Helen Brough, consultant in paediatric allergy and professor at King’s College in London, gives this advice:
- If newborns or infants have normal skin, they do not need any moisturising creams or lotions to prevent eczema.
- However, if the children have dry skin or rashes (eczema), a skin care product should then be used. This protects not only against atopic dermatitis but also reduces the likelihood that a food allergy will develop later on. But precautions are necessary: Hands should be thoroughly washed before applying cream on children. The cream should not be taken out of the container with the fingers, but with a clean cream spatula or spoon instead.
Which ingredients should the cream contain, and which should be avoided?
Not every cream is suitable for the task. In recent years, scientists have extensively investigated and discussed the optimal ingredients.
The PEBBLES study, which is currently underway in Australia, is investigating a so-called trilipid cream. It contains the lipids ceramide, cholesterol and fatty acids (at a 3:1:1 ratio). This triple lipid combination mirrors the normal fat content in the skin, thereby helping to maintain a normal skin barrier (Lowe 2019).
The first small-scale PEBBLES study revealed positive results for the cream (Lowe 2018):
- Atopic dermatitis developed in 16% of the 36 children who did not receive any cream.
- By contrast, atopic dermatitis developed in only 5% of the 34 children who received the cream.
Furthermore, food allergies were not as prevalent in children who had received the cream during their first year of life.
These results are currently being verified in a larger PEBBLES study with 760 children.
The initial studies that focused on creams and the prevention of atopic dermatitis and food allergies in children date back to 2014. They investigated Vaseline-based creams. The creams were applied regularly by the parents during the initial weeks of life. Atopic dermatitis then appeared less likely to develop.
However, larger and statistically robuster studies have since demonstrated that the daily application of Vaseline-based creams does not protect against atopic dermatitis (Chalmers 2020). Brough specifically referred to the colonisation of the skin by the bacterium Staphylococcus aureus, which can increase the risk of food allergies.
Nor do skin care products based on the wax-like substance paraffin prevent atopic dermatitis. This was the finding of the PreventADALL study published in 2020 (Skjerven 2020), in which parents applied a face cream containing paraffin on their newborns starting at two weeks of age and bathed them regularly using a paraffin-containing oil as a bath additive.
Should creams containing urea be used on children?
Urea can disrupt kidney function in newborns. Creams containing urea should therefore not be used on newborns, according to Brough. A cream with a lower concentration of urea than for adults should be used on infants. Glycerine is an ingredient that is better tolerated, said Brough.
Brough H. Targeting the skin immune response for disease prevention and control – Skin care from birth for allergy prevention: results today. Presentation at the EAACI Congress 2020, Friday 8 June 2020.
Lowe AJ et al. A Randomized Trial of a Barrier Lipid Replacement Strategy for the Prevention of Atopic Dermatitis and Allergic Sensitization: The PEBBLES Pilot Study. Br J Dermatol 2018;178(1):e19-e21
Lowe AJ et al. PEBBLES study protocol: a randomised controlled trial to prevent atopic dermatitis, food allergy and sensitisation in infants with a family history of allergic disease using a skin barrier improvement strategy. BMJ Open 2019;9:e024594