Racial and Ethnic Variations in Skin Barrier Properties and Cultural Practices in Skin of Color Newborns, Infants, and Children

July 2023 | Volume 22 | Issue 7 | 657 | Copyright © July 2023


Published online June 27, 2023

Lawrence A. Schachner MD FAAD FAAPa, Anneke Andriessen PhDb, Latanya Benjamin MD FAAD FAAPc, Mercedes E. Gonzalez MD FAADd, Pearl Kwong MD PhD FAADe, Heather Woolery-Lloyd MD FAADf, Candrice Heath MD FAAD FAAPg

aDepartment of Dermatology and Cutaneous Surgery, Prof Department of Pediatrics, Leonard M. Miller School of Medicine, University of Miami, FL 
bRadboud UMC, Nijmegen and Andriessen Consultants, Malden, The Netherlands 
cDepartment of Women's and Children's Health, Florida Atlantic University, Boca Raton, FL 
dDr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Leonard M. Miller School of Medicine, University of Miami, Medical Director, Pediatric Dermatology of Miami, Miami, FL
ePediatric Dermatology, Jacksonville, FL 
fSkin of Color Division, Dr Phillip Frost Department of Dermatology and Cutaneous Surgery University of Miami, Miller School of Medicine Miami, FL
gLewis Katz School of Medicine, Department of Dermatology, Director of Pediatric Dermatology, Temple University Hospital, Philadelphia, PA

Abstract
Background: The skin of newborns and infants of all races/ethnicity is more susceptible to skin barrier disruption than adult skin. This consensus paper offers insights into potential skincare implications for using gentle cleansers and moisturizers for skin of color (SOC) newborns, infants, and children.
Methods: Six pediatric dermatologists and dermatologists used a Delphi communication technique to adopt 5 statements for SOC newborns, infants, and children on skin barrier integrity and the importance of skin care to promote a healthy skin barrier. 
Results: Regardless of ethnicity, newborn and infant skin is still developing and more susceptible to infections and chemical and thermal damage. A growing body of evidence supports skincare starting early in life, recognizing that the ongoing daily use of gentle cleansers and moisturizers containing barrier lipids, such as ceramides, promotes a healthy skin barrier. Understanding cultural differences in everyday skincare practices for SOC newborns, infants, and children is critical for developing an evidence base to substantiate skincare practices. 
Conclusions: Closing knowledge gaps in the clinical presentation, cultural differences, and approach to treating skin conditions using skincare for SOC newborns, infants, and children may improve patient outcomes.  

Schachner  LA, Andriessen A, Benjamin  L, et al. Racial/ethnic variations in skin barrier properties and cultural practices in skin of color newborns, infants and children. J Drugs Dermatol. 2023;22(7):657-663. doi:10.36849/JDD.7305.

INTRODUCTION

Newborn and infant skin is still developing, as indicated by elevated trans-epidermal water loss (TEWL), skin surface pH, and desquamation.1-8 The skin of newborns and infants, with its distinct anatomical and functional properties, is susceptible to skin barrier disruption.1-8

Newborn and infant skin has elevated thermal conductance and is more susceptible to infections and chemical and thermal damage because of immature barrier function.1-9 The neonatal and infant skin requires particular caution with topical skincare regimens.8-14 Advice on how best to care for newborns' and infants' skin has long been debated, with opinions repeatedly changing over time in response to new concerns.14 Further, skincare guidelines should also consider racial/ethnic variations in skin properties and cultural practices to allow healthcare professionals to tailor recommendations to individual patients.

Data on racial/ethnic variations, effects on barrier function, and the potential role of adjunctive skin care for newborns, infants, and children are relatively limited. Newborns and infants with a skin of color (SOC) include people of African, Asian, Latinx, 
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