A Consensus About the Importance of Ceramide Containing Skincare for Normal and Sensitive Skin Conditions in Neonates and Infants

August 2020 | Volume 19 | Issue 8 | Original Article | 769 | Copyright © August 2020


Published online July 31, 2020

Lawrence A. Schachner MD FAAD FAAPa, Anneke Andriessen PhDb, Latanya Benjamin MD FAAP FAADc, Alanna F. Bree MDd, Peter A. Lechman MD MBA FAAPe, Ayleen A. Pinera-Llano MDf, Leon Kircik MD FAADg

aDivision of Pediatric Dermatology, Department of Dermatology & Cutaneous Surgery, Department of Pediatrics, Leonard M. Miller School of Medicine, University of Miami, FL bRadboud UMC, Nijmegen and Andriessen Consultants, Malden, The Netherlands cFlorida Atlantic University, Boca Raton, FL dBaylor College of Medicine and Texas Children’s Hospital, Houston, TX; A Children’s House for Pediatric Dermatology, Houston, TX eNorthwestern Medical Group, Chicago, IL; Northwestern University Feinberg School of Medicine, Chicago, IL fKing Bay Pediatrics, Maimi, FL, General Pediatrics, Nicklaus Children’s Hospital, Miami, FL gIchan School of Medicine at Mount Sinai, New York, NY; Indiana University Medical Center, Indianapolis, IN; Physicians Skin Care, PLLC, Louisville, KY; DermResearch, PLLC, Louisville, KY

Abstract
Background: Neonates and infants are susceptible to skin barrier disruption as their skin anatomically and functionally is still developing. The process of skin acidification plays a vital role in barrier maturation and the activation of enzymes involved in the extracellular processing of stratum corneum lipids. The current consensus paper explores challenges, and current treatment approaches in neonatal and infant normal and sensitive skin and the role of ceramides containing moisturizers.
Methods: For this purpose, an expert panel of pediatric dermatologists and dermatologists discussed information from systematic literature searches, coupled with expert opinion and experience of the panel, to adopt eight statements. The consensus process consisted of a modified Delphi technique.
Results: During the first years after birth, the neonatal and infant skin is more permeable to topical agents and, therefore, requires particular caution with topical skincare regimens. Mildly acidic or pH-neutral cleansers have benefits for neonates and infants. Skincare for neonates and infants should be safe, effective, and fragrance free as well as sensitizing agent-free. Additionally, the skincare should be pleasant to use, containing ingredients that benefit the lipid and water content of the SC, such as those products containing ceramides.
Conclusion: Taking into consideration the maturation process of neonatal and infant skin, the application of moisturizers and cleansers containing barrier lipids may help maintain the protective skin barrier and soothe with long-term moisturizing benefits.

J Drugs Dermatol. 2020;19(8) 769-776: doi:10.36849/JDD.2020.5252

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BACKGROUND

At birth, the neonates’ skin is structurally and functionally immature compared to adult skin.1 Neonates and infants exhibit distinct anatomical and functional skin properties making it susceptible to skin barrier disruption.1-3 Infant skin functionally is still developing as indicated by elevated trans-epidermal water loss (TEWL), skin surface pH and desquamation.2-5 Several mechanisms may play a role in the slightly alkaline skin pH at birth; the most relevant could be the exposure to the alkaline amniotic fluid during the preborn life.4,5

The process of skin acidification, which takes place during the first years after birth, plays a vital role in barrier maturation and the activation of enzymes involved in the extracellular processing of stratum corneum lipids.4,5 The definition of sensitive skin is normal-appearing, not atopic skin, which overreacts to various factors that would not cause a reaction in healthy skin.2 Neonatal and infant skin is more fragile, at risk of heat loss, has elevated thermal conductance, and is more susceptible to infections and chemical and thermal damage.1-5 During the first years after birth, the infant skin is more permeable to topical agents, which may induce systemic toxicity.3 The neonatal and infant skin, therefore, requires particular caution with topical skincare regimens.1-3

PH-neutral or mildly acidic cleansers have benefits for neonates and infants.1-3

Taking into consideration the maturation process of neonatal and infant skin, the application of moisturizers and cleansers