Chinese, Singaporean, and Taiwanese populations all have specific FLG null mutations unique to their ethnic group, and they rarely exhibit the mutations commonly observed in White patients with AD.43 FLG mutations seem to play less a pathogenic role in patients of African origin than in individuals of European or Asian ancestry.41,43
Statement 5: Skincare for neonates and infants should be:
Loss of function in FLG has been associated with skin barrier abnormalities, the abnormal architecture of the lamellar bilayer, and increased TEWL in White patients with AD.44 The prevalence of loss of function in FLG varies by population, with lower frequencies reported in AD patients of East Asian and African descent.44
Some data do suggest that an increase in TEWL and a decrease in CER in Black skin may contribute to pruritus and its related conditions.45,46 Studies from AD patients of Asian and African descent living in Europe and the US indicate that pruritus may be more frequent and severe.46 Further variations in mast cell composition have been shown in Black skin, which may be of functional relevance.47
Studies mostly on White newborns have indicated an impaired SC barrier function at birth in AD-predisposed newborns.11 An impaired skin barrier function assessed at birth and 2 months of age may precede clinical AD.12 Following this assumption, therefore, a genetically predisposed child may present with xerosis; however, the exposure to environmental triggers may lead to actual AD flares.31,32
Two small prospective, randomized controlled trials demonstrated that daily moisturizer use prevented AD in 32% of Japanese and 50% of Anglo-American high-risk newborns.50,51 The Japanese study further suggested that allergic sensitization during this period was associated with AD but not with moisturizer use.50 More recent and ongoing studies are still evaluating whether neonatal moisturization in AD-prone newborns is significantly beneficial.52
Although there are few studies including SOC infants and children, skincare such as cleansers and moisturizers should be integral to AD prevention, treatment, and maintenance for all newborns, infants, and children.14,15
Statement 4: In all ethnic categories, newborn/infant skin has elevated transepidermal water loss, altered skin surface pH values, and increased desquamation, making it more susceptible to sensitization, infections, and chemical and thermal damage.
Skin surface pH at birth is typically more alkaline than adult skin, ranging from 6.34 to 7.5, depending on the anatomical site.14,15 A mature SC has a pH usually between 4.0 to 6.0, while the body's internal pH is about 7.4.24 Skin acidification plays an important
Skin surface pH at birth is typically more alkaline than adult skin, ranging from 6.34 to 7.5, depending on the anatomical site.14,15 A mature SC has a pH usually between 4.0 to 6.0, while the body's internal pH is about 7.4.24 Skin acidification plays an important
role in barrier maturation and the activation of enzymes involved in the extracellular processing of SC lipids.6,8-11,14
Studies comparing newborn and infant with adult skin properties in various SOC populations found similar differences in SC thickness, water handling properties, and SC pH between infants and adults, as studies that did not distinguish between ethnicities.1,35,55-57 Infant SC was thinner than adult SC and exhibited higher SC pH, water content, and TEWL levels (Table 1).1,35,55-57
The skin of newborns and infants is more fragile and at risk of heat loss, has elevated thermal conductance, and is more susceptible to infections and chemical and thermal damage than adult skin.1-9 Exposure to common irritants, including saliva, nasal secretions, urine, feces, fecal enzymes, dirt, and microbial pathogens for long periods can lead to discomfort, irritation, infection, and skin barrier disruption in the vulnerable newborn and infant skin.14,15 Particular caution with topical skincare regimens is needed for newborns and infants, requiring products with a physiological pH-(4.0 to 6.5).8-14 The use of cleansers and moisturizers containing SC lipids may help maintain and promote the protective skin barrier and soothe with long-term moisturizing benefits.14
Newborns and infants are particularly vulnerable to transcutaneous toxin exposure as they have a high surface-to-weight ratio, immature epidermis, and a compromised skin barrier.58 Topical agents, which are harmless for adults, may cause respiratory distress, neurological toxicity, and even death in the pediatric and neonatal age groups depending upon systemic absorption.14,15,58 Topical agents that may cause toxic reactions include isopropanol, benzocaine, pyrethrin, hexachlorophene, salicylic acid, and many others.14,15,58
• Safe
• Promoting a healthy skin barrier
• Fragrance and sensitizing agent-free
• Pleasant to use
• Containing ingredients that benefit the lipid and water content of the stratum corneum, such as those products containing ceramides.
