Researchers have found new evidence that atopic eczema develops before birth and is linked to a child’s growth in the womb and shortly after birth, according to a new study being presented at the British Association of Dermatologists’ Annual Meeting in Edinburgh (3rd-5th July 2018).

The study found that infants with eczema demonstrated altered patterns of growth during pregnancy, including impairment in growth of length starting in early pregnancy, prior to eczema becoming evident. The findings suggest that growth is impaired prior to the start of the disease process and its treatment, and that there are important influences acting during pregnancy on this common skin condition.

Within the Southampton Women’s Survey, a mother-offspring study, 1759 infants had serial measurements of their length, head and abdominal circumference during pregnancy at 11, 19 and 34 weeks, at birth, and at ages 6 and 12 months, and were assessed for eczema at ages 6 and/or 12 months.

Evidence of faltering growth in length from 11 weeks’ of pregnancy and shorter femur length, smaller abdominal circumference and a higher head to abdominal circumference ratio at 34 weeks’ gestation were associated with 20% or greater increased risks of eczema at age 6 months. Infants who had had a larger head circumference in early pregnancy and a declining abdominal growth velocity from 19 to 34 weeks of pregnancy had a 33% greater likelihood of eczema at age 12 months.

One possible explanation for these findings is “brain sparing” responses where the growth of the head and brain takes priority over the growth of the rest of the body. One organ that could be affected is the thymus, which is important in regulating the immune system, and this could result in an imbalance in immune cells and chemicals producing the inflammatory response seen in atopic eczema.

Dr Sarah El-Heis, the study’s lead researcher from the University of Southampton and the MRC Lifecourse Epidemiology Unit, said:

“Infants with eczema have an increased risk of impaired growth, which is a clinical concern that underpins recommendations to monitor growth in all infants with eczema. A number of reasons for the impaired growth have been proposed and include effects of the inflammatory process, topical corticosteroid treatment or an inappropriately restrictive diet. However, we have shown that infants with eczema at age 6 and 12 months have altered growth patterns before they are born and before eczema becomes evident, suggesting that there are important influences acting during pregnancy.”

Nina Goad, of the British Association of Dermatologists, said:

“Research into this common disorder has taken some interesting turns in recent years, with discoveries relating to birthweight, maternal socioeconomic status and even maternal mood during pregnancy impacting on risk factors. What is becoming clear is that there is no one, simple answer to why some babies develop eczema, and instead there is a complex interplay of factors, some of which are genetic and some of which are environmental. This study provides more data to help scientists explore the possible causes and how they may relate to one another.”

Atopic eczema is a very common skin condition due to skin inflammation. It may start at any age but the onset is often in childhood. One in every five children in the UK is affected by eczema at some stage. It may also start later in life in people who did not have eczema as a child.

The term ‘atopic’ is used to describe a group of conditions, which include asthma, eczema and hay-fever and food allergy. These conditions are all linked by an increased activity of the allergy side of the body’s immune system. ‘Eczema’ is a term which comes from the Greek word ‘to boil’ and is used to describe red, dry, itchy skin which can sometimes become weeping, blistered, crusted, scaling and thickened.

For more information on eczema, see the British Association of Dermatologists’ Patient Information Leaflet.

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Notes to editors:

If using this study, please ensure you mention that the study was released at the British Association of Dermatologists’ Annual Conference.

The conference will be held at the Edinburgh EICC from July 3rd to 5th and is attended by approximately 1,300 UK and worldwide dermatologists.

For more information please contact the media team: comms@bad.org.uk, 0207 391 6084. Website: www.bad.org.uk.

About us:
The British Association of Dermatologists is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease. For further information about the charity, visit www.bad.org.uk

The Medical Research Council (MRC) is at the forefront of scientific discovery to improve human health. Founded in 1913 to tackle tuberculosis, the MRC now invests taxpayers’ money in some of the best medical research in the world across every area of health. Thirty-two MRC-funded researchers have won Nobel prizes in a wide range of disciplines, and MRC scientists have been behind such diverse discoveries as vitamins, the structure of DNA and the link between smoking and cancer, as well as achievements such as pioneering the use of randomised controlled trials, the invention of MRI scanning, and the development of a group of antibodies used in the making of some of the most successful drugs ever developed. Today, MRC-funded scientists tackle some of the greatest health problems facing humanity in the 21st century, from the rising tide of chronic diseases associated with ageing to the threats posed by rapidly mutating micro-organisms. The Medical Research Council is part of UK Research and Innovation. https://mrc.ukri.org/

Developmental influences and the risk of atopic eczema during infancy.
S. El-Heis,1 S. Crozier,1 E. Healy,2 S. Robinson,1,3 N. Harvey,1,3 J. Baird,1,3 H. Inskip,1,3 C. Cooper1,3,4 and K. Godfrey1,3,5
1MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, U.K, 2Dermatopharmacology, Faculty of Medicine, University of Southampton, Southampton, U.K., 3NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, U.K., 4NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, U.K. and 5Institute of Developmental Sciences, University of Southampton, Southampton, U.K.

Evidence that atopic eczema partly originates in utero is increasing, where genetic predisposition and environmental exposures act together in determining the risk of developing this multifactorial condition. This research examined early life developmental influences on infantile atopic eczema at ages 6 and 12 months. In the well-characterized preconception Southampton Women’s Survey mother–offspring cohort, infantile atopic eczema was ascertained by trained research staff using modified U.K. Working Party Criteria for the Definition of Atopic Dermatitis.

In cohort subsamples, data were available that enabled analyses of maternal stress and low mood (n = 3008), maternal serum nicotinamide and related tryptophan metabolite concentrations (n = 497), and fetal/infant growth patterns (n = 1759) in relation to infantile eczema. Maternal preconception perceived stress affecting health [OR 1.21 (95% CI 1.08–1.35), P = 0.001] and stress in daily living [OR 1.16 (1.03–1.30), P = 0.014] were associated with an increased risk of offspring atopic eczema age 12 months; this was independent of maternal postpartum mood and stress. Infants whose mothers had higher levels of nicotinamide during pregnancy had a lower risk of eczema at age 12 months [OR 0.69 (0.53–0.91) per SD change, P = 0.007]; findings were similar for the related metabolite anthranilic acid [OR 0.63 (0.48–0.83), P = 0.001]. Fetal and infant linear, head and abdominal size and growth velocity standard deviation scores were derived from anthropometric measurements at 11, 19 and 34 weeks’ gestation, birth and ages 6 and 12 months. Shorter femur length, smaller abdominal circumference and higher head to abdominal circumference ratio at 34 weeks’ gestation were associated with increased risks of eczema at age 6 months (eczema odds ratio per standard deviation (OR/SD) increase 0.81 (0.69–0.96), P = 0.017; 0.78 (0.65–0.93), P = 0.006; 1.37, (1.15–1.63), P = 0.001, respectively). A lower velocity of linear growth from 11 weeks’ gestation to birth was associated with eczema age 6 months (0.80 (0.65–0.98), P = 0.034).

Infants with atopic eczema age 12 months had a larger head circumference in early gestation and faltering of abdominal growth velocity from 19 to 34 weeks’ gestation (0.67 (0.51–0.88), P = 0.003). The findings demonstrate impacts of maternal psychological well-being and micronutrient status on infantile atopic eczema. The impaired linear growth of infants with atopic eczema was shown to commence in utero, prior to the clinical onset of the condition. The findings provide new evidence that atopic eczema partly originates during prenatal development, and point to potential interventions to optimize maternal health beginning prior to conception to ultimately reduce the risk of infantile atopic eczema. Conflict of interest: KMG has received reimbursement for speaking at conferences sponsored by companies selling nutritional products and is part of an academic consortium that has received research funding from Abbott Nutrition, Nestec and Danone.