近日，英国诺丁汉大学Hywel C Williams及其研究小组对婴儿每日使用润肤剂来预防湿疹的疗效进行了观察。该项研究成果发表在2020年2月19日出版的《柳叶刀》上。

湿疹出现前先发生皮肤屏障功能障碍。研究组测试了出生第一年每天使用润肤剂预防高危儿童湿疹的疗效。

研究组在英国的12家医院和4个初级保健点进行了一项多中心、务实、平行分组的随机对照试验。2014年11月19日至2016年11月18日，通过产前或产后服务与家人联系，研究组招募了1394例湿疹高风险的足月婴儿。将其按1：1随机分组，其中693例接受每天涂抹润肤剂+标准皮肤护理建议（润肤剂组），701例仅接受标准皮肤护理建议（对照组）。

在数据完整的患儿中，润肤剂组在3个月时的依从性为88%，6个月时为82%，12个月时为74%。2岁时，润肤剂组598例婴儿中发生139例（23%）湿疹，对照组612例婴儿中发生150例（25%），差异不显著。润肤剂组每名幼儿在第一年平均皮肤感染0.23次，对照组为0.15次，校正发病率比率为1.55。

总之，高危儿童在出生第一年每天使用润肤剂非但不能预防湿疹，还增加了皮肤感染的风险。该研究表明，对于家族中有湿疹、哮喘或过敏性鼻炎的新生儿不应尝试每天涂抹润肤剂来预防湿疹。

附：英文原文

Title: Daily emollient during infancy for prevention of eczema: the BEEP randomised controlled trial

Author: Joanne R Chalmers, Rachel H Haines, Lucy E Bradshaw, Alan A Montgomery, Kim S Thomas, Sara J Brown, Matthew J Ridd, Sandra Lawton, Eric L Simpson, Michael J Cork, Tracey H Sach, Carsten Flohr, Eleanor J Mitchell, Richard Swinden, Stella Tarr, Susan Davies-Jones, Nicola Jay, Maeve M Kelleher, Michael R Perkin, Robert J Boyle, Hywel C Williams

Issue&Volume: 2020-02-19

Abstract: BackgroundSkin barrier dysfunction precedes eczema development. We tested whether daily use of emollient in the first year could prevent eczema in high-risk children.MethodsWe did a multicentre, pragmatic, parallel-group, randomised controlled trial in 12 hospitals and four primary care sites across the UK. Families were approached via antenatal or postnatal services for recruitment of term infants (at least 37 weeks' gestation) at high risk of developing eczema (ie, at least one first-degree relative with parent-reported eczema, allergic rhinitis, or asthma, diagnosed by a doctor). Term newborns with a family history of atopic disease were randomly assigned (1:1) to application of emollient daily (either Diprobase cream or DoubleBase gel) for the first year plus standard skin-care advice (emollient group) or standard skin-care advice only (control group). The randomisation schedule was created using computer-generated code (stratified by recruiting centre and number of first-degree relatives with atopic disease) and participants were assigned to groups using an internet-based randomisation system. The primary outcome was eczema at age 2 years (defined by UK working party criteria) with analysis as randomised regardless of adherence to allocation for participants with outcome data collected, and adjusting for stratification variables. This trial is registered with ISRCTN, ISRCTN21528841. Data collection for long-term follow-up is ongoing, but the trial is closed to recruitment.Findings1394 newborns were randomly assigned to study groups between Nov 19, 2014, and Nov 18, 2016; 693 were assigned to the emollient group and 701 to the control group. Adherence in the emollient group was 88% (466 of 532) at 3 months, 82% (427 of 519) at 6 months, and 74% (375 of 506) at 12 months in those with complete questionnaire data. At age 2 years, eczema was present in 139 (23%) of 598 infants with outcome data collected in the emollient group and 150 (25%) of 612 infants in the control group (adjusted relative risk 0·95 [95% CI 0·78 to 1·16], p=0·61; adjusted risk difference –1·2% [–5·9 to 3·6]). Other eczema definitions supported the results of the primary analysis. Mean number of skin infections per child in year 1 was 0·23 (SD 0·68) in the emollient group versus 0·15 (0·46) in the control group; adjusted incidence rate ratio 1·55 (95% CI 1·15 to 2·09).InterpretationWe found no evidence that daily emollient during the first year of life prevents eczema in high-risk children and some evidence to suggest an increased risk of skin infections. Our study shows that families with eczema, asthma, or allergic rhinitis should not use daily emollients to try and prevent eczema in their newborn.

DOI: 10.1016/S0140-6736(19)32984-8

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32984-8/fulltext