Predicting Skin Barrier Dysfunction and Atopic Dermatitis in Early Infancy

J Allergy Clin Immunol Pract. 2020 Feb;8(2):664-673.e5. doi: 10.1016/j.jaip.2019.09.014. Epub 2019 Sep 27.


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.

Keywords: Allergic diseases; Atopic dermatitis; Atopy; Dry skin; Eczema; PreventADALL; Skin barrier; TEWL; Xerosis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cesarean Section
  • Child
  • Cohort Studies
  • Dermatitis, Atopic* / diagnosis
  • Dermatitis, Atopic* / epidemiology
  • Eczema*
  • Female
  • Humans
  • Infant
  • Male
  • Pregnancy
  • Prospective Studies
  • Skin