Effectiveness of Early Moisturizer Use in Atopic Dermatitis Prevention

In the 2025 study by Simpson et al entitled “Emollients to Prevent Pediatric Eczema: A Randomized Clinical Trial,” once-daily, full-body emollient use initiated at 9 weeks¹ of age significantly reduced the cumulative incidence of atopic dermatitis (AD) by 24 months.

Pediatric atopic dermatitis (AD) is a common, chronic inflammatory skin disorder associated with substantial healthcare burden in the United States, impaired quality of life for children and families, and increased risk of allergic comorbidities. Growing evidence indicates that skin barrier dysfunction often precedes the onset of AD, raising the question of whether early skin barrier restoration could aid in AD prevention. Prior studies of barrier-enhancing interventions have produced mixed results, primarily focusing on infants with elevated atopic risk.

In a recent review, Sulejmani et al highlight the conflicting evidence surrounding AD prevention strategies involving moisturizers and microbiome modulation.² An early pilot study in high-risk infants found that daily full-body moisturizer therapy reduced AD risk by 50%. However, a subsequent larger randomized controlled trial yielded contradictory findings. The 2017 BEEP trial found no protective effect of whole-body emollient application during the first year of life in high-risk infants, while the 2018 Prevent ADALL trial, conducted in a general infant population, found that AD was more common in infants in the skin intervention group receiving facial moisturizer and oil bath than in other groups. Despite different conclusions, this area has been plagued by serious heterogeneity in study design, including some questionable decisions about what constitutes “moisturization” in the first place.

Other studies have explored microbiome modulation for AD prevention with encouraging results. The randomized trial by Kalliomäki et al found that infants of mothers supplemented with the probiotic Lactobacillus during pregnancy and postnatally were about 50% less likely to develop AD at 2 years.³ Similarly, Grüber et al demonstrated that low-risk infants under 8 weeks of age who received formula supplemented with prebiotic oligosaccharides had lower rates of AD than controls at 1 year⁴. These findings highlight the uncertainty surrounding AD prevention research and show the need for larger, standardized trials to clarify the potential of moisturizers and microbiome in targeted AD intervention.

The current study presented the Community-Based Assessment of Skin Care, Eczema, and Allergies (CASCADE) trial and was the first large, community-based randomized controlled trial to evaluate whether routine emollient application prevents AD in infants not preselected for atopic risk. Investigators recruited 1,247 infant–parent dyads (infants ≤ 8 weeks of age) from 25 community clinics across 4 US states and randomized participants to either intervention or control arms. Families in the intervention group were instructed to apply a once-daily, full-body moisturizer from a choice of 5 bland, fragrance-free emollients, while families in the control group were advised to avoid routine emollient use.

Given the safety, accessibility, and wide cultural acceptance of moisturizers, this strategy represents a practical preven­ tive approach for families with young children. The stronger protective effects in infants without a family history of atopy and in dog-owning households suggest that genetic and environmental modifiers may influence responsiveness to barrier-directed prevention. While reductions in food allergy and skin infection were not statistically significant, these findings raise important questions for future long-term stud­ ies assessing whether early emollient use may also mitigate the broader spectrum of allergic comorbidities.

COMMENTS AND CLINICAL IMPLICATIONS

This pragmatic, community-based randomized controlled trial provides compelling evidence that early, routine emol­ lient use significantly reduces the incidence of AD by age 2.

STUDY RESULTS

The primary outcome was cumulative incidence of physician-diagnosed and recorded AD at 24 months. Secondary outcomes included health record audits of AD diagnoses, skin infections, food allergy testing, and other related comorbidities. The authors collected the Children’s Eczema Questionnaire; patients who met its criteria or received an AD diagnosis also completed the Patient-Oriented Eczema Measure (POEM) and the Infant Dermatology Quality of Life Index.

At 24 months, the cumulative incidence of AD was 36.1% in the emollient group vs 43.0% in the control group, rep­ resenting a statistically significant reduction (RR = 0.84; 95% CI, 0.73 to 0.97; P = 0.02). The protective effect was strongest in infants without a family history of AD (absolute risk reduction, 10.1%) and in households with dogs (14.2%). Although skin infections and food allergy were less frequent in the emollient arm, these differences were not statistically significant. Similarly, POEM and quality-of-life scores trended toward improvement but did not attain significance.

apply a once-daily, full-body moisturizer from a choice of 5 bland, fragrance-free emollients, while families in the control group were advised to avoid routine emollient use.

1. Simpson EL, Michaels LC, Ramsey K, et al; CASCADE Consortium. Emollients to prevent pediatric eczema: a randomized clinical trial. JAMA Dermatol. 2025;doi:10.1001/jamadermatol.2025.2357
2. Sulejmani P, Lio PA. The state of prevention in atopic dermatitis: an update. Pract Dermatol. 2023;Aug:19-22.
3. Kalliomäki M, Salminen S, Arvilommi H, et al. Probiotics in primary prevention of atopic disease: a randomised placebocontrolled trial. Lancet. 2001;357(9262):1076-1079.
4. Grüber C, van Stuijvenberg M, Mosca F, et al. Reduced occurrence of early atopic dermatitis because of immunoactivity prebiotics among low-atopy-risk infants. J Allergy Clin Immunol. 2010;126(4):791-797.