Dynamic trends in skin barrier function from birth to age 6months and infantile atopic dermatitis: A Chinese prospective cohort study.

Ying Ye,Xiaotian Chen,Piaoping Zhao,Xiangyuan Huang,Lingfeng He,Limin Dou,Liuhui Wang,Weili Yan,Yi Zhang,Hongjian Gu,Kaku Ken,Lei Zhang,Yun Li,Wei Gao,Yalan Dou

doi:10.1002/clt2.12043

Abstract

BackgroundSkin barrier functions develop after birth and may be related to skin disorders in infants. We aimed to assess associations between dynamic trends of four skin barrier functional parameters in early life with infant atopic dermatitis (AD).MethodsBased on the prospective cohort MKNFOAD (NCT02889081), we examined transepidermal water loss (TEWL), stratum corneum hydration (SCH), skin pH, and sebum content at five anatomical sites (cheek, forehead, forearm, abdomen, and lower leg) in 418 term infants at birth, 42 days, and 6 months. Trend differences by sex and association with AD at age 1 year were tested using variance analyses. Associations of the parameters with AD risk were tested using discrete time survival analysis, adjusting extensive covariates including parental history of allergy, infant’s sex, birth weight (kg), and delivery mode. Odds ratios (ORs) and 95% confidence interval (CIs) were reported.ResultsOverall TEWL and SCH appeared trends of increase while skin surface pH and sebum content showed trends of decrease within the first six postnatal months. Sex differences were significant for sebum content only (p < 0.001). After adjustment for parental and children covariates, cheek TEWL at birth (OR = 1.26, 95% CI 1.00–1.57, p = 0.045) and 42 days (OR = 1.52, 95% CI 1.17–1.97, p = 0.002) were significantly associated with increased AD risk. Associations were not observed between SCH, skin pH, and sebum content at birth or 42 days with AD.ConclusionsSkin barrier functions of Chinese term infants varied nonlinearly after birth. Higher postnatal TEWL levels in early life indicate higher risk of early‐onset AD.

Highlights

The skin barrier has a protective role against the external world and in maintaining homeostasis
After adjustment for parental and children covariates, cheek transepidermal water loss (TEWL) (OR=1.26, 95% confidence interval (CI) 1.00–1.57, p=0.045) at birth and 42 days (OR=1.52, 95% CI 1.17–1.97, p=0.002) were significantly associated with increased atopic dermatitis (AD) risk
Associations were not observed between stratum corneum hydration (SCH), skin pH, and sebum content at birth or 42 days with AD

Summary

Introduction

The skin barrier has a protective role against the external world and in maintaining homeostasis. Skin properties are related to ethnicity and skin phototype[13,14,15]; studies on the features of postnatal skin physiologic development among Asian infant populations are relatively limited[16]. As skin barrier functions differ among anatomical sites[17,18], measurements including exposed and unexposed sites will help to provide comprehensive data, to reveal regional variation in postnatal trends of skin physiologic development. There is evidence of a reverse association with AD of TEWL23,24; the contribution of the other parameters is unclear Quantitative description of these parameters during infancy will facilitate comprehensive clinical evaluation of infant skin status and identifying high-risk infants among the general population. Skin barrier functions develop after birth and may be related to skin disorders in infants

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