Prevention of diaper dermatitis in infants--a literature review.

Diaper dermatitis (DD) is one of the most common skin conditions in neonates and infants, with a peak between the ages of 9 and 12 months. Appropriate skin care practices that support skin barrier function and protect the buttocks skin from urine and feces are supposed to be effective in the prevention of DD. Despite many recommendations for parents and caregivers on proper diaper skin care, there is no up-to-date synthesis of the available evidence to develop recommendations for DD prevention practice. Therefore we performed a systematic literature review on the efficacy of nonmedical skin care practices on the diapered area of healthy, full-term infants ages 0 to 24 months. We identified 13 studies covering skin care practices such as cleansing, bathing, and application of topical products. DD prevalence and incidence and physiologic skin parameters were used as efficacy parameters. The results of this review indicate that cleansing of the diaper area using baby wipes or water and a washcloth have comparable effects on diapered skin. Bathing with a liquid baby cleanser twice weekly seems comparable with water alone. The application of ointments containing zinc oxide or petrolatum with or without vitamin A seems to have comparable effects on DD severity. There seems to be no information on whether single skin care practices such as cleansing, bathing, and application of topical preparations can prevent DD. High-quality randomized clinical trials are needed to show the effectiveness of skin care practices for controlling and preventing DD.

Skin care practices for newborns and infants: review of the clinical evidence for best practices.

In recent years, there have been continuing efforts to understand the effects of baby skin care routines and products on the healthy development of baby skin. Such efforts aim ultimately to determine the best infant skin care practices. The pediatric and dermatologic communities have not reached consensus on what constitutes an appropriate cleansing practice. In the United States, guidelines for neonatal skin care have been developed, propagated, and implemented. The accumulated knowledge has promoted evidence-based clinical practices and, therefore, may help to improve clinical outcomes, although these guidelines primarily cover the care of preterm newborns and the treatment of those with other health problems. High-level, long-term clinical evidence of the effective and safe cleansing of healthy, full-term newborns and infants is scarce. This review presents a comprehensive analysis of the scientific literature on baby skin development, cleansing practices, and related products (for healthy newborns and babies) since 1970. The evidence drawn from the reviewed literature can be summarized as follows: Bathing immersed in water seems generally superior to washing alone. Bathing or washing with synthetic detergents (syndets) or mild liquid baby cleansers seems comparable with or even superior to water alone. Nevertheless, larger randomized clinical trials with age-defined cohorts of babies as well as more-defined parameters are required to identify optimal practices and products for skin cleansing of healthy infants. These parameters may include standardized skin function parameters such as transepidermal water loss, stratum corneum hydration, skin surface pH, and sebum production. Clinical skin scores such as the Neonatal Skin Condition Score may be employed as outcome measures.

Lipid uptake and skin occlusion following topical application of oils on adult and infant skin.

BACKGROUND: Topical application of oils and oil-based formulations is common practice in skin care for both adults and infants. Only limited knowledge however is available regarding skin penetration and occlusive potential of oils and common methods for measuring skin moisturization fall short when it comes to the moisturizing effect of oils. OBJECTIVE: In this study we used in vivo confocal Raman microspectroscopy to test the efficacy of paraffin oil (mineral oil) and two vegetable oils in terms of skin penetration and occlusion. Petrolatum was used as a positive control. METHODS: The products were applied topically on the forearms of nine volunteers and seven infants and Raman spectra were acquired before and at 30 and 90 min following application. Depth concentration profiles for lipid and water were calculated from the Raman spectra. Skin occlusion was assessed from the amount of stratum corneum (SC) swelling measured from the water concentration profiles. RESULTS: The paraffin oil and the vegetable oils penetrate the top layers of the SC with similar concentration profiles, a result that was confirmed both for adult and infant skin. The three oils tested demonstrated modest SC swelling (10-20%) compared to moderate swelling (40-60%) for petrolatum. CONCLUSION: These data indicate that there is no statistical difference between the paraffin oil and vegetable oils in terms of skin penetration and skin occlusion. The results for petrolatum show that in vivo confocal Raman microspectroscopy is sensitive and specific enough to measure both lipid uptake and skin occlusion events following topical application.