usual care; all parents were advised to bathe the child twice weekly. Parents in the emollient group could choose one of five products (Cetaphil lotion, Vanicream lotion, Vaseline, or CeraVe lotion or ointment), which was then mailed to them every 6 months. The parents could change products if desired during the study. Groups were balanced at baseline, with approximately one-half of patients in each group who had a sibling with atopy (analysis was stratified by this factor). Analysis was by intention to treat. The primary outcome was the primary care physician's diagnosis of atopic dermatitis, as determined by a chart auditor masked to treatment assignment. It does not appear that the primary care physicians were masked.

At 2 years, atopic dermatitis was less likely to have been diagnosed in the emollient group overall (36.1% vs 43.0%; P = .02; number needed to treat [NNT] = 14). The absolute risk reduction was greater in children at low risk without an affected relative (−10.4%; NNT = 10) than in those who were at high risk (−3.4%; P was not significant). Having a dog was an important effect modifier: Infants in households with a dog had a very large reduction in risk (−14.2%; 95% CI, −23 to −5; NNT = 7); no significant reduction occurred in households without a dog. Because there was a lack of sample size and parents who switched emollients, it was not possible to assess whether one product was better than the others.

Study Design: Randomized controlled trial (single-blinded)

Funding Source: Government

Allocation: Concealed

Setting: Outpatient (any)

Reference: Simpson EL, Michaels LC, Ramsey K, et al.; CASCADE Consortium. Emollients to prevent pediatric eczema: a randomized clinical trial. JAMA Dermatol. 2025; 161(9): 957-965.

Editor’s Note: Dr. Ebell is cofounder and editor-in-chief of Essential Evidence Plus.