## 6 Effect of Emollients on the Prevention of AD among Newborns and Children  
Currently, we can distinguish three strategies in the prevention of atopic dermatitis: primary, secondary and tertiary prevention [23; 100]. According to the recommendations of the Polish Dermatological Society, primary prophylaxis includes children at high risk but without disease symptoms. It involves prolonged breastfeeding (up to 4-6 months of age), limiting exposure to airborne allergens and using emollients from the first day of life [100]. Secondary prophylaxis of AD, on the other hand, applies to patients with fairly early symptoms of the disease, but without its advancement. It involves the introduction of appropriate care of the skin covered with lesions (use of emollients every 4-6 h) and avoidance of irritants, as well as elimination of allergens that exacerbate symptoms. And tertiary prevention, which applies to full-blown patients, focuses on reducing the severity of symptoms, preventing recurrence and the development of other allergic diseases. It is based on psychological counseling and patient education. Tertiary prophylaxis also includes the use of antihistamines and specific immunotherapy, which is used to prevent the development of symptoms from other organs [19; 23; 100; 101]. More recently, emollients have been recommended for the prevention of primary atopic dermatitis in newborns. There are randomized trials that showed a 32% and 50% reduction in the risk of atopic dermatitis with regular use of emollients from birth in newborns with risk factors [24; 25]. One study analyzed the effect of using emollients on improving the skin barrier and skin microbiota in 6-month-old infants with a positive family history of AD. According to the authors [28], reduced skin pH and increased Streptococcus salivarius in the skin microbiota after long-term use of emollients may have a preventive effect on the development of AD in children. The acidic pH of the skin counteracts the bacterial dysbiosis of the skin characteristic of atopic dermatitis [28]. Streptococcus salivarius strains have been shown to reduce the production of pro-inflammatory cytokines and chemokines interleukin-6 and interleukin-1 and -8 [28; 102; 103]. They also reduce TNF-alpha production in in vitro epithelial assays. _S. salivarius_ stimulates TH1 lymphocytes and antagonizes TH2, and it is for this reason that its increased participation on the skin surface reduces inflammation initiated by TH2 lymphocytes in atopic dermatitis [28; 102; 103]. The Barrier Enhancement for Eczema Prevention study evaluated the impact of daily use of emollients during a child's first year of life [104]. The study included 1394 infants with risk factors for developing AD. They were randomly divided into a group using emollients and a control group without the use of emollients [104]. According to the authors of the above study, the diagnosis of AD was made in 31% of infants in the group using emollients prophylactically and 28% of infants in the control group. Atopic dermatitis was diagnosed in these children between 12 and 60 months of age. The incidence of atopic dermatitis between the groups was thus comparable, and daily use of emollients in the first year of life did not significantly prevent the development of the disease. Similar results were obtained in a population-based study conducted at Oslo University Hospital and Ostfold Hospital Trust in Oslo and Karolinska University Hospital in Stockholm, which included 2397 newborns born between 2015 and 2017 [105]. They were assigned to four groups: a control group without skin care with infant feeding guidelines maintained, a group using skin softeners, a food intervention group (supplementing feeding with peanuts, cow's milk, wheat and eggs) and a final group that combined skin and food interventions.