It is unknown whether skin biomarkers collected in infancy can predict the onset of atopic dermatitis (AD), and be used in future prevention trials to identify children at risk. We sought to examine whether skin biomarkers can predict atopic dermatitis during the first 2 years of life. 300 term and 150 preterm children were enrolled at birth and followed for AD until the age of 2 years. Skin tape strips were collected at 0-3 days and 2 months of age and analyzed for selected immune and barrier

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... iomarkers. Hazard ratio (HR) with 95% confidence interval (CI) using Cox-regression was calculated for the risk of AD. The 2-year prevalence of AD was 34.6% (99/286) and 21.2% (25/118) among term and preterm children, respectively. Skin biomarkers collected at birth did not predict AD. Elevated TARC/CCL17-levels collected at 2 months of age increased the overall risk of AD (HR 2.11; 95% CI 1.36-3.26; P=0.0008) and moderate-to-severe AD (HR 4.97; 95% CI 2.09-11.80; P=0.0003). Interleukin (IL)-8 and IL-18 predicted moderate-to-severe AD. Low filaggrin degradation product levels increased the risk of AD (HR 2.04; 95% CI 1.32-3.15; P=0.001). Elevated biomarker levels at 2 months predicted AD at other skin sites and many months after collection. This study showed that non-invasively collected skin biomarkers of barrier and immune pathways can precede the onset of AD.