Abstract
Purpose
Transepidermal water loss (TEWL) and stratum corneum hydration (SCH) are commonly used to assess epidermal barrier hydration. We investigated the associations of TEWL and SCH levels in newborns and the incidence of atopic dermatitis (AD) within the first 3 months of age.
Methods
We measured SCH and TEWL levels on the cheeks of 330 healthy full-term Vietnamese newborns within 48 hours after birth using a GPSkin Barrier Pro® device (GPOWER Inc., Korea). Subsequently, 233 newborns completed the follow-up via telephone calls over a period of 3 months. Any cases of AD and other skin disorders, including seborrheic dermatitis, diaper dermatitis, perianal dermatitis, or contact dermatitis that developed during the follow-up period, were recorded; AD was diagnosed based on the UK Working Party diagnostic criteria.
Results
A total of 233 newborns were followed up during the first 3 months of age, of whom 29 (12.4%) were diagnosed with AD. An increased risk of AD development was associated with higher TEWL levels within 48 hours after birth (adjusted risk ratio [aRR], 1.31; 95% confidence interval [CI], 1.14–1.51; P < 0.001) and longer gestational age (aRR, 2.71; 95% CI, 1.11–6.65, P = 0.029). A receiver operating characteristic curve analysis indicated that the TEWL levels could serve as a predictive factor for AD development in the first 3 months of life, with an area under the curve of 0.77 (95% CI, 0.67–0.86, P < 0.001).
Conclusions
The TEWL levels and gestational age within 48 hours after birth could serve as predictive factors for the development of AD in the first 3 months of life. This finding establishes a basis for the development of optimal prevention methods for AD.
Keywords: Atopic dermatitis, gestational age, infant, newborn, transepidermal water loss, stratum corneum hydration, receiver operating characteristic curve analysis, predictive factors
INTRODUCTION
Atopic dermatitis (AD) is a common allergic skin disorder in children, affecting up to 25% of the pediatric population globally and imposing a significant economic burden.1,2 The onset of AD typically occurs between 3 and 6 months of age, with approximately 60% of patients developing the condition within their first year of life. AD is associated with an increased risk of several comorbidities, such as food allergies, asthma, allergic rhinitis, and mental health disorders.1 Therefore, the development of diagnostic and monitoring tools in early childhood is crucial for the effective management of this disease.
Epidermal barrier dysfunction is a key factor in the pathogenesis of AD,3 which is indicated by changes in lipid composition,4,5 decreased stratum corneum hydration (SCH),6 increased transepidermal water loss (TEWL), and elevated skin pH.5,7 Filaggrin (FLG) deficiency, one of the major contributors to barrier impairment, compromises corneocyte integrity and water-binding capacity, thereby increasing TEWL and promoting xerosis.8 Ye et al.3 concluded that cheek TEWL levels measured at birth and day 42 were significantly associated with an increased risk of AD by the age of 1 year. To establish a foundational understanding for identifying early predictors and proposing prevention strategies for neonatal AD, we conducted a study in a larger population of Vietnamese newborns to investigate the associations of TEWL, SCH levels, as well as other clinical characteristics of the newborns, with the risk of AD development within the first 3 months of life.
MATERIALS AND METHODS
Participants and study design
We conducted a descriptive cohort study of 330 newborns recruited at the University Medical Center, Ho Chi Minh City, Vietnam. Newborns were eligible for this study if they had: (1) a full-term birth (gestational age 37–42 weeks) and (2) no moisturizer applied within 3 hours before measurement. Newborns diagnosed with a congenital disorder, neonatal jaundice, and/or neonatal infection were excluded. A positive history of atopy was defined as having at least one family member (father, mother, or siblings) with a known history of atopy (AD, asthma, allergic rhinitis, or food allergies), as reported by parents. The TEWL and SCH levels were measured within 48 hours after birth using a noninvasive skin measurement technique. The newborns were followed up until 3 months of age; AD and other dermatitis, including seborrheic dermatitis, diaper dermatitis, perianal dermatitis, or contact dermatitis that developed during the study period were recorded. Among 330 newborns who underwent TEWL and SCH measurements, 233 completed the follow-up.
This study was approved by the Institutional Review Board (IRB) of the University of Medicine and Pharmacy at Ho Chi Minh City (IRB number: IRB-VN01002/IORG0008603/FWA00023448).
Measurement of skin barrier function
The SCH and TEWL values were measured simultaneously on the cheek using the GPSKIN Barrier Pro® device (GPOWER Inc., Hanam, Korea). This handheld, non-invasive device utilizes the Corneometer CM825 principle to measure SCH and employs the closed, unventilated-chamber principle from Delfin Technologies to assess TEWL.9 GPSkin Barrier Pro® demonstrated a moderate to strong correlation with other available devices for measuring TEWL and SCH,10 and represents a reliable method for assessing skin barrier function.9 All measurements were taken while the newborns were calm,3,11,12 under standardized environmental conditions in an airtight room with a temperature of 22°C–26°C and humidity ranging between 40% and 65%.13 The median value was derived from three consecutive measurements.
AD diagnosis
The children were followed up during the first 3 months through telephone surveys on Days 30, 60, and 90 to assess any AD developed during the study period, based on the UK Working Party diagnostic criteria.14 Specifically, the researcher conducted video calls with families, asking questions about the recurrent episodes of the AD-related symptoms, including (1) itching behaviors such as crying, fussing, scratching, (2) skin dryness, (3) characteristics, and locations of the skin lesions such as cheeks, forehead, flexural areas, or outer limbs, and (4) family histories of AD in first-degree relatives. Infants who met at least three criteria of the UK Working Party diagnostic criteria were diagnosed with AD. All evaluations were performed by dermatologists or allergists trained in AD management.
Statistical analysis
Statistical analyses were performed using Stata 14.0 (StataCorp LLC, College Station, TX, USA), and a P value less than 0.05 was regarded as statistically significant. Categorical variables are presented as numbers and percentages. Continuous variables were tested for normality (Shapiro-Wilk test) and are presented as mean ± standard deviation. Group comparisons used χ2 for categorical variables and Student’s t-tests or one-way analysis of variance for continuous variables. Multivariable logistic regressions, adjusted for TEWL, SCH, gestational age, sex, mode of delivery, and family history of atopy, were performed to identify independent risk factors for AD. We conducted receiver operating characteristic (ROC) curve analysis to identify the optimal cutoff for mean TEWL values measured during the first 48 hours of life. Based on this, we divided the initial population into two groups: high and low TEWL. The survival function of the time to AD development was estimated by the Kaplan-Meier method, and the adjusted hazard ratio (aHR) was estimated by a Cox regression model to assess the association between the TEWL values and AD development.
RESULTS
Clinical characteristics of newborns
Table 1 presents the characteristics of the study subjects. The average gestational age of newborns was 39.0 ± 0.8 weeks (data not shown). Among the 330 subjects, 276 (83.6%) had a gestational age of 37–40 weeks, while 54 (16.4%) had a gestational age of 40 weeks or longer. Males were predominant, with a male-to-female ratio of 1.5:1.0. A total of 261 out of 330 (79.1%) study subjects were born by cesarean section. We recorded that 144 of 330 infants (43.6%) had a family history of atopy, and 46 of 330 (13.9%) had a family history of AD. The mean SCH and TEWL levels of the newborns were 15.0 ± 7.5 a.u. and 5.8 ± 2.8 g/m2/h, respectively.
Table 1. General clinical characteristics of the study subjects.
| Characteristics | Newborns (n = 330) | |
|---|---|---|
| Gestational age | ||
| < 40 wk | 276/330 (83.6) | |
| ≥ 40 wk | 54/330 (16.4) | |
| Sex | ||
| Male | 198/330 (60.0) | |
| Female | 102/330 (40.0) | |
| Area of residence | ||
| Urban | 190/330 (57.6) | |
| Rural | 140/330 (42.4) | |
| Age of mothers (yr) | 30.0 (28.0–33.0) | |
| Cesarean section | 261/330 (79.1) | |
| Birth weight (g) | 3,200.0 (3,000.0–3,400.0) | |
| Birth height (cm) | 49.0 (48.0–50.0) | |
| Family history of atopy | 144/330 (43.6) | |
| Family history of AD | 46/330 (13.9) | |
| SCH (a.u.) | 15.0 ± 7.5 | |
| TEWL (g/m2/h) | 5.8 ± 2.8 | |
Data are presented as number (%) and mean ± standard deviation or median (interquartile range).
AD, atopic dermatitis; SCH, stratum corneum hydration; TEWL, transepidermal water loss.
The cumulative incidence of AD
The cumulative incidence of AD in the study population was 5.1% (13 of 255) at the first month, 8.1% (19 of 235) at 2 months of age, and 12.4% (29 of 233) at 3 months of age (data not shown).
The levels of SCH and TEWL within 48 hours after birth and the associations with family history of atopy
The associations of SCH and TEWL levels with other clinical characteristics are shown in Table 2. Newborns with a gestational age of 40 weeks or longer had a significantly higher mean TEWL levels than those with a gestational age of less than 40 weeks (6.6 ± 2.5 g/m2/h vs. 5.6 ± 2.8 g/m2/h, P = 0.003). Additionally, the mean TEWL levels of newborns who had a family history of atopy were significantly higher than those of the newborns without a family history of atopy (6.3 ± 3.1 g/m2/h vs. 5.4 ± 2.5 g/m2/h, P = 0.027). The TEWL levels of newborns with a family history of AD (6.4 ± 3.6 g/m2/h) tended to be higher than those without a family history of AD (5.7 ± 2.6 g/m2/h); however, the difference was not statistically significant (P = 0.400).
Table 2. The relationship between newborn SCH and TEWL levels and clinical characteristics.
| Characteristics | SCH (a.u.) | P value | TEWL (g/m2/h) | P value | |
|---|---|---|---|---|---|
| Gestational age | 0.343 | 0.003 | |||
| < 40 wk | 14.8 ± 7.5 | 5.6 ± 2.8 | |||
| ≥ 40 wk | 15.9 ± 7.5 | 6.6 ± 2.5 | |||
| Sex | 0.567 | 0.208 | |||
| Male | 14.7 ± 7.2 | 5.7 ± 2.8 | |||
| Female | 15.4 ± 8.0 | 6.0 ± 2.8 | |||
| Birth method | 0.967 | 0.889 | |||
| Vaginal birth | 14.7 ± 7.0 | 5.7 ± 2.6 | |||
| Cesarean section | 15.0 ± 7.7 | 6.8 ± 2.9 | |||
| Family history of atopy | 0.653 | 0.027 | |||
| No | 15.2 ± 7.8 | 5.4 ± 2.5 | |||
| Yes | 14.7 ± 7.2 | 6.3 ± 3.1 | |||
| Family history of AD | 0.248 | 0.400 | |||
| No | 15.2 ± 7.4 | 5.7 ± 2.6 | |||
| Yes | 14.0 ± 8.2 | 6.4 ± 3.6 | |||
The P values were calculated by Student’s t-test.
SCH, stratum corneum hydration; TEWL, transepidermal water loss; AD, atopic dermatitis.
Increased TEWL levels within 48 hours after birth and longer gestational age at birth are associated with increased risk of AD
SCH levels within 48 hours after birth were not associated with the incidence of AD in the first 3 months (P > 0.050 for all, Fig. 1A). However, the infants who were diagnosed with AD in the first 3 months of age had significantly higher TEWL levels within 48 hours after birth compared to those who were diagnosed with other dermatitis as well as those without skin disorders (P < 0.001 for all, Fig. 1B).
Fig. 1. Clinical implications of newborn SCH and TEWL levels in patients with atopic dermatitis. Comparison of newborn SCH (A) and TEWL (B) levels according to skin disorders in the first 3 months of age. The groups include atopic dermatitis, other dermatitis (seborrheic dermatitis, diaper dermatitis, perianal dermatitis, contact dermatitis, subclinical atopic dermatitis), and no dermatitis. Data are presented as means ± standard deviations. The P values were obtained using one-way analysis of variance with Bonferroni’s post hoc test.
SCH, stratum corneum hydration; TEWL, transepidermal water loss.
In logistic regression analysis, we observed that increased TEWL levels within 48 hours after birth were associated with an increased risk of AD development (adjusted risk ratio [aRR], 1.31; 95% confidence interval [CI], 1.14–1.51, P < 0.001) (Table 3). Notably, a gestational age of 40 weeks or longer was also associated with an increased risk of AD in the first 3 months of age (aRR, 2.71; 95% CI, 1.11–6.65, P = 0.029).
Table 3. Predictors of atopic dermatitis by multivariate logistic regression analysis.
| Characteristics | Logistic regression | ||
|---|---|---|---|
| aRR (95% CI) | P value | ||
| Gestational age | 0.029 | ||
| < 40 wk | 1 | ||
| ≥ 40 wk | 2.71 (1.11–6.65) | ||
| Sex | 0.680 | ||
| Male | 1 | ||
| Female | 0.83 (0.35–1.98) | ||
| Birth method | 0.525 | ||
| Vaginal birth | 1 | ||
| Cesarean section | 1.46 (0.45–4.68) | ||
| TEWL (g/m2/h) | 1.31 (1.14–1.51) | < 0.001 | |
| SCH (a.u.) | 1.01 (0.96–1.06) | 0.732 | |
| Family history of atopy | 0.472 | ||
| No | 1 | ||
| Yes | 1.37 (0.58–3.24) | ||
Risk ratios were adjusted for gestational age, gender, birth method, TEWL, SCH, and family history of atopy.
aRR, adjusted risk ratio; CI, confidence interval; TEWL, transepidermal water loss; SCH, stratum corneum hydration.
Increased TEWL levels within 48 hours after birth predict AD development in the first 3 months of age
The ROC curve for newborn TEWL levels was obtained to predict AD development within the first 3 months of life. TEWL levels showed moderate predictive value with statistical significance (area under the curve, 0.77; 95% CI, 0.67–0.86, P < 0.001) (Fig. 2).
Fig. 2. The receiver operating characteristic curve shows the true positive and false positive rates of the transepidermal water loss levels in detecting atopic dermatitis in the first 3 months of life.
AUC, area under the curve; CI, confidence interval.
Based on the optimal cutoff value of 6.2 g/m2/h (68.9% sensitivity and 69.6% specificity), we further divided the study population into 2 groups: newborns with high TEWL levels (≥ 6.2 g/m2/h) and those with low TEWL levels (< 6.2 g/m2/h). Using the log-rank test, we found that the newborns with high TEWL levels had a higher risk of AD development within the first 3 months of life compared to those with low TEWL levels, with an adjusted hazard ratio aHR of 3.31 (95% CI, 1.47–7.44, P = 0.004) (Supplementary Fig. S1).
DISCUSSION
Our study demonstrated that elevated TEWL levels within 48 hours after birth were associated with an increased risk of AD development. Furthermore, newborn TEWL levels had good predictive value for the development of AD in infants. These results indicate that newborn TEWL levels can be a potential marker for predicting AD development in infants, which helps improve management and prevention strategies.
In contrast to SCH levels, which are also associated with skin barrier dysfunction, TEWL emerged as the most pivotal factor in predicting the risk of AD in the present study. A study examining four parameters (SCH, TEWL, pH, and sebum content) in Chinese infants across five anatomical sites revealed a strong correlation between elevated TEWL levels on the cheek at birth and increased AD risk, even after adjusting for parental and child covariates.3 Consistent findings have been reported in later studies, as detailed in Supplementary Table S1. Heritable FLG loss-of-function mutations have an established association with AD pathophysiology. Previous investigations have highlighted a close interplay between FLG mutations and heightened TEWL values in 3-month-old infants, irrespective of skin condition.15 Our study recorded higher TEWL levels in newborns, but not higher SCH levels, suggesting that genetic factors could affect the epidermal layer functions of newborns. Although both TEWL and SCH serve as non-invasive indicators of barrier integrity, SCH may be more susceptible to systemic metabolic influences,16 thereby limiting its specificity in predicting barrier-related conditions such as AD.
Several studies have demonstrated that premature infants exhibit markedly higher TEWL values compared to full-term infants.17,18 Nevertheless, to date, few studies have specifically explored the association between TEWL values and gestational age, especially in full-term infants.19,20 Our study found that full-term infants with a gestational age of 40 weeks or more had higher TEWL than those with a gestational age of less than 40 weeks. This could be due to reduced vernix caseosa in post-term infants, which results in prolonged exposure to protease-rich amniotic fluid, thereby compromising the skin barrier function, increasing TEWL, and leading to skin dryness.19 Moreover, we also observed that the infants born at 40 weeks or longer of gestational age had a 2.71 times higher risk of developing AD in the first 3 months compared to those born at 37–40 weeks of gestational age. A previous study examined AD incidence and risk factors up to the age of seven across early-term, full-term, late-term, and post-term births, identifying that post-term birth was the only predictive factor of AD.21 Another study suggested that prematurity was associated with a reduced risk of AD development.18 Several theories have been proposed to explain this association, including the hypothesis of tolerance and sensitization to antigens of the immune system in children.18 The immature skin barrier in preterm infants may dampen immune responses, in contrast to older children in whom barrier defects can promote inflammation.22 Other studies have suggested that altered skin microbiota may trigger local immune reactions that prevent AD.23 Furthermore, shortening the exposure time to the Th2 cytokine environment during pregnancy may alter the Th1/Th2 balance in premature children, which may decrease the risk of AD.18 Taken together, AD risk could be positively associated with the gestational age of the newborns and the underlying mechanisms need to be further studied.
This study has several limitations. First, AD diagnosis relied solely on telephone interviews, which may have introduced reporting bias. Second, the 3-month follow-up period may be insufficient to capture later-onset AD. Third, we did not evaluate TEWL in premature infants. Fourth, the high proportion of cesarean deliveries in the present study, which was conducted in a tertiary hospital, could affect the AD prevalence. Finally, another possible confounder was the differences in skincare routines of the parents for their children; however, previous studies with large cohorts showed that moisturizer application from birth did not affect the development of AD.24,25 The observed association may reflect a transient impairment of the skin barrier rather than a persistent defect, warranting further longitudinal investigation.
The present study demonstrated that TEWL levels and gestational age within 48 hours after birth could be considered predictive factors for the development of AD in the first 3 months of life. This finding not only aids in identifying high-risk groups for AD but also provides a basis for developing optimal prevention strategies for the disease.
ACKNOWLEDGMENTS
We greatly appreciate Prof. In-Hong Choi, MD, PhD, from Yonsei University Health System for her support in the English editing of this manuscript.
Footnotes
Disclosure: There are no financial or other issues that might lead to conflict of interest.
Patient Consent Statement: Written informed consent was provided by the parents of all newborns at the time of recruitment.
SUPPLEMENTARY MATERIALS
Summary and comparison of the results of some prior studies
Kaplan-Meier curve for diagnosis of atopic dermatitis stratified by high TEWL and low TEWL levels.
References
- 1.Langan SM, Irvine AD, Weidinger S. Atopic dermatitis. Lancet. 2020;396:345–360. doi: 10.1016/S0140-6736(20)31286-1. [DOI] [PubMed] [Google Scholar]
- 2.Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, et al. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014;70:338–351. doi: 10.1016/j.jaad.2013.10.010. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Ye Y, Zhao P, Dou L, Zhang Y, Ken K, Gu H, et al. Dynamic trends in skin barrier function from birth to age 6 months and infantile atopic dermatitis: a Chinese prospective cohort study. Clin Transl Allergy. 2021;11:e12043. doi: 10.1002/clt2.12043. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Baurecht H, Rühlemann MC, Rodríguez E, Thielking F, Harder I, Erkens AS, et al. Epidermal lipid composition, barrier integrity, and eczematous inflammation are associated with skin microbiome configuration. J Allergy Clin Immunol. 2018;141:1668–1676.e16. doi: 10.1016/j.jaci.2018.01.019. [DOI] [PubMed] [Google Scholar]
- 5.Jungersted JM, Scheer H, Mempel M, Baurecht H, Cifuentes L, Høgh JK, et al. Stratum corneum lipids, skin barrier function and filaggrin mutations in patients with atopic eczema. Allergy. 2010;65:911–918. doi: 10.1111/j.1398-9995.2010.02326.x. [DOI] [PubMed] [Google Scholar]
- 6.Tsakok T, Woolf R, Smith CH, Weidinger S, Flohr C. Atopic dermatitis: the skin barrier and beyond. Br J Dermatol. 2019;180:464–474. doi: 10.1111/bjd.16934. [DOI] [PubMed] [Google Scholar]
- 7.Seidenari S, Giusti G. Objective assessment of the skin of children affected by atopic dermatitis: a study of pH, capacitance and TEWL in eczematous and clinically uninvolved skin. Acta Derm Venereol. 1995;75:429–433. doi: 10.2340/0001555575429433. [DOI] [PubMed] [Google Scholar]
- 8.Scott IR, Harding CR. Filaggrin breakdown to water binding compounds during development of the rat stratum corneum is controlled by the water activity of the environment. Dev Biol. 1986;115:84–92. doi: 10.1016/0012-1606(86)90230-7. [DOI] [PubMed] [Google Scholar]
- 9.Ye L, Wang Z, Li Z, Lv C, Man MQ. Validation of GPSkin Barrier® for assessing epidermal permeability barrier function and stratum corneum hydration in humans. Skin Res Technol. 2019;25:25–29. doi: 10.1111/srt.12590. [DOI] [PubMed] [Google Scholar]
- 10.Grinich EE, Shah AV, Simpson EL. Validation of a novel smartphone application-enabled, patient-operated skin barrier device. Skin Res Technol. 2019;25:612–617. doi: 10.1111/srt.12692. [DOI] [PubMed] [Google Scholar]
- 11.Berents TL, Lødrup Carlsen KC, Mowinckel P, Skjerven HO, Rolfsjord LB, Bradley M, et al. Transepidermal water loss in infancy associated with atopic eczema at 2 years of age: a population-based cohort study. Br J Dermatol. 2017;177:e35–e37. doi: 10.1111/bjd.15157. [DOI] [PubMed] [Google Scholar]
- 12.Horimukai K, Morita K, Narita M, Kondo M, Kabashima S, Inoue E, et al. Transepidermal water loss measurement during infancy can predict the subsequent development of atopic dermatitis regardless of filaggrin mutations. Allergol Int. 2016;65:103–108. doi: 10.1016/j.alit.2015.09.004. [DOI] [PubMed] [Google Scholar]
- 13.Logger JGM, Driessen RJB, de Jong EMGJ, van Erp PEJ. Value of GPSkin for the measurement of skin barrier impairment and for monitoring of rosacea treatment in daily practice. Skin Res Technol. 2021;27:15–23. doi: 10.1111/srt.12900. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Williams HC, Burney PG, Pembroke AC, Hay RJ. The U.K. working party’s diagnostic criteria for atopic dermatitis. III. Independent hospital validation. Br J Dermatol. 1994;131:406–416. doi: 10.1111/j.1365-2133.1994.tb08532.x. [DOI] [PubMed] [Google Scholar]
- 15.Flohr C, England K, Radulovic S, McLean WH, Campbel LE, Barker J, et al. Filaggrin loss-of-function mutations are associated with early-onset eczema, eczema severity and transepidermal water loss at 3 months of age. Br J Dermatol. 2010;163:1333–1336. doi: 10.1111/j.1365-2133.2010.10068.x. [DOI] [PubMed] [Google Scholar]
- 16.Darlenski R, Mihaylova V, Handjieva-Darlenska T. The link between obesity and the skin. Front Nutr. 2022;9:855573. doi: 10.3389/fnut.2022.855573. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Zhu T, Zhao J, Qu Y, Zhang L, Mu D. Association of very preterm birth with decreased risk of eczema: a systematic review and meta-analysis. J Am Acad Dermatol. 2018;78:1142–1148.e8. doi: 10.1016/j.jaad.2017.12.015. [DOI] [PubMed] [Google Scholar]
- 18.Kowalik A, Cichocka-Jarosz E, Kwinta P. Atopic dermatitis and gestational age - is there an association between them? A review of the literature and an analysis of pathology. Postepy Dermatol Alergol. 2023;40:341–349. doi: 10.5114/ada.2023.128999. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Visscher MO, Adam R, Brink S, Odio M. Newborn infant skin: physiology, development, and care. Clin Dermatol. 2015;33:271–280. doi: 10.1016/j.clindermatol.2014.12.003. [DOI] [PubMed] [Google Scholar]
- 20.Mathanda TR, M Bhat R, Hegde P, Anand S. Transepidermal water loss in neonates: baseline values using a closed-chamber system. Pediatr Dermatol. 2016;33:33–37. doi: 10.1111/pde.12704. [DOI] [PubMed] [Google Scholar]
- 21.Korhonen P, Haataja P, Ojala R, Hirvonen M, Korppi M, Paassilta M, et al. Asthma and atopic dermatitis after early-, late-, and post-term birth. Pediatr Pulmonol. 2018;53:269–277. doi: 10.1002/ppul.23942. [DOI] [PubMed] [Google Scholar]
- 22.Scharschmidt TC, Vasquez KS, Truong HA, Gearty SV, Pauli ML, Nosbaum A, et al. A wave of regulatory T cells into neonatal skin mediates tolerance to commensal microbes. Immunity. 2015;43:1011–1021. doi: 10.1016/j.immuni.2015.10.016. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Goedicke-Fritz S, Härtel C, Krasteva-Christ G, Kopp MV, Meyer S, Zemlin M. Preterm birth affects the risk of developing immune-mediated diseases. Front Immunol. 2017;8:1266. doi: 10.3389/fimmu.2017.01266. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Chalmers JR, Haines RH, Bradshaw LE, Montgomery AA, Thomas KS, Brown SJ, et al. Daily emollient during infancy for prevention of eczema: the BEEP randomised controlled trial. Lancet. 2020;395:962–972. doi: 10.1016/S0140-6736(19)32984-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Skjerven HO, Lie A, Vettukattil R, Rehbinder EM, LeBlanc M, Asarnoj A, et al. Early food intervention and skin emollients to prevent food allergy in young children (PreventADALL): a factorial, multicentre, cluster-randomised trial. Lancet. 2022;399:2398–2411. doi: 10.1016/S0140-6736(22)00687-0. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Summary and comparison of the results of some prior studies
Kaplan-Meier curve for diagnosis of atopic dermatitis stratified by high TEWL and low TEWL levels.