## 6 Effect of Emollients on the Prevention of AD among Newborns and Children
As it turned out, AD was diagnosed in 8% of infants in the group with no skin or nutritional interventions, 11% of infants in the group that used emollients, 9% in the group that used supplemental feeding, and 5% in the group that combined skin and nutritional interventions. Thus, the introduction of emollients and appropriate supplemental nutrition did not reduce the development of atopic dermatitis for the infants studied. Recommendations in the Use of Emollients in Atopic Dermatitis and Their Synergism with Other Behaviors and Therapies  
Referring to the recommendations of dermatological societies in Europe (EADV, ET-FAD) and in the United States (American Academy of Dermatology), it should be noted that they recommend the use of emollients in mild AD during periods of remission, while during exacerbations they indicate combining them with topical corticosteroids or calcineurin inhibitors [1]. The European Task Force on Atopic Dermatitis (ETFAD) recommends using large amounts of emollients in patients with AD--namely, a minimum of 30 g/day or 1 kg/month for an adult [24]. According to the European Academy of Dermatology and Venereology (EADV), on the other hand, the correct amount of emollient used per skin surface in children should be 150-200 g per week, while in adults it should be 500 g [1; 106]. The authors of [23] do not recommend applying too many emollients to the skin, as a high frequency and large amounts can cause folliculitis or childhood seborrheic dermatitis. Also important in the application of emollients to the skin is the method of application, namely with clockwise circular motions [23]. Yet, in the context of the prevention of atopic dermatitis in newborns and children, the American College of Allergy, Asthma and Immunology says that further research is needed to evaluate the effect of emollients on the prevention of atopic dermatitis in newborns, as well as to determine whether the type of emollient applied, frequency, duration and age are relevant to the prevention of atopic dermatitis [107]. A similar position is represented by the European Task Force on Atopic Dermatitis, which does not provide recommendations for primary prevention of AD, as the quality and quantity of data in this area is not satisfactory [24]. The American Academy of Pediatrics recommends a skin care regimen based on the use of fragrance-free emollients after bathing [14]. The authors of [14] note that bathing in patients with AD can be carried out in lukewarm water for 10 to 15 min every 2 or 3 days. One randomized study evaluated the effect of bathing frequency on the severity of AD symptoms among 28 children (between 6 months and 10 years of age) [108]. Symptom improvement was measured using the SCORAD scale. As it turned out, bathing frequency had no significant effect on the course of AD. ETFAD recommends regular baths or showers in lukewarm 34-37 \({}^{\circ}\)C water from two to seven times a week using mild surfactants, and the preferred products should be galenic forms--syndets or emollients for washing based on softening oils. Bath emollients usually contain paraffin and synthetic fatty acid esters such as isopropyl myristate. These ingredients lubricate and soften the epidermis. At the same time, they are lightweight and allow oxygen and water exchange in the skin [18; 18; 24; 109; 110]. Sometimes emollients in the form of lotions, creams or cleansing products may contain antimicrobial ingredients (such as chlorhexidine) to limit the development of bacterial superinfections in AD [24; 109; 110]. Studies have proven that the use of harsh detergents and alkaline soaps adversely affected the skin lesions of patients with AD [23; 24]. The ban on the use of soaps in atopic dermatitis is called the \"Scholtz procedure\" in the United States [18]. According to the authors of [111], it is extremely important to educate AD patients about skin care management especially in the context of children with atopic dermatitis.