Daily Emollient Use in Infants Linked to Reduced Atopic Dermatitis Risk

A recent randomized clinical trial has revealed that the daily application of emollients to infants can significantly reduce the incidence of atopic dermatitis (AD) by the age of two. Conducted by Dr. Eric Simpson, MD, MCR, of the Department of Dermatology at Oregon Health & Science University, the study, known as the Community-Based Assessment of Skin Care, Eczema, and Allergies (CASCADE trial), involved 1,247 infant-parent dyads who were enrolled from 25 community-based pediatric and family medicine clinics across four statewide practice-based research networks.

The premise of the CASCADE trial was to assess whether a regimen of full-body emollient application initiated within the first nine weeks of life could effectively lower the cumulative incidence of AD in a general population of infants, none of whom were specifically selected for a high risk of developing the condition. According to the findings published in the Journal of the American Academy of Dermatology, the cumulative incidence of AD at 24 months was notably lower in the intervention group at 36.1%, compared to 43.0% in the control group, resulting in a relative risk reduction of 16%. This decrease was particularly pronounced among infants not deemed to be at high risk for AD, where the relative risk was 0.75.

Dr. Simpson noted, "The findings suggest that early and routine emollient use may provide a preventive approach for families, especially given that 64% of participants reported using emollients prior to the study. This implies that such practices are already integrated into many households in the United States."

The trial's methodology involved the randomized allocation of participants into two groups: one receiving the daily moisturizer and the other serving as a control without emollient application. The primary outcome was the physician-diagnosed incidence of AD recorded in medical records by the age of two, with an intention-to-treat analysis employed to address missing outcomes through multiple imputation techniques. These statistical methods, supported by generalized linear models, emphasized the robustness of the reported findings.

In terms of demographics, the study cohort comprised 44.3% female infants, with an average age of 23.9 days at randomization. The trial revealed that while the intervention group's AD incidence was significantly lower, there was a notable interaction with family history of atopic disease, suggesting that infants with first-degree relatives exhibiting atopic conditions experienced less pronounced benefits from the intervention.

Interestingly, the study also examined the role of household pets in the observed outcomes. Infants living in homes with dogs exhibited a stronger protective effect from the emollient intervention, further illustrating the complexity of environmental factors influencing the development of AD.

Moreover, the study reported a slight reduction in rates of skin infections among the treatment group (19.8%) compared to the control group (21.1%), although this difference was not statistically significant.

The implications of these findings extend beyond mere incidence rates of AD. Dr. Simpson emphasized that early intervention through emollient application could play a crucial role in potentially mitigating allergic comorbidities, sleep disturbances, and mental health issues associated with early-onset AD. The research team has called for further investigation into the cost-effectiveness of this preventive strategy, as well as its long-term impact on the psychosocial well-being of affected children.

Overall, the CASCADE trial marks a significant advancement in understanding the role of skin care practices in pediatric health, positioning daily emollient use as a viable preventative measure against atopic dermatitis in infants. The study serves as a pivotal reference for pediatricians and dermatologists in advising families on infant skin care and the potential benefits of early emollient application.

References: - Simpson EL, Michaels LC, Ramsey K, et al. Emollients to Prevent Pediatric Eczema: A Randomized Clinical Trial. JAMA Dermatol. Published online July 23, 2025. doi:10.1001/jamadermatol.2025.2357 - Fitch J. Atopic dermatitis phenotypes and allergic disease development in children. Contemporary Pediatrics. July 25, 2025. Retrieved from https://www.contemporarypediatrics.com/view/atopic-dermatitis-phenotypes-and-allergic-disease-development-in-children