and First Nations descent. Knowledge gaps in the clinical presentation, cultural differences, and approach to treating skin conditions using skincare for SOC newborns, infants, and children contribute to disparities in care.1
This manuscript offers insights into these knowledge gaps and their potential skincare implications for using gentle cleansers and moisturizers for SOC newborns, infants, and children.
MATERIALS AND METHODS
A panel of 6 pediatric dermatologists and dermatologists (advisors) who treat newborns, infants, and children of SOC developed a consensus paper for this population on skin barrier integrity and the importance of ceramides (CERs)-containing skincare to help maintain their developing skin barrier. The paper used the Delphi communication technique for interactive decision-making for medical projects.16,17 The selected information from the literature searches, coupled with the advisors' opinions and experience, was used to adopt statements that aim to provide clinical information for pediatric dermatologists, dermatologists, and pediatric healthcare providers treating SOC newborns, infants, and children.
Structured Literature Review
On February 12, 2022, the advisors convened in Miami Beach, Florida. In preparation for the meeting, a structured search of the English-language literature was performed on December 23, 2021, using PubMed, with Google Scholar as a secondary source. The search included literature on skin barrier function, the current best practices for using nonprescription skincare, and clinical research studies for SOC newborns and infants published in English from 2010 to 2021. Excluded were publications with no original data (unless a review article was deemed relevant), not dealing with nonprescription skincare, and written in a language other than English.
Search Terms: SOC newborns, infants AND skin barrier physiology, function, dysfunction, barrier maturation, vernix, OR erythema, OR skin breakdown, OR diaper care, umbilical cord care, OR skin barrier protection, AND depletion of stratum corneum lipids, AND atopic dermatitis prevention, AND treatment, OR mitigation of atopic dermatitis, AND skincare, cleansers, moisturizers, emollients, ceramides, ce¬ramide containing skincare, AOR SOC newborns, infants AND skin maturation and moisturization, efficacy, safety, tolerability, OR SOC newborns, infants, AND skin irritation using skincare.
Search Terms: SOC newborns, infants AND skin barrier physiology, function, dysfunction, barrier maturation, vernix, OR erythema, OR skin breakdown, OR diaper care, umbilical cord care, OR skin barrier protection, AND depletion of stratum corneum lipids, AND atopic dermatitis prevention, AND treatment, OR mitigation of atopic dermatitis, AND skincare, cleansers, moisturizers, emollients, ceramides, ce¬ramide containing skincare, AOR SOC newborns, infants AND skin maturation and moisturization, efficacy, safety, tolerability, OR SOC newborns, infants, AND skin irritation using skincare.
Selected publications were manually reviewed for additional resources.
The searches yielded 128 papers and, after the exclusion of 21 articles, 107 papers clinically relevant to current best practices in SOC newborns and infants to promote skin barrier integrity and to help mitigate atopic dermatitis (AD) remained. Of the 107 papers, 60 addressed newborns, infants, and skincare generally, and 19 discussed specifically SOC newborns, infants, and skincare. Although the number of clinical studies on skincare for this group is growing, there were no robust comparative studies on skincare for SOC newborns, infants, and children to justify a systematic review.17
To estimate the state of the art in skin care for SOC newborns, infants, and children, the 23 clinical studies were graded independently by 2 reviewers (AA and HA). The reviewers assigned a level of evidence for each treatment (Type of study: A [high quality clinical double-blind, randomized controlled trial (RCT)], B [lesser quality RCT], C [comparative study with severe methodological limitations], and 1 [further research is unlikely to change confidence in the estimate of treatment effect] to level 4 [any estimate of effect is very uncertain]) using the pre-established criteria.17
Development of the Statements
The reviewers drafted 17 evidence-based statements on the role of skin care in promoting a healthy barrier in SOC newborns and infants and the potential mitigation of AD in SOC children. During the meeting, the advisors were divided into 3 groups, and drawing from the draft statements, they each selected their top 5 statements. After discussion, the advisors reached a consensus on 5 statements focusing on the science of racial/ethnic skin barrier differences and the importance of cultural practices, underscoring the need for clinicians to understand that there are physiological and cultural differences to consider when treating newborns and infants with SOC.
RESULTS
Statement 1: Excluding culture and ethnicity restricts our overall understanding of health research evidence.
Studies evaluating racial/ethnic differences in skin properties have been small-scale and mainly include adults rather than children.10,18 These studies have shown inter-individual differences and inconsistencies in anatomical study sites measured, which are greater than racial/ethnic differences measured by the investigators.10,18 Xerosis occurs in all races; however, the severity and impact of xerosis between racial/ethnic groups can vary.18
Misdiagnosis of dermatologic conditions is common in newborns/infants with SOC, as many clinicians expect these conditions to look and behave as they do in White infants.19,20
An algorithm for practitioners to address skin conditions in newborns and infants was published previously; however, the racial/ethnic variations in the skin of neonates as well as cultural differences, require additional considerations for clinicians and
