the surfactant to deeper layers.15
A synthetic cleanser of non-ionic and amphoteric surfactants (pH around 5.5) was compared to water for skin cleansing of infants.33 Biophysical and clinical measurements (TEWL, pH, SC hydration, dryness, erythema) revealed that both did not compromise SC integrity.33 Various papers recommend that a pH-neutral, mild liquid cleanser is the preferred infant cleansing choice.9,14,15,21-23
Synthetic cleansers that do not contain soap may avoid adverse effects; however, robust evidence and clinical consensus on their use in neonates and infants are lacking.33-38
The inconsistent outcome measures hamper the available evidence on bathing, cleanser use versus water alone, and diaper care.34
The choice of cleanser and moisturizer is dependent on individual preference as long as the products used are free of fragrance and common sensitizers.14
The panel agreed that the advice that may be given to parents includes synthetic cleansers or liquid cleansers containing a mixture of fatty acids, cholesterol, and CERs.14 humectants, or emollients.14 Moisturizers with occlusives, such as petrolatum, mineral oil, lanolin, olive oil, jojoba oil, etc, coat the SC and decrease TEWL.14 Moisturizers with humectants can improve hydration of the SC, but in dry weather conditions can dry the skin further.14 For that reason, these agents should be used together with occlusives.14 Examples include glycerin, urea, hyaluronic acid alpha, beta hydroxy acids, propylene glycol, etc.
Emollients may include SC type lipids, such as CER, fatty acids, cetyl stearate, cholesterol, etc., which soften and smooth the skin by filling spaces between skin cells and creating a smooth skin surface.14
A systematic review and meta-analysis of evidence suggest that daily use of full-body emollient therapy may reduce the risk of AD in infants with a genetic predisposition to AD; however, the use of olive oil or sunflower oil for infant xerosis may adversely affect skin barrier function.34
Formulations that contain ceramides mimic physiological lipids supporting homeostasis and improving skin condition.14,39-46 Those with dry and sensitive skin and particularly neonates and infants at risk for AD or having AD, greatly benefit from frequent moisturizer use (Box 3).14 Moisturizer use decreases pruritus, symptoms, and the severity of AD, while also improving quality of life.14,42,43,46 Moreover, the number of AD flares and the time to flaring is reduced when ceramide-containing skincare is frequently applied.14,42,43,46
Erythema
Neonatal skin differs in structure and function from adult skin, and hence the dermatoses seen during this period differ in their clinical presentation. Depending on the etiology, various groups of dermatoses may be distinguished. For example, inherited or congenital disorders [Netherton syndrome, congenital ichthyosis, etc.], infectious diseases (herpes simplex, bullous impetigo, etc), and other skin fragility conditions may present uniquely in newborns.21
Most hereditary disorders with increased skin fragility may occur first during the neonatal period before four months of age, at an average of 7–9 weeks of life.46 Congenital erythroderma is less common but is strongly suggestive of ichthyosis, Netherton syndrome, or immunodeficiency syndromes.46
A synthetic cleanser of non-ionic and amphoteric surfactants (pH around 5.5) was compared to water for skin cleansing of infants.33 Biophysical and clinical measurements (TEWL, pH, SC hydration, dryness, erythema) revealed that both did not compromise SC integrity.33 Various papers recommend that a pH-neutral, mild liquid cleanser is the preferred infant cleansing choice.9,14,15,21-23
Synthetic cleansers that do not contain soap may avoid adverse effects; however, robust evidence and clinical consensus on their use in neonates and infants are lacking.33-38
The inconsistent outcome measures hamper the available evidence on bathing, cleanser use versus water alone, and diaper care.34
The choice of cleanser and moisturizer is dependent on individual preference as long as the products used are free of fragrance and common sensitizers.14
The panel agreed that the advice that may be given to parents includes synthetic cleansers or liquid cleansers containing a mixture of fatty acids, cholesterol, and CERs.14 humectants, or emollients.14 Moisturizers with occlusives, such as petrolatum, mineral oil, lanolin, olive oil, jojoba oil, etc, coat the SC and decrease TEWL.14 Moisturizers with humectants can improve hydration of the SC, but in dry weather conditions can dry the skin further.14 For that reason, these agents should be used together with occlusives.14 Examples include glycerin, urea, hyaluronic acid alpha, beta hydroxy acids, propylene glycol, etc.
Emollients may include SC type lipids, such as CER, fatty acids, cetyl stearate, cholesterol, etc., which soften and smooth the skin by filling spaces between skin cells and creating a smooth skin surface.14
A systematic review and meta-analysis of evidence suggest that daily use of full-body emollient therapy may reduce the risk of AD in infants with a genetic predisposition to AD; however, the use of olive oil or sunflower oil for infant xerosis may adversely affect skin barrier function.34
Formulations that contain ceramides mimic physiological lipids supporting homeostasis and improving skin condition.14,39-46 Those with dry and sensitive skin and particularly neonates and infants at risk for AD or having AD, greatly benefit from frequent moisturizer use (Box 3).14 Moisturizer use decreases pruritus, symptoms, and the severity of AD, while also improving quality of life.14,42,43,46 Moreover, the number of AD flares and the time to flaring is reduced when ceramide-containing skincare is frequently applied.14,42,43,46
Erythema
Neonatal skin differs in structure and function from adult skin, and hence the dermatoses seen during this period differ in their clinical presentation. Depending on the etiology, various groups of dermatoses may be distinguished. For example, inherited or congenital disorders [Netherton syndrome, congenital ichthyosis, etc.], infectious diseases (herpes simplex, bullous impetigo, etc), and other skin fragility conditions may present uniquely in newborns.21
Most hereditary disorders with increased skin fragility may occur first during the neonatal period before four months of age, at an average of 7–9 weeks of life.46 Congenital erythroderma is less common but is strongly suggestive of ichthyosis, Netherton syndrome, or immunodeficiency syndromes.46
