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

Statement 8: Skincare started shortly after birth may avoid skin damage-inducing dermatological conditions, such as atopic dermatitis, that can affect the overall well-being of the pediatric patient.

Data on the effects of skincare for neonates and infants with sensitive, non-atopic conditions is lacking. However, there is a growing body of evidence supporting skincare starting early in life and ongoing for inflammatory skin conditions. Clinical guidelines and consensus papers on AD worldwide recognize the benefits of ongoing daily use of moisturizers aiming to reduce inflammation and to restore skin barrier function.43-57 Parental education on avoiding triggers of AD and how to apply gentle cleansers and moisturizers are an integral part of AD prevention, treatment, and maintenance.43-57

Promoting the skin barrier function, starting early in life by using moisturizers from birth, may not only be beneficial for the neonatal and infant skin but also may help to prevent AD.21,23 Two prospective, randomized controlled trials revealed that daily use of a moisturizer prevented AD in 32% of Japanese and 50% of Anglo-American high-risk neonates.24,25 More extensive research is needed to study whether moisturizer use from birth onwards reduces allergic sensitization by preventing the development of AD.24,25

Another randomized controlled study examined the effects of the twice-daily application of a ceramide-containing emollient for the first six months of life on the incidence of AD and skin barrier dysfunction in high-risk infants up to 12 months of age.36 Clinical follow-up revealed that twice-daily prophylactic use of the moisturizer might have a more substantial potential to prevent the development of food sensitization than the once-daily application of emollients used in previous trials.36

AD represents a significant health expenditure and is associated with multiple comorbidities.60-63 Daily moisturization may represent a cost-effective, preventative strategy to reduce the burden of AD and as prevention for AD among high-risk newborns.64


The skin of neonates and infants exhibits distinct anatomical and functional properties that might be clinically reflected by its susceptibility to skin barrier disruption. Infant skin functionally is still developing, as indicated by elevated TEWL, skin surface pH values, and elevated desquamation. Neonates and infant skin is more fragile and susceptible to infections, chemical, and thermal damage.

Skincare for neonates and infants should be safe, effective, inexpensive, and fragrance 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. Several studies have shown that skincare, including appropriate cleansers and moisturizers, can reduce the risk of AD in ADprone newborns. More robust studies are needed to confirm the perceived benefits of skincare in neonates and infants.


The authors disclosed receipt of an unrestricted educational grant from CeraVe USA for support with the research of this work.


1. Blume-Peytani U, Tan J, Tennstedt D, et al. Fragility of epidermis in newborns, children and adolescents. J Eur Acad Dermatol Venerol. 2016;30(5):S4:3-56. https://doi.org/10.1111/jdv.13636
2. Stalder JF, Tennstedt D, Deleuran M et al. Fragility of epidermis and its consequence in dermatology. J Eur Acad Dermatol Venereol. 2014;28(Suppl 4):1-18.
3. Oranges T, Dini V, Romanelli M. Skin physiology of the neonate and infant: clinical implications. Adv Wound Care (New Rochelle) 2015 Oct 1; 4(10):587– 595. doi: 10.1089/wound.2015.0642 PMCID: PMC4593874 PMID: 26487977
4. Ludriksone L. Garcia Bartels N, Kanti V, Blume-Peytavi U, Kottner J. Skin barrier function in infancy: a systematic review. Arch Dermatol Res. 2014;306:591-599.
5. Rawlings AV. Molecular basis for stratum corneum maturation and moisturization. Br J Dermatol. 2014;171 (Suppl 3):19-28
6. Brouwers MC, Kho ME, Browman GP, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ. 2010;182(18):E839-842. https://www.ncbi.nlm.nih.gov/pubmed/20603348.
7. Fluhr JW, Darlenski R, Lachmann N, et al. Infant epidermal skin physiology: adaptation after birth. Br J Dermatol. 2012;166:483-490 .
8. Fluhr JW, Lachmann N, Baudouin C et al. Development and organization of human stratum corneum after birth: electron microscopy isotropy score and immunocytochemical corneocyte labelling as epidermal maturation's markers in infancy. Br J Dermatol. 2014 Nov;171(5):978-86.
9. Visscher MO, Narendran V. Neonatal infant skin: development, structure and function. Newborn Infant Nursing Reviews. 2014;14(4):135-141.
10. Chittock J, Cooke A, Lavender T, et al. Development of stratum corneum chymotrypsin- like protease activity and natural moisturizing factors from birth to 4 weeks of age compared with adults. Br J Dermatol. 2016;175(3):713-720.
11. Boiten WA, Berkers T, Absalah S, et al. Applying a vernix caseosa based formulation accelerates skin barrier repair by modulating lipid biosynthesis. J Lipid Research. 2018;59(11):259-260. http://www.jlr.org
12. Blume-Peytavi U, Hauser M, Stamatas GN, Pathirana D. Garcia Bartels N. Skin care practices for newborns and infants: review of the clinical evidence for best practices. Pediatr Dermatol. 2012;29:1-14.
13. Holm T, Rutishauser D, Kai-Larsen Y, et al. Protein biomarkers in vernix with potential to predict the development of atopic eczema in early childhood. Allergy. 2014;69(1):104-112.
14. Telofski LS, Morello AP 3rd, Mack Correa MC, Stamatas GN. The infant skin barrier: can we preserve, protect, and enhance the barrier? Dermatol Res Pract. 2012; 198789.
15. Cices A, Bayers S, Verzi AE, Schachner LA, West DP, Micali G. Poisoning through pediatric skin. Am J Clin Dermatol. 2017;18(3):391-403.
16. Kelleher M, Dunn-Galvin A, Hourihane JO et al. Skin barrier dysfunction measured by transepidermal water loss at 2 days and 2 months predates and predicts atopic dermatitis at 1 year. J Allergy Clin Immunol. 2015;135:930- 935.
17. Stamatas GN, Nikolovski J, Luedtke MA, et al. Infant skin microstructure assessed in vivo differs from adult skin in organization and at the cellular level. Pediatr Dermatol 2010;27:125-131 [PubMed] [Google Scholar]
18. Trojahn C, Dobos G, Schario M, Ludriksone L, Blume-Peytavi U, Kottner J. Relation between skin micro-topography, roughness, and skin age. Skin Res Technol. 2015;21:69-75.
19. Moore JM, Rawlings AV. The chemistry, function and (patho)physiology of stratum corneum barrier ceramides. Int J Cosmetic Sci. 2017;39(4):366-372. doi:10.1111/ics.12399.
20. Skolova B, Janusova B, Vavrova K. Ceramides with a pentadecasphingosine chain and short acyls have strong permeabilization effects on skin and model lipid membranes. Biochim Biophys Acta. 2016;1858(2):220-32.
21. Lowe AJ, Leung DYM, Tang MLK, Su JC, Allen KJ. The skin as a target for prevention of the atopic march. Ann Allergy Asthma Immunol. 2018;120(2):145- 151.
22. Sahle, F. F., T. Gebre-Mariam, B. Dobner, J. Wohlrab, and R. H. Neubert. Skin