Some newborn babies have a defective skin barrier before they get eczema
Data published today from BASELINE (Ireland’s first prospective birth cohort study) in the Journal of Allergy and Clinical Immunology, the world’s highest ranked allergy journal.
Eczema is the most common chronic skin condition in children and adults, affecting all aspects of a person’s life, including sleeping, eating, playing, swimming and socializing, and is also associated with altered mental health in adults. Medical care of eczema is estimated to cost up to $3.4 billion dollars per annum in the United States.
10% of Irish people carry a mutation in the gene most commonly associated with eczema, FLG, which codes the expression of a protein called filaggrin. Low filaggrin expression in the skin is the hallmark of eczema, and causes defects in skin barrier function, making eczema more severe and skin infections and allergies more common.
The BASELINE Allergy study group led by Professor Jonathan Hourihane and Research Fellow Dr Maeve Kelleher (both UCC) and Professor Alan Irvine (TCD) measured water evaporation in the skin of 1903 newborn babies in Cork University Hospital, and followed them up until 12 months of age. Infants who had a high value for this transepidermal water loss (TEWL) and a combination of a filaggrin mutation and allergic parents were seven times more likely to have eczema at 12 months, despite having no visible skin barrier defect or eczema at the time of measurement before they left the maternity hospital.
Professor Hourihane says: “This is the largest set of neonatal skin barrier assessments ever performed, performed just after birth, several weeks earlier than any similar and smaller studies. This association of a neonatal skin barrier defect, present in some but not all children, offers hope that an intervention in this time period could prevent eczema developing in these highest-risk children targeted for a simple intervention with moisturisers to protect their skin barrier. It was also fascinating to find that low TEWL readings after birth appeared to be protective for eczema at 12 months, so there might be a double-edged benefit for using this test more routinely. Prevention of eczema may also prevent the development of asthma and food allergy, which are strongly associated with eczema because the allergens get through the broken skin and cause the development of allergies. This may add to the growing strategies to prevent these common and occasionally serious and fatal illnesses such as asthma and food allergy. More trials will be needed on the basis of this unique finding in Irish children.”