Prevention of Atopic Dermatitis
Hywel C. Williams, Joanne Chalmers
Despite advances in atopic dermatitis (AD) treatments, research into AD prevention has been slow. Systematic reviews of prevention strategies promoting exclusive and prolonged breastfeeding, or interventions that reduce ingested or airborne allergens during pregnancy and after birth have generally not shown convincing benefit. Maternal/infant supplements such as Vitamin D have also not shown any benefit with the possible exception of omega-3 fatty acids. Systematic reviews suggest that probiotics could reduce AD incidence by around 20%, although the studies are quite variable and might benefit from individual patient data meta-analysis. Skin barrier enhancement from birth to prevent AD and food allergy has received recent interest, and results from national trials are awaited. It is possible that trying to influence major immunological changes that characterise AD at birth through infant-directed interventions may be too late, and more attention might be directed at fetal programming in utero.
Just like we can prevent infectious diseases like polio, it should be possible to prevent eczema (atopic dermatitis), food allergy and asthma. Most things that have been tried so far to prevent eczema including exclusive breastfeeding, timing of starting solids, supplements like Vitamin D and reducing house dust mite don’t seem to work. Taking probiotics (friendly gut bacteria) during pregnancy probably reduces the risk of eczema by around 20%, although we are still not sure what combination is best. New research is trying to find out if special creams that make a baby’s skin barrier stronger can prevent eczema.