Research Summary

Daily Infant Emollient Use Reduces Atopic Dermatitis Incidence by Age 2 in Community-Based Trial

Kate Young

Key Highlights

  • Daily emollient use from infancy reduced the risk of developing atopic dermatitis (AD) by age 24 months.
  • The protective effect was strongest in children without a family history of atopy and in households with dogs.
  • No significant differences were observed in adverse events or safety outcomes between groups.
  • The intervention was feasible in a real-world, community-based setting.

A large, pragmatic randomized trial demonstrated that daily, full-body emollient use beginning before 9 weeks of age reduced the incidence of atopic dermatitis (AD) at 24 months compared with standard care. Infants receiving emollient intervention had a 16% lower risk of developing AD overall, with a number needed to treat of 15. The effect was particularly pronounced in children without a family history of atopy and those with dogs in the household. No significant increase in adverse events was noted.

Atopic dermatitis imposes a substantial burden on affected children and families, with associations to food allergy, asthma, sleep disruption, and psychosocial challenges. Previous trials testing skin barrier–enhancing interventions have produced mixed results, and most have targeted high-risk populations rather than a broad, community-based infant cohort. This study sought to address whether emollient use could prevent AD in infants not selected for elevated risk, thereby filling an important evidence gap for primary care clinicians.

The Community-Based Assessment of Skin Care, Eczema, and Allergies (CASCADE) trial was a pragmatic, single-blind, decentralized randomized clinical trial enrolling 1247 infant-parent dyads from 25 primary care and family medicine clinics across four states. Infants were randomized by age 9 weeks to receive once-daily, full-body emollient application from a choice of five bland formulations or to a control group that refrained from routine emollient use. Outcomes were tracked through medical record review and electronic surveys, with the primary endpoint being physician-diagnosed AD by 24 months.

At 2 years, the cumulative incidence of AD was 36.1% in the moisturizer group compared with 43.0% in controls (RR, 0.84; 95% CI, 0.73-0.97; P = .02). Among infants without a family history of atopy, the intervention was associated with a 24% relative risk reduction. Dog ownership further strengthened the protective effect (RR, 0.68; 95% CI, 0.50-0.90). Secondary outcomes showed no significant differences in skin infections or food allergy rates between groups. Safety outcomes were comparable, with mild rashes being the most frequently reported adverse event across both arms.

Limitations include the absence of genetic testing, the potential influence of emollient cost or adherence outside a trial setting, and the lack of formal food allergy testing. Additionally, the study did not determine the relative efficacy of different emollient formulations.

“This randomized clinical trial found that full-body emollient application starting during the first 2 months of life reduced the risk of AD development, especially in those without a family history of AD and who had a dog in the household,” the authors concluded. “Further work will be needed on the cost-effectiveness of this approach and implementation strategies.”

Reference:
Simpson EL, Michaels LC, Ramsey K, Fagnan LJ, Nease DE, et al. Emollients to prevent pediatric eczema: a randomized clinical trial. JAMA Dermatol. 2025 Jul 23;161(9):957–65. doi: 10.1001/jamadermatol.2025.2357.