Infant skin care: prevention of diaper dermatitis

Skin care in children has been a problem exercising the minds of both parents and doctors from the moment of birth. Why are they so interested in knowing about the infant skin and care for it? Consideration must be given to the anatomical and physiological features of the newborn skin structure and differences from the adult skin structure. Its weight accounts for 10–13% of the newborn body weight as compared to 3% of the adult body weight. Anatomical maturity only partially correlates with functional maturity, these differences concern both barrier function and thermoregulation. The epidermis in newborns and infants is much thinner, looser, the layers are underdeveloped. The epidermal basement membrane connecting the epidermis and the dermis is made up of four poorly differentiated sublayers, the cells are of small size, the number of desmosomes  at the cell-cell  junctions is also much lower, which results in the unstable connection between the epidermis and the dermis. These distinctive features explain the difference in the newborn skin care, the choice of care products, the prevention of various pathological conditions, and even the subtleties of treatment. The variety of skin care products for newborns, the difference in composition and different dosage forms can cause confusion in young parents, and improper use of such products and various disturbing factors can lead to impairment of the normal state and function of the skin. And as a consequence of this, various pathological conditions may develop that already require active and even long-term treatment. The purpose of this article is to give the reader a brief picture of the anatomical and functional features of the skin structure, any changes developing in the postnatal period, and the need for the use of skin care products. It provides the skincare rules, compliance with which will not lead to the opposite effect.

1. Gorlanov I.A., Leina L.M., Milyavskaya I.R. Skin of newborns: differential diagnosis of pathological conditions and care. Meditsinskiy Sovet = Medical Council. 2013;(2-3):41-49 (In Russ.) doi: 10.21518/2079-701X-2013-2-3-41-49.

2. Ryumina I.I., Zubkov V.V. Newborn skin care. Meditsinskiy sovet = Medical Council. 2017;(9):32-37. (In Russ.) doi: 10.21518/2079-701X-2017-9-32-37.

3. Marchini G., Lindow S., Brismar H., Stabi B., Berggren V., Ulfgren A.K. et al. The newborn infant is protected by an innate antimicrobial barrier: peptide antibiotics are present in the skin and vernix caseosa. Br J Dermatol. 2002;147(6):1127-1134. doi: 10.1046/j.1365-2133.2002.05014.x.

4. Ivanova N.A. Kostrakina L.N. The experience of using bepanthen and bepanthen plus in the treatment of atopic dermatitis in children. Consilium medicum. Pediatrics. 2005;(1):39-41. (In Russ.) Available at: https://con-med.ru/mag-azines/pediatry/pediatry-01-2005/opyt_prime-neniya_bepantena_i_bepantena_plyus_v_leche-nii_atopicheskogo_dermatita_u_detey/

5. Belyaeva IA. Current recommendations for a newborn's skin care: traditions and innovations (literature review). RMZH = RMJ. 2018;2:125-128. (In Russ.) Available at https://www.rmj.ru/articles/pediatriya/Sovremennye_rekomendacii_pouhodu_zakoghey_novoroghdennogo_tradicii_iinnovacii_obzor_literatury/#ixzz5z8yxxjbZ.

6. Fluhr J.W., Darlenski R., Lachmann N., Baudouin C., Msika P., De Belilovsky C., Hachem J.-P. Infant epidermal skin physiology: adaptation after birth. Br J Dermatol. 2012;166(3):483-490. doi: 10.1111/j.1365-2133.2011.10659.x.

7. Fluhr J.W., Darlenski R., Taieb A. et al. Functional skin adaptation in infancy - almost complete but not fully competent. Experimental Dermatology. 2010;19(6):483-492. doi: 10.1111/j.1600-0625.2009.01023.x.

8. Zakharova I.N., Pshenichnikova I.I., Machneva E.B. Proper skin care for newborns and young children: what a pediatrician needs to know. Consilium Medicum. Pediatrics. 2016;(1):24-30. (In Russ.) Available at: https://con-med.ru/mag-azines/pediatry/pediatry-01-2016/pravilnyy_ukhod_za_kozhey_novorozhdennykh_i_detey_rannego_vozrasta_chto_nuzhno_znat_pediatru/

9. Yatsyk G.V., Akoev Yu.S. Clinical efficacy of various skin care products for newborns based on D-panthenol. Consilium Medicum. Pediatrics. 2004;6(2):41-43. (In Russ.) Available at: http://old.consilium-medicum.com/media/pediatr/04_02/22.shtml.

10. Hachem J.P, Crumrine D., Fluhr J., Brown B.E., Feingold K.R., Elias P.M. pH directly regulates epidermal permeability barrier homeostasis, and stratum corneum integrity/cohesion. J Invest Dermatol. 2003;121(2):345-353. doi: 10.1046/j.1523-1747.2003.12365.x.

11. Goncharova O. V. Basic rules of skin care of the child of the first months of life. Consilium Medicum. Pediatrics. 2013;(3):5-9. (In Russ.) Available at: https://con-med.ru/magazines/pedi-atry/pediatry-03-2013/osnovnye_pravila_ukhoda_za_kozhey_rebenka_pervykh_mesyatsev_zhizni/

12. Rybkina N.L. Modern approaches to newborn skin care: pediatrician's tactics. Vestnik sovre-mennoy klinicheskoy meditsiny = Bulletin of modern clinical medicine. 2014;7(6):84-89. (In Russ.) Available at: https://cyberleninka.ru/article/v/sovremennye-podhody-k-uhodu-za-kozhey-novorozhdennogo-taktika-pediatra.

13. Araviyskaya E.R., Sokolovsky E.V. Skin barrier properties and basic care: innovations in theory and practice. Vestnik dermatologii i vene-rologii = Bulletin of Dermatology and Venereology. 2010;(6):135-139. (In Russ.) Available at: https://www.elibrary.ru/item.asp?id=15590178.

14. Zver'kova F.A. Skin diseases of young children. Saint Petersburg: Sotis; 1994. (In Russ.)

15. Geppe NA., Belousova N.A., Pakhomova O.A., Im V.V. Prevention of diaper dermatitis. Consilium Medicum. Pediatrics. 2002;5(10):33-35. (In Russ.) Available at: http://old.consilium-medicum.com/media/consilium/02_10c/34.shtml.

16. Atherton D., Mills K. What can be done to keep babies' skin healthy? RCM Midwives. 2004;7(7):288-290. Available at: https://www.researchgate.net/publication/8396378_What_Can_Be_Done_to_Keep_Babies'_Skin_Healthy.

17. Blume-Peytavi U., Hauser M., Stamatas G.N., Pathirana D. Skin care practices for newborns and infants: review of the clinical evidence for best practices. Pediatr Dermatol. 2012;29(1):1-14. doi: 10.1111/j.1525-1470.2011.01594.x.

18. Blume-Peytavi U., Lavender T., Jenerowicz, Ryumina I., Stalder J.-F., Torrelo A., Cork MJ. Recommendations from a European Roundtable Meeting on Best Practice Healthy Infant Skin Care. Pediatric Dermatol. 2016;33(3):311-321. doi: 10.1111/pde.12819.

19. Hoeger P., Enzmann C. Skin physiology of the neonate and young infant: a prospective study of functional skin parameters during early infancy. Pediatr Dermatol. 2002;19(3);256-262. doi: 10.1046/j.1525-1470.2002.00082.x.

20. Fluhr J.W., Elias P.M. Stratum corneum pH: Formation and function of the “acid mantle". Exogenous Dermatol. 2002;1(4):163-175. doi: 10.1159/000066140.

21. Gregory K. Microbiome aspects of perinatal and neonatal health. The Journal of Perinatal & Neonatal Nursing. 2011;25(2):158-162. doi: 10.1097/JPN.0b013e3182169346.

22. Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN). New Neonatal Skin Care Evidence-Based Practice Guideline. Nursing for Women's Health. 2013;17(6):545-546 2013. doi: 10.1111/1751-486X.12085.

23. Schmid-Wendtner M.H., Korting H.C. The pH of the skin surface and its impact on the barrier function. Skin Pharmacol. Physiol. 2006;19(6):296-302. doi: 10.1159/000094670.

24. Darmstadt G.L., Dinlos J.G. Neonatal Skin Care. Pediatric Clinics of North America. 2000;47(4):757-782. doi: 10.1016/S0031-3955(05)70239-X.

25. Del Rosso J.O. Cutaneous rosacea: a thorough overview of pathogenesis, clinical presentations, and current recommendations on management. Vestnik dermatologii i venerologii = Bulletin of Dermatology and Venereology. 2016;(2):21-31. (In Russ.) doi: 10.25208/0042-4609-2016-0-2-21-31.

26. Kanada R.N., Merin M.R., Munden A., Friedlander S.F. A prospective study of cuta-neus findins in newborns in the United States: correlation with race, ethnicity, and gestational status using updated classification and nomenclature. The J of Pediatr. 2012;161(2):240-245. doi: 10.1016/j.jpeds.2012.02.052.

27. Studenikin V.M., Studenikina N.I. Skin Care of children of the first years of life: neuropediatric aspects. Lechashchiy vrach = Attending Physician. 2008;(3):66-70. (In Russ.) Available at: https://www.lvrach.ru/2008/03/4910422/

28. Belousova N.A., Belousova E.G. Early childhood Care. Lechashchiy vrach = Attending Physician. 2007;(1):14-17. (In Russ.) Available at: https://www.lvrach.ru/2007/01/4534603/

29. Odio M., Friedlander S.F. Diaper dermatitis and advances in diaper technology. Curr Opin Pediatr. 2000;12(4):342-346. Available at: https://journals.lww.com/co-pediatrics/Fulltext/2000/08000/Diaper_dermatitis_and_advances_in_diaper.11.aspx.

30. Madison K.C. Barrier function of the skin: ‘la raison d'etre' of the epidermis. J Invest Dermatol. 2003;121(2):231-241. doi: 10.1046/j.1523-1747.2003.12359.x.

31. Keshishian E.S., Sakharova E.S. Skin Care children during the first years of life. Lechashchiy vrach = Attending Physician. 2004;(10). (In Russ.) Available at: https://www.lvrach.ru/2004/10/4531888/

32. Little K., Cutcliffe S. The safe use of children's toys within the healthcare setting. Nurs Times. 2006;102(38):34-37. Available at: https://www.ncbi.nlm.nih.gov/pubmed/17017580.

33. Kotlukov V.K., Kuzmenko L.G., Antipova N.V. The application of the external dermatological Agent of the series Bepanten in children during the first years of life. Consilium Medicum. Pediatrics. 2010;(2):64-67. (In Russ.) Available at: https://con-med.ru/magazines/pediatry/pediatry-02-2010/primenenie_naruzhnykh_dermatologicheskikh_sredstv_serii_bepanten_u_detey_pervykh_let_zhizni/

34. Lavender T., Bedwell C., Roberts S.A., Hart A., Turner M.A., Carter L-A., Cork MJ. Randomized, controlled trial evaluating a baby wash product on skin barrier function in healthy, term neonates. J Obstet Gynecol Neonatal Nurs. 2013;42:203-214. doi: 10.1111/1552-6909.12015.

35. Ramos-e-Silva M., Boza J.C., Cestari T.F. Effects of age (neonates and elderly) on skin barrier function. Clinics in Dermatology. 2012;30(3):274-276. doi: 10.1016/j.clindermatol.2011.08.024.