Eight weeks of newborn emollient: less eczema at five years, but the margin is thin

Design

Single-centre randomised trial, blinded five-year follow-up (STOP-AD)

Population

177 children born at term at high risk of atopic dermatitis

Primary outcome

Point prevalence of atopic dermatitis at 5 years

Effect

12.3% vs 24.0%; RR 0.52 (95% CI 0.26 to 1.02)

STOP-AD was a single-centre randomised trial in term infants at high risk of atopic dermatitis. Babies were assigned within four days of birth to twice-daily whole-body emollient for eight weeks or routine skin care. This report is the blinded five-year follow-up of 177 children.

At five years, atopic dermatitis was present in 12.3% of the emollient group and 24.0% of controls (risk ratio 0.52, 95% CI 0.26 to 1.02). Among children with eczema, severity was also lower. After multiple imputation for missing children, the effect was similar but no longer significant (odds ratio 0.45, 0.19 to 1.03).

Larger trials of emollients for prevention have been inconsistent, and some found no benefit. This result keeps the question open rather than settling it. For a high-risk family who wish to try a simple emollient early, it is a reasonable, low-cost discussion; it is not a reason to recommend routine emollients to all newborns.

• Discuss early emollient use with families who have a strong history of atopy.
• Use a simple, fragrance-free emollient if parents choose to try it.
• Do not recommend emollients routinely for all newborns on this evidence.
• Explain that the five-year result was borderline and based on a small trial.

Why it matters

Parents want something they can do; this is cheap and safe, but not proven.

Don't overread it

Borderline significance, single centre and attrition; larger trials have been mixed.

The statistics, in plain English

A risk ratio of 0.52 suggests about half the eczema, but the interval reaches 1.02, meaning no effect is still possible. Losing children to follow-up adds uncertainty; the imputed analysis, which accounts for that, did not reach significance.

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