Dynamic Trends in Skin Barrier Function From Birth to Age 6 Months and Infantile Atopic Dermatitis: A Chinese Prospective Cohort Study

Abstract BackgroundSkin barrier functions develop after birth and may be related to skin disorders in infants. ObjectivesWe aimed to assess associations between dynamic trends of four skin barrier functional parameters in early life with infant atopic dermatitis (AD).MethodsBased on the prospective cohort MKNFOAD (NCT02889081), we examined transepidermal water loss (TEWL), stratum corneum hydration (SCH), skin pH, and sebum content at five anatomical sites (cheek, forehead, forearm, abdomen, and lower leg) in 418 term infants at birth, 42 days, and 6 months. Trend differences by sex and association with AD at age 1 year were tested using variance analyses. Associations of the parameters with AD risk were tested using discrete time survival analysis, adjusting extensive covariates including parental history of allergy, infant’s sex, birth weight (kg), and delivery mode. Odds ratios (ORs) and 95% confidence interval (CIs) were reported.ResultsOverall TEWL and SCH appeared trends of increase while skin surface pH and sebum content showed trends of decrease within the first 6 postnatal months. Sex differences were significant for sebum content only (p<0.001). After adjustment for parental and children covariates, cheek TEWL (OR=1.26, 95% CI 1.00–1.57, p=0.045) at birth and 42 days (OR=1.52, 95% CI 1.17–1.97, p=0.002) were significantly associated with increased AD risk. Associations were not observed between SCH, skin pH, and sebum content at birth or 42 days with AD. ConclusionsSkin barrier functions of Chinese term infants varied nonlinearly after birth. Higher postnatal TEWL levels in early life indicate higher risk of early-onset AD.