Published online June 22, 2007
PEDIATRICS Vol. 119 No. 3 March 2007, pp. e716-e723 (doi:10.1542/peds.2006-0893)
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ARTICLE

Early-Life Risk Factors for Occurrence of Atopic Dermatitis During the First Year

Mikio Sugiyama, MDa, Hirokazu Arakawa, MD, PhDa, Kiyoshi Ozawa, MD, PhDb, Takahisa Mizuno, MDa, Hiroyuki Mochizuki, MD, PhDa, Kenichi Tokuyama, MD, PhDa and Akihiro Morikawa, MD, PhDa

a Department of Pediatrics and Developmental Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
b Ozawa Obstetric Clinic, Gunma, Japan

OBJECTIVE. In a prospective birth cohort study, we sought to identify perinatal predictors of the occurrence of atopic dermatitis in the first year of life.

METHODS. Associations of family history, infection during pregnancy, cord blood cytokine concentrations, and skin function parameters with atopic dermatitis were analyzed. Stratum corneum hydration was measured with an impedance meter until 5 days after delivery and again at 1 month.

RESULTS. Complete data were obtained for 213 infants, including 27 diagnosed by a physician as having atopic dermatitis during their first year and 26 diagnosed as having infantile eczema during their first month. The risk of atopic dermatitis during the first year of life was related to maternal atopic dermatitis, lower concentrations of macrophage inflammatory protein-1β in cord blood, and greater skin moisture in the surface and stratum corneum of the forehead and cheek at 1 month of age but not to viral or bacterial infection during pregnancy or breastfeeding. Paternal hay fever was associated negatively with the development of atopic dermatitis. High concentrations of interleukin-5, interleukin-17, and macrophage chemotactic protein-1 and only surface moisture in the cheek were associated with greater risk of infantile eczema in the first month.

CONCLUSIONS. The association of atopic dermatitis in infancy with reduced neonatal macrophage inflammatory protein-1β levels suggests a link with immature immune responses at birth. Stratum corneum barrier disruption in atopic dermatitis may involve impairment of cutaneous adaptation to extrauterine life. The majority of risk factors had different effects on infant eczema and atopic dermatitis, indicating different causes.

Key Words: atopic dermatitis • skin physiology • cytokine • chemokine • infantile eczema

Abbreviations: AD—atopic dermatitis • IL—interleukin • TNF—tumor necrosis factor • IFN—interferon • MCP—monocyte chemotactic protein • MIP—macrophage inflammatory protein • OR—odds ratio • CI—confidence interval • Th—T helper

Accepted Sep 22, 2006.