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      Recommendations from a European Roundtable Meeting on Best Practice Healthy Infant Skin Care

      research-article
      , M.D. 1 , , , Ph.D., R.M., R.G.N. 2 , , M.D. 3 , , M.D. 4 , , M.D. 5 , , M.D. 6 , , M.D. 7
      Pediatric Dermatology
      John Wiley and Sons Inc.

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          Abstract

          Background

          European roundtable meeting recommendations on bathing and cleansing of infants were published in 2009; a second meeting was held to update and expand these recommendations in light of new evidence and the continued need to address uncertainty surrounding this aspect of routine care.

          Methods

          The previous roundtable recommendations concerning infant cleansing, bathing, and use of liquid cleansers were critically reviewed and updated and the quality of evidence was evaluated using the Grading of Recommendation Assessment, Development and Evaluation system. New recommendations were developed to provide guidance on diaper care and the use of emollients. A series of recommendations was formulated to characterize the attributes of ideal liquid cleansers, wipes, and emollients.

          Results

          Newborn bathing can be performed without harming the infant, provided basic safety procedures are followed. Water alone or appropriately designed liquid cleansers can be used during bathing without impairing the skin maturation process. The diaper area should be kept clean and dry; from birth, the diaper area may be gently cleansed with cotton balls/squares and water or by using appropriately designed wipes. Appropriately formulated emollients can be used to maintain and enhance skin barrier function. Appropriately formulated baby oils can be applied for physiologic (transitory) skin dryness and in small quantities to the bath. Baby products that are left on should be formulated to buffer and maintain babies’ skin surface at approximately pH 5.5, and the formulations and their constituent ingredients should have undergone an extensive program of safety testing. Formulations should be effectively preserved; products containing harsh surfactants, such as sodium lauryl sulfate, should be avoided.

          Conclusion

          Health care professionals can use these recommendations as the basis of their advice to parents.

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          Most cited references45

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          pH directly regulates epidermal permeability barrier homeostasis, and stratum corneum integrity/cohesion.

          Both exposure of stratum corneum to neutral pH buffers and blockade of acidification mechanisms disturb cutaneous permeability barrier homeostasis and stratum corneum integrity/cohesion, but these approaches all introduce potentially confounding variables. To study the consequences of stratum corneum neutralization, independent of hydration, we applied two chemically unrelated superbases, 1,1,3,3-tetramethylguanidine or 1,8-diazabicyclo [5,4,0] undec-7-ene, in propylene glycol:ethanol (7:3) to hairless mouse skin and assessed whether discrete pH changes alone regulate cutaneous permeability barrier function and stratum corneum integrity/cohesion, as well as the responsible mechanisms. Both 1,1,3,3-tetramethylguanidine and 1,8-diazabicyclo [5,4,0] undec-7-ene applications increased skin surface pH in parallel with abnormalities in both barrier homeostasis and stratum corneum integrity/cohesion. The latter was attributable to rapid activation (<20 min) of serine proteases, assessed by in situ zymography, followed by serine-protease-mediated degradation of corneodesmosomes. Western blotting revealed degradation of desmoglein 1, a key corneodesmosome structural protein, in parallel with loss of corneodesmosomes. Coapplication of serine protease inhibitors with the superbase normalized stratum corneum integrity/cohesion. The superbases also delayed permeability barrier recovery, attributable to decreased beta-glucocerebrosidase activity, assessed zymographically, resulting in a lipid-processing defect on electron microscopy. These studies demonstrate unequivocally that stratum corneum neutralization alone provokes stratum corneum functional abnormalities, including aberrant permeability barrier homeostasis and decreased stratum corneum integrity/cohesion, as well as the mechanisms responsible for these abnormalities.
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            New perspectives on epidermal barrier dysfunction in atopic dermatitis: gene-environment interactions.

            Atopic dermatitis (AD) is a multifactorial, chronic inflammatory skin disorder in which genetic mutations and cutaneous hyperreactivity to environmental stimuli play a causative role. Genetic mutations alone might not be enough to cause clinical manifestations of AD, and this review will propose a new perspective on the importance of epidermal barrier dysfunction in genetically predisposed individuals, predisposing them to the harmful effects of environmental agents. The skin barrier is known to be damaged in patients with AD, both in acute eczematous lesions and also in clinically unaffected skin. Skin barrier function can be impaired first by a genetic predisposition to produce increased levels of stratum corneum chymotryptic enzyme. This protease enzyme causes premature breakdown of corneodesmosomes, leading to impairment of the epidermal barrier. The addition of environmental interactions, such as washing with soap and detergents, or long-term application of topical corticosteroids can further increase production of stratum corneum chymotryptic enzyme and impair epidermal barrier function. The epidermal barrier can also be damaged by exogenous proteases from house dust mites and Staphylococcus aureus. One or more of these factors in combination might lead to a defective barrier, thereby increasing the risk of allergen penetration and succeeding inflammatory reaction, thus contributing to exacerbations of this disease.
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              Newborn infant skin: physiology, development, and care.

              Infant skin is critical to the newborn child's transition from the womb environment to the journey to self-sufficiency. This review provides an integrative perspective on the skin development in full term and premature infants. There is a particular focus on the role of vernix caseosa and on the implications of skin development for epidermal penetration of exogenous compounds. Healthy full-term newborn skin is well-developed and functional at birth, with a thick epidermis and well-formed stratum corneum (SC) layers. Transepidermal water loss is very low at birth, equal to, or lower than adults, indicating a highly effective skin barrier. Vernix facilitates SC development in full-term infants through a variety of mechanisms including physical protection from amniotic fluid and enzymes, antimicrobial effects, skin surface pH lowering, provision of lipids, and hydration. Premature infants, particularly those of very low birth weight, have a poor skin barrier with few cornified layers and deficient dermal proteins. They are at increased risk for skin damage, increased permeability to exogenous agents and infection. The SC barrier develops rapidly after birth but complete maturation requires weeks to months. The best methods for caring for infant skin, particularly in the diaper region, are described and related to these developmental changes.
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                Author and article information

                Journal
                Pediatr Dermatol
                Pediatr Dermatol
                10.1111/(ISSN)1525-1470
                PDE
                Pediatric Dermatology
                John Wiley and Sons Inc. (Hoboken )
                0736-8046
                1525-1470
                26 February 2016
                May-Jun 2016
                : 33
                : 3 ( doiID: 10.1111/pde.2016.33.issue-3 )
                : 311-321
                Affiliations
                [ 1 ] Department of Dermatology and Allergy Clinical Research Center for Hair and Skin ScienceCharité‐Universitätsmedizin Berlin BerlinGermany
                [ 2 ] School of Nursing, Midwifery and Social WorkUniversity of Manchester ManchesterUK
                [ 3 ] Department of DermatologyPoznan University of Medical Sciences PoznanPoland
                [ 4 ] Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of RussiaFederal State Budget Institution MoscowRussia
                [ 5 ] Department of DermatologyNantes University Hospital NantesFrance
                [ 6 ] Department of DermatologyHospital Infantil Universitario Niño Jesús MadridSpain
                [ 7 ] Academic Unit of Dermatology Research, Department of Infection and Immunity Faculty of Medicine, Dentistry and HealthUniversity of Sheffield Medical School SheffieldUK
                Author notes
                [*] [* ]Address correspondence to Ulrike Blume‐Peytavi, M.D., Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité‐Universitätsmedizin Berlin, Charitéplatz 1, Berlin, Germany, or e‐mail: ulrike.blume-peytavi@ 123456charite.de .
                Article
                PDE12819
                10.1111/pde.12819
                5069619
                26919683
                c2a4aa0d-b593-4964-a076-0327921bef0a
                © 2016 The Authors. Pediatric Dermatology Published by Wiley Periodicals, Inc.

                This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 12 March 2015
                : 19 October 2015
                : 15 December 2015
                Page count
                Pages: 11
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                pde12819
                May/June 2016
                Converter:WILEY_ML3GV2_TO_NLMPMC version:4.9.5 mode:remove_FC converted:19.10.2016

                Dermatology
                Dermatology

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