No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Abstract
Infants wearing breathable disposable diapers experienced significantly less diaper dermatitis (DD) compared to infants wearing standard, nonbreathable disposable diapers in a series of double-blind clinical trials. Severe DD, including confirmed infection with Candida albicans, was reduced by 38-50% among infants wearing highly breathable (HB) diapers. The prevalence of DD was inversely related to the breathability of the garments. The inhibitory effect of breathable diapers on the survival of Candida was further confirmed in controlled experiments with adult volunteers. A suspension of C. albicans cells was applied to delineated sites on the volar forearm. Each site was then covered by a full-thickness patch from either an HB or a standard diaper. Survival of Candida colonies was reduced by almost two-thirds in the breathable diaper-covered sites compared to the control sites.
... However, the pathogenesis of DDE is not known, but it can be compared with what is known in children, that their development is complex and multifactorial, factors that may interfere are: increase of pH (by microbial flora); excessive humidity, which generates more friction with direct damage to the skin barrier; production of ammonium hydroxide (by increasing pH); presence of lipases and proteases (by contact with feces), these are irritating to the skin generating severe erythema and cutaneous damage, humidity and several proteolytic enzymes have been found to degrade filaggrin, which has been described as a natural moisturization factor (NMF), and higher level of transepidermal water loss (TEWL), both factors act on the direct function of the cutaneous barrier [7,8] the association of microbial flora is very important, of the most reported bacteria is Staphylococcus aureus, some even methicillin resistance strains; in a lower proportion: Streptococcus spp. (β-hemolytic) and Escherichia coli [4,9]. However, the most important infectious association as well as children is with Candida yeasts, particularly Candida albicans, which has been reported in more than 60% [10]. ...
... As in children the DDE can be controlled with constant changing of diapers, so with the use of high-tech diapers like: hypoallergenic, superabsorbent (sodium polyacrylate) [1,2,4] and specially the breathable diaper [9], which have micropores that allow evaporation, and compared to traditional diapers reduce half of DD, there is even a study in adults (healthy volunteers) comparing both diapers, in which C. albicans was inoculated, and it was observed that breathable diapers reduced by 62% CFU (Colony Forming Unit) [9]. The disadvantage is the cost that does not allow its massive use particularly in underdeveloped countries [4]. ...
... As in children the DDE can be controlled with constant changing of diapers, so with the use of high-tech diapers like: hypoallergenic, superabsorbent (sodium polyacrylate) [1,2,4] and specially the breathable diaper [9], which have micropores that allow evaporation, and compared to traditional diapers reduce half of DD, there is even a study in adults (healthy volunteers) comparing both diapers, in which C. albicans was inoculated, and it was observed that breathable diapers reduced by 62% CFU (Colony Forming Unit) [9]. The disadvantage is the cost that does not allow its massive use particularly in underdeveloped countries [4]. ...
... C. albicans and other yeasts provide examples of perfect adaptation to pH changes, which is controlled by two genes: PHR2, which is activated in acidic environments and is deactivated when pH increases, and PHR1, which does the opposite, i.e. is activated at a high pH (neutral and basic levels) [23]. Another proven factor in developing fungi (yeasts and dermatophytes) is CO 2 levels, which are higher in the occlusive environment of standard disposable diapers and barely detectable in breathable diapers [16,24,25]. ...
... Candida albicans, settle infection, causing increased yeast numbers and a micromorphological change from blastoconidia to hyphae and pseudohyphae, which penetrate the superficial parts of the stratum corneum and epidermis [18,19,25]. In general, secondary Candida yeast infections are the most common complication of DD, occurring in more than 80 % of cases. ...
... They can absorb 50-80 times their weight in fluid [11,16]. The second type of diapers is called breathable diapers [25]. These are made of microporous membranes that enable evaporation while preventing leaks. ...
Diapers create particular conditions of moisture and friction, and with urine and feces come increased pH and irritating enzymes (lipases and proteases). Fungi can take advantage of all these factors. Candida yeasts, especially C. albicans, are responsible for the most frequent secondary infections and are isolated in more than 80 % of cases. Correct diagnosis is important for ensuring the correct prescription of topical antimycotics. Nystatin, imidazoles and ciclopirox are effective. It is important to realize there are resistant strains. Dermatophytes can infect the diaper area, with the most common agent being Epidermophyton floccosum. The clinical characteristics of dermatophytosis are different from those of candidiasis, and it can be diagnosed and treated simply. Malassezia yeasts can aggravate conditions affecting the diaper area, such as seborrheic dermatitis, atopic dermatitis, and inverse psoriasis. Additional treatment is recommended in this case, because they usually involve complement activation and increased specific IgE levels. Erythrasma is a pseudomycosis that is indistinguishable from candidiasis and may also occur in large skin folds. It is treated with topical antibacterial products and some antimycotics.
... 10 This has also been noted elsewhere. 19 Children with oropharyngeal candidiasis often have candidal DD due to excretion of C. albicans in the feces. 20 In the diaper area of healthy infants, C. albicans has been found in very few cases (< 4%). ...
... 11 Another advancement in diapers is the use of a "breathable backsheet" that allows water vapor to flow out of the diaper by means of microporous membranes, without leaking liquids. 11,19 In a study evaluating the effects of breathable diapers on C. albicans infection on the forearm skin of adults, infection was reduced by 62% under breathable diaper patches compared with nonbreathable diaper patches. 19 In a single-blind clinical study comparing the use of diapers with a breathable cover to those without (controls), diapers were randomly assigned to between 230 and 260 infants between 3 and 15 months of age. ...
... 11,19 In a study evaluating the effects of breathable diapers on C. albicans infection on the forearm skin of adults, infection was reduced by 62% under breathable diaper patches compared with nonbreathable diaper patches. 19 In a single-blind clinical study comparing the use of diapers with a breathable cover to those without (controls), diapers were randomly assigned to between 230 and 260 infants between 3 and 15 months of age. 19 Infants wore the diapers for 7 weeks. ...
... Diaper dermatit in among the widely seen inflamatory skin disease in babes as well as neonatals [1][2][3]. As most of the parent does not see the diaper dermatit as a disease, and most of the 0 -18 month old 0 -18 month old chil- dren are treated at homes the proper prevalence is un- known [4,5]. ...
... For years it has been believed that amonium the prod- uct of bacterial breakdown of urea in the child's urine to be the cause of diaper dermatit, but nowadays the con- cesus show that among the main causes are excessive moisture, friction, excessive hydration from long time contact of skin with urine and feces, fungus infections, bacterial infections, the type of diaper used, skin damage from the orally taken drugs which pass unabsorbed through the intestines, feeding style and skin Ph. [3,10,11]. ...
... The thinness of the 0 -18 month old children's skin compared to adults [3,12], frequent appearence of diar- hoea as well as frequent use of antibiotic because of in- fections lead to an increased risk of the diaper dermatit diease in 0 -18 month old children [3,11]. Also in other studies it has bee shown that skin disease history is one of the risk factor for the diaper dermatit development [1,7], however in one of the study negative results were found [9]. ...
... This concept is supported by previous data showing the presence of Candida yeasts in some, but not all instances of DD. The full microbial community has yet to be characterized, both in terms of anatomical site and/or during episodes of DD. [21] In any case, the differences in the DD prevalence and severity within the diapered region require additional studies to understand possible contributors, including the role of the microbiome. ...
... [30] This is consistent with previous work demonstrating a reduction in the incidence of Candida infections in the diapered area by the use of more "breathable" diapers that are designed to improve air exchange and reduce humidity within the diaper. [21] In addition to the regional microbiome differences, there were also shifts in each of these communities based on the level of DD present. As DD scores increased, there was a shift in relative abundance that demonstrated higher community percentages of faecal coliforms, such as Enterococcus, and lower percentages of Staphylococcus strains. ...
It has been recognized for nearly a century that human beings are inhabited by a remarkably dense and diverse microbial ecosystem, yet we are only just beginning to understand and appreciate the many roles that these microbes play in human health and development. Establishment of the microbiome begins at birth but many previous studies on infant skin health have focused on Candida species. Little is known on the full microbial composition across different areas and even less is known on how these communities change during disease/inflammatory states. In this clinical study, infants were recruited during periods of diaper dermatitis (DD) and health to characterize the skin microbiome in these two states. Substantial shifts in the skin microbiome were observed across 4 sites in the diapered area (genitals, intertriginous, buttocks and perianal), as well as, during periods of DD. As DD scores increased, there was a shift in relative abundance that demonstrated higher community percentages of fecal coliforms, such as Enterococcus, and lower percentages of Staphylococcus strains. In high rash samples, the predominant Staphylococcus species is S. aureus, potentially implicating S. aureus as a DD etiological agent. This study provides new information related to the microbiome on infant skin in the diapered area and provides insights into the role of the microbiome in the development of DD.
... However, skin in the diaper area may be compromised by diaper rash, mechanical irritation, or occlusion and hydration that may affect dermal absorption. Differences between the diapered area and the non-diapered area have reduced over time with the advent of modern diaper technologies that keeps moisture away from the baby skin in the diaper area (Adam, 2008;Akin et al., 2001;Wong et al., 1992). In a study conducted by Stamatas et al., 2011, Infants with diaper dermatitis were measured in the areas of lesional diapered skin, non-lesional diapered skin, and control (non-diapered skin on the outer thigh). ...
... However, skin in the diaper area may be compromised by diaper rash, mechanical irritation, or occlusion and hydration that may affect dermal absorption. Differences between the diapered area and the non-diapered area have reduced over time with the advent of modern diaper technologies that keeps moisture away from the baby skin in the diaper area (Adam, 2008;Akin et al., 2001;Wong et al., 1992). In a study conducted by Stamatas et al., 2011, Infants with diaper dermatitis were measured in the areas of lesional diapered skin, non-lesional diapered skin, and control (non-diapered skin on the outer thigh). ...
Modern disposable diapers are complex products and ubiquitous globally. A robust safety assessment for disposable diapers include two important exposure parameters, i) frequency of diaper use & ii) constituent transfer from diaper to skin from direct and indirect skin contact materials. This article uses published information and original studies to quantify the exposure parameters for diapers. Using growth tables for the first three years of diapered life, an average body weight of 10-11 kg can be calculated, with a 10th percentile for females (8.5-8.8 kg). Data from surveys and diary studies were conducted to determine the frequency of use of diapers. The overall mean in the US is 4.7 diapers per day with a 75th, 90(th), and 95th percentile of 5.0, 6.0, and 7.0 respectively. Using diaper topsheet-lotion transfer as a model, direct transfer to skin from the topsheet was 3.0-4.3% of the starting amount of lotion. Indirect transfer of diaper core materials as a measure of re-wetting of the skin via urine resurfacing back to the topsheet under pressure was estimated at a range of 0.32-0.66% averaging 0.46%. As described, a thorough data-based understanding of exposure is critical for a robust exposure based safety assessment of disposable diapers.
... "Breathable" diapers containing microporous film covers have been shown to diminish excessive skin hydration and reduce the prevalence of diaper dermatitis (3,4). Consequently, these undergarments should be more comfortable to the wearer than conventional "nonbreathable" diapers. ...
... The diaper-covered skin of infants can be up to10 times more hydrated than other regions of the body as a result of being kept partially occluded most of the time and frequently exposed to urine [4]. Excessive hydration is the major cause of diaper dermatitis, a painful condition that is stressful to both the wearer and the care provider. ...
Breathable diapers were rated significantly drier, cooler and more comfortable than nonbreathable diapers over a range of controlled environmental conditions. Healthy, continent adults evaluated two types of diapers, one of which contained a microporous, breathable outer cover and the other a standard occlusive cover, in a series of blinded, comparison studies under various external conditions and activity levels. The subjects were capable of perceiving comfort or discomfort in the diaper area to a remarkable degree. Subjective perceptions of warmth and wetness underneath the diaper correlated with objective measurements of temperature and relative humidity (RH). Comfort ratings for the breathable diaper increased significantly over that of the nonbreathable garment as ambient temperature, RH and physical activity increased. Data analysis showed that the sensation of wetness in the diaper area was strongly associated with discomfort.
... Approximately half (53%) used disposable diapers exclusively, 43% used both cloth and disposable diapers and 4% used cloth exclusively. Of the 1500 communitybased infants who used disposable diapers with absorbent gel polymer, 33% had mild dermatitis and 2-6% had severe cases [34]. A survey of 1773 hospital nursery staff was conducted to determine the characteristics of DD among typical patients. ...
... Moderate cases decreased to 32% for AGMs with breathable covers [92]. Severe DD, including rash with C. albicans, was reduced by 38-50% among infants in disposables with a breathable outer cover and the reduction was directly related to the technical breathability [34]. The breathable cover created conditions unfavorable to C. albicans survival. ...
Diaper dermatitis is a highly prevalent condition that causes discomfort and stress for patients and frustration for healthcare staff. Diaper technology has evolved to substantially lessen the severity of diaper dermatitis, but additional improvements are needed. Premature infants and incontinent adults are particularly at risk for developing diaper dermatitis and its potential consequences. Contributing factors include overhydration, irritants, friction, increased skin pH, diet, gestational age, antibiotic use, diarrhea and medical condition. Treatments aim to reduce hydration, provide a semipermeable 'layer' to facilitate skin barrier repair, shield the skin from irritants, deactivate specific fecal components and maintain skin surface contact. The published research on the effects of diaper dermatitis treatments is especially sparse. Controlled clinical trials are needed to provide definitive evidence for selection of effective treatments. This article discusses the incidence and etiology of diaper dermatitis in infants and adults. It provides the scientific basis for repair of diaper skin barrier damage and describes recent developments that will be available in the future.
... Firstly, the air gap model can be divided into several parts based on the distribution of diaper dermatitis-prone areas. Studies 5,29,30 have shown that diaper rash is generally seen on the genitals, perineum, perianal area, and inner thighs, as well as some skin folds (e.g. inguinal folds and gluteal crease). ...
The air gap between baby skin and top sheet of disposable diapers is the main place where baby’s metabolic heat, perspiration, and moisture produced by evaporation of urine stay and transfer. Heat and moisture transfer underneath a diaper are greatly affected by the shape and size of the air gap, therefore, it is of significant importance to explore the air gap between diaper and baby skin for comfort and skin health of babies. Currently, it is still a big problem to accurately measure and characterize the air gap of diaper for scholars. In this article, a new approach to measure the air gap, combining three-dimensional scanning, liquid silicone rubber filling, and image processing methods, was proposed to obtain the shape and size of the air gap between diaper and baby skin by region, for quantitative research on heat and moisture transfer mechanism of diapers. In addition, several indicators, including air volume, air gap thickness, and contact area, as well as clothing area factor of the diaper, were chosen to quantify the air gap size and distributions. After verification of accuracy and repeatability, this new approach can effectively measure the size of the air gap underneath the diaper, and provide a feasible way for exploration on quantitative relationship between thermal and moisture comfort of diapers and their structural design, fit, and diapering habits. Furthermore, diaper designers and baby caregivers can obtain guidelines of diaper structural design, wearing and change to improve the microclimate in the diaper for baby comfort and skin health.
... It can be said that the infants who wear breathable diapers are less likely to get rash than the ones who use the non-breathable diapers. One of the most effective solution for DD (Diaper dermatitis) or diaper rash is concluded as using breathable disposable diaper for infants [5,[7][8][9][10][11][12]. ...
Disposable breathable diapers are considered as one of the most important developments in diaper sector. Breathable diapers keep the child’s skin dry and provide a comfortable feeling to the child. Breathability of diapers is obtained by using the breathable back sheet layer which is the most outer layer that the diaper comprises. In this study, the effects of laminating and printing processes on back sheet material breathability are studied. For this aim, four types of back sheet samples namely; film, printed film, laminated film and printedlaminated film are tested for breathability. For breathability testing, water vapour permeability test was applied with two different test devices which principally operate in different ambient conditions. As a result of the study, it is seen that, the breathability of back sheet component decreases as a result of printing and laminating processes. Also, it can be concluded that the ambient conditions for standard textile fabrics is not convenient for testing back sheet samples. Since, the test does not simulate the real ambient conditions of microclimate between the diaper and the child’s skin during diaper use.
... Acrylate-based superabsorbent hydrogels are currently extensively used in personal care products to absorb fluids; they keep moisture and promote skin health and consumer comfort. Furthermore, a number of studies have showed the advantages resulting from the use of superabsorbent materials in personal care products, and their safety and effectiveness [41,42]. In addition to keeping skin dry and preventing diaper rash, the SAP helps control the spread of germs in care medical units. ...
Development of new products and materials, especially those which are based on renewable organic resources using innovative sustainable processes, represents an increasing interest in both academic and industrial research. Cellulose and its derivatives have demonstrated to be versatile materials with unique chemical structure which provides a good platform for the construction of hydrogel networks with distinctive properties as respects of swelling ability and sensibility to external stimuli. Indeed, the high density of free hydroxyl groups in the cellulose structure makes them become a solid substrate that can undergo functionalization, allowing the production of new materials for novel advanced applications. Moreover, the smart behaviour of these materials, in response to specific environmental stimuli, namely temperature, pH, ionic strength, determines the obtained hydrogels especially attractive for in vivo applications. Consequently, cellulose-based hydrogels are promising materials, biodegradable, biocompatible, and the low cost, which exhibit properties that make them attractive in many applications, particularly in biomedical and environmental applications. Keywords: cellulose-based hydrogels; biocompatibility; biomedical and environmental applications 1. General remarks Hydrogels are material that exhibit three-dimensional network of hydrophilic polymers, capable to swell and retain a large amount of water within its structure [1]. The chemical crosslinking [2], physical entanglement [3], hydrogen bonds [4], and ionic bonds [5] are responsible to achieve the network of hydrogels. They can be obtained from the synthetic and natural polymers [6], and depend on various parameters, including the preparation method, charge, as well as mechanical and structural characteristics. Due to their excellent hydrophilicity, permeability, compatibility, and low friction coefficient, polymer-based hydrogels have been used extensively as drug delivery, food, cosmetics, high water-absorbing resin, contact lenses, corneal, implant, substitutes for skin, tendons, ligaments, cartilage, and bone [7,8]. Furthermore, an exclusive class of hydrogels-superporous hydrogels-can potentially be used for both short-and long term applications, as superdisintegrant, controlled release platform, and a gastroretentive drug delivery system. Also, superporous hydrogels have been successfully used as soil improvers [9], slow release fertilizers [10,11], pesticide release devices [12]. Recently, hydrogels have captured progressively the interest of researchers, due to the intrinsic properties corresponding of the medical applications. They can serve as scaffolds that provide structural integrity to tissue constructs, control drug, and protein delivery to tissues and cultures, and serve as adhesives or barriers between tissue and material surfaces. The advantages provided by hydrogels for drug delivery applications include the possibility of sustained release, leading to the maintenance of a high local concentration of an active pharmaceutical ingredient over an extended period of time [13]. Their biocompatibility, ability to release water-soluble compounds from the polymeric matrix, and versatility in modeling the physico-chemical properties, permit the generation of new biomaterials with applications in controlled drug release. Among them, polymers of natural origin are one of the most attractive options, mainly due to their similarities with the extracellular matrix (ECM), chemical versatility, as well as typically good biological performance. It is worth noting that natural polymers have better biocompatibility and less latent toxic effect than most synthetic polymer hydrogels [14], so pure natural polymer hydrogels would be more suitable for biomaterials [15]. Indeed, polysaccharide-based hydrogels behave as smart materials and offer a variety of properties that can be exploited in several applications. Moreover, polysaccharides are gaining a particular attention as components of stimuli-responsive drug delivery systems, especially since they can be obtained in a well characterized and reproductible manner from natural sources [16]. In this context, they can be promising for application in the biomaterial domain, due to their unique benefits, like non-toxicity, abundance, biodegradability, biocompatibility, and biological functions [17]. The most important properties of polysaccharides are derived from natural sources, and their difficulty imposed new synthetic chemical modification methods, the aim being to promote new biological activities and to modify their final properties for specific goals. Furthermore, polysaccharide-based materials have opened new roads in the biomedical domain, namely in the tissue engineering of controlled drug delivery systems and cell immobilization. According those above-mentioned, cellulose represents the most abundant renewable and biodegradable polymeric material, being considered as the main constituent of plants and natural fibers. Also, cellulose is an environmentally friendly alternative to conventional materials and exhibit properties that make them very attractive in many applications [18]. Nowadays, cellulose derivatives-based hydrogel have gained a great popularity in agriculture and pharmaceutical industry, and Polymer science: research advances, practical applications and educational aspects (A. Méndez-Vilas; A. Solano, Eds.) _______________________________________________________________________________________________ 108
... A series of factors favor Candida infection in the diaper area. They are mostly acidophilic yeasts that thrive at skin pH, which is around 5.5 or 6.0 in newborns; another proven factor in developing fungi (yeasts and dermatophytes) is CO 2 levels, which are higher in the occlusive environment (Odio and Friedlander, 2000;Allen andKing, 1978 andAkin et al., 2001). Most reports point out the main infectious agent is C. albicans (80-90%), other species have been found in lesser proportions: Candida tropicalis, Candida parapsilosis, and Candida glabrata (Dan et al., 2006). ...
Diaper dermatitis (DD) is the most common cutaneous diagnosis in infancy that affects almost every child during the early months of their life time; most cases are associated with the yeast colonization of Candida or DD candidiasis and some dermatophytes. It is an irritating and inflammatory acute dermatitis in the perineal and perianal areas resulting from the occlusion and irritation caused by diapers. The study aimed to assess the association between Candida species and some dermatophytes in infants with napkin dermatitis and determine the prevalence of DD in relation with yeast (Candida) colonization and identify common Candida spp. which is responsible for Candida (fungal) DD among infants. Data from 210 infants aged between (0 and 18) months are collected from January to August 2018 in Raparin Hospital in Erbil City. The cases include 113 (53.80%) male infants and 97 (46.19%) female infants and diagnosed with DD. Results of 210 infant with diaper rash participated in this study. 188 (89.52%) were positive for Candida spp. and Dermatophytes (molds). From the total yeast number, Candida albicans was the most predominant species accounting 128 (84.21%), while 24 (15.78%) were non-albicans and dermatophyte molds among which Malassezias spp that accounted 26 (13.83%) and 10 (5.32%), respectively. The percentage of misdiagnosed cases was 9 (4.28%). Infants at age group 6–12 months showed high frequency with diaper rash 127 (60.47%). The prevalence of DD is higher in urban 120 (57.14%) than rural area 90 (42.85%). Furthermore, high prevalence DD found in hot season than colds was 121 (64.36%) and 67 (35.63%), respectively. In conclusion, I found that there are high association between DD with Candida spp. and dermatophytes and Candida albicans is a common invader of all types of napkin eruption.
... Superabsorbents are mainly used in diapers, sanitary napkins, adult incontinence products, feminine hygiene products as an absorbent for water. These personal care products are very important for keeping individuals dry and hygienic especially during the period time [333][334][335]. It has taken the place of cloth, cotton, cellulose fiber etc. which were traditionally used as absorbent. ...
Hydrogels are a kind of three dimensional polymeric network system which has a significant amount of water imbibing capacity despite being soluble in it. Because of the potential applications of hydrogels in different fields such as biomedical, pharmaceutical, personal care products, biosensors, and cosmetics, it has become a very popular area of research in recent decades. Hydrogels, prepared from synthetic polymers and petrochemicals are not ecofriendly. For preparing biodegradable hydrogels, most available plant polysaccharides like starch are utilized. In its structure, starch has a large number of hydroxyl groups that aid in hydrogel networking. For their easy availability and applications, starch-based hydrogels (SHs) have gained huge attention. Moreover, SHs are non-toxic, biocompatible, and cheap. For these reasons, SHs can be an alternative to synthetic hydrogels. The main focus of this review is to provide a comprehensive summary of the structure and characteristics of starch, preparation, and characterization of SHs. This review also addresses several potential multidimensional applications of SHs and shows some future aspects in accordance.
Graphic abstract
... In recent years, scholars began to pay attention to thermal and moisture comfort of diapers and applied new technology for optimization, e.g. breathable diapers with a microporous membrane on the back layer [6,7], which are permeable to air and vapor, but impervious to liquid, providing a dry and comfort microclimate for babies. ...
In order to further improve evaluation of baby disposable diapers and optimize product design, as well as enhance thermal and moisture comfort and safety of the baby, heat and moisture transfer mechanisms in the wearing state of diapers were analysed, and current evaluation technologies of diaper’s thermal and moisture comfort were summarized from material and product perspectives. In view of current problems, the following suggestions were proposed for improvement: 1) It is necessary to pay attention to the effects of changes after urine absorption in properties of diaper materials and the dynamic changes in size of the micro-space underneath the diaper on thermal and moisture comfort; 2) Experiments for evaluation need to be closer to life scene and the manikin system needs to be standardized; 3) In order to predict skin health of babies in the future research, correlation between thermal and moisture comfort and skin damage needs to be established.
... These peculiar properties of SAPs are attractive for several application fields, where the controlled absorption and/or release of large quantities of water is required [4]. This capacity can be applied for instance to products of personal hygiene like child and feminine napkins [5,6]. Even more appealing is the possibility of a controlled/prolonged water release in agriculture, pharmaceutical and biomedical fields [7]. ...
Superabsorbent polymers (SAPs) are organic materials possessing high capacity to absorb and retain large volumes of water, saline and physiological solutions (at least 10–20 times their weight). The most commonly used SAPs are acrylated-based polymers that are not biodegradable or recyclable. To overcome these limits, carboxymethylcellulose (CMC) with hydroxyethylcellulose (HEC) hydrogels were synthetized in this work and dried using a supercritical assisted process at 200 bar and 45 °C. The solvent exchange procedure influenced the final aerogel morphology and, thus, the aerogel swelling ratio (SR). A solvent exchange starting from 50 % v/v ethanol, preserved the native gel nanofibrous morphology, producing a SR up to 20 times larger than the ones reported in the literature using the same process, corresponding to a water uptake larger than 500 times the weight of the dried aerogel.
... These products keep moisture and wetness away from the skin and help in promoting skin health and consumer comfort. In recent years, many studies reported the advantages of the use of superabsorbent materials in personal care products and their safety and effectiveness [53,54]. Superabsorbent hydrogels also help in controlling the spread of germs in group care settings and play the significant role in minimizing the risk of spread of gastrointestinal illnesses [55]. ...
... Biocompatibility superabsorbent hydrogels can absorb fluids and keep moisture and humidity away from the skin in order to improve health and comfort of consumer [85,86]. However, conventional superabsorbents like acrylate-based hydrogels are [79], (c) scheme of the MB adsorption behavior of nanocomposite hydrogels, (d) adsorption isotherms of MB on diverse hydrogels. ...
... Among absorbent pads, much risk assessment has been done dominantly for baby diapers [2][3][4][5]18,24,[30][31][32][33][34][35][36][37][38][39][40], while similar potential risks for feminine hygiene pads and other absorbent products exists. This paper aims to review the risk assessment methodologies that have been applied to disposable absorbent products including baby/adult diapers and feminine hygiene pads. ...
Disposable absorbent hygiene products have evolved for superior performance, enhancing the convenience of daily lives. However, the use of disposable hygiene pads has brought safety concerns on chemical exposure, and significant efforts have been made to assess the potential risks associated with use of hygiene pads. This article intends to overview the safety assessment framework of diapers and feminine pads, which includes hazard identification, hazard characterization, exposure assessment, risk characterization, and post-market risk management. Risk assessment of various constituents are reviewed for quantification methods and conservative estimation of exposure parameters. By reviewing the up-to-date considerations in risk assessment, we aim to provide insightful discussion on safety evaluation of current versions of disposable absorbent products. More clinical testing and post-market surveillance are needed for continuous monitoring of potential health impacts of advanced products and constituents.
... Among the absorbent pads, many risk assessment was done dominantly for baby diapers [2][3][4][5]18,24,[30][31][32][33][34][35][36][37][38][39][40], while there would exist similar potential risks for feminine hygiene pads and other absorbent products. This paper aims to review the risk assessment methodology that had been applied to disposable absorbent products including baby/adult diapers and feminine hygiene pads. ...
Disposable absorbent hygiene products have evolved for superior performance, enhancing the convenience of daily lives. Yet the use of disposable hygiene pads has brought safety concerns on chemical exposure, and significant efforts have been made to assess the potential risks associated with use of hygiene pads. This article intends to overview the safety assessment framework of diapers and feminine pads, which includes hazard identification, hazard characterization, exposure assessment, risk characterization, and postmarket risk management. Risk assessment of various constituents are reviewed for quantification methods and conservative estimation of exposure parameters. By reviewing the up-to-date considerations in risk assessment, we aim to provide insightful discussion on safety evaluation of current versions of disposable absorbent products. More clinical testing and postmarket surveillance are needed for continuous monitoring of potential health impacts of advanced products and constituents.
... Then, disposable diaper was introduced and now is widely used in China [20][21][22], which was found to promote consolidated nighttime sleep and positive mother-infant interactions [23]. Most importantly, the use of disposable diapers has been proved to be effective in preventing the emergence of diaper rash [24][25][26], because (1) excrement, such as urine and poo, does not adhere to skin easily, especially for the high quality materials and (2) the inside of a disposable diaper space cannot be easily filled with humidity if the mother changes it in time. ...
Background
Diaper rash, also known as diaper dermatitis (DD), is a very common skin condition in infants, and use of disposable diapers with breathable materials is an effective approach for the management of diaper rash. In China, new material diapers and standard diapers are currently the two most commonly used disposable diapers. This study aimed to compare the effectiveness of new material diapers versus standard diaper for the prevention of diaper rash in Chinese babies.
Methods
A total of 80 eligible babies admitted to Shanghai Skin Diseases Hospital during the period from June through July, 2016, were enrolled and randomized into two groups. Babies in Group A (n = 41) used the new material diapers, and babies in Group B (n = 39) used standard diapers. Two weeks after the use of the diaper, the babies used the alternate product for the next 2 weeks. Skin conditions were assessed on the front and back waist, right and left buttock, pubic region, anal region, and right and left groin using a 6-point scoring system based on four parameters in 0, 2, and 4 weeks after use of the diapers.
Results
There were changes of the mean skin assessment score in each of the six regions after the use of the diapers. There were significant differences, in the mean skin assessment score of the front waist in Group A between weeks 2 and 4 (P = 0.006) and in Group B between weeks 0 and 2 (P = 0.004), and no significant differences were detected in the mean skin assessment score of the back waist and buttock in both Group A and Group B on weeks 0, 2, and 4. A higher mean skin assessment score of the pubic region was assessed in Group A on week 4 than on week 2 (P = 0.036), with a higher score seen on week 2 than on week 0 (P = 0.048), while no significant differences were found in Group B among weeks 0, 2, or 4. There was a higher mean score of the anal region assessed in Group A on week 2 than on week 0 (P = 0.01), while a higher mean score was found in Group B on week 2 than on weeks 0 (P = 0.036) and 4 (P = 0.01). In addition, a higher mean skin assessment score of the groin was detected on week 2 than on week 0 in both Group A (P = 0.00001) and Group B (P = 0.0001).
Conclusion
The new material diaper is superior to the standard diaper for the prevention of diaper rash in Chinese babies.
... Biocompatibility superabsorbent hydrogels can absorb fluids and keep moisture and humidity away from the skin in order to improve health and comfort of consumer [85,86]. However, conventional superabsorbents like acrylate-based hydrogels are [79], (c) scheme of the MB adsorption behavior of nanocomposite hydrogels, (d) adsorption isotherms of MB on diverse hydrogels. ...
... 2,3,8 Outer breathable backsheets consist of microporous membranes, enabling a moisture vapor flux while preventing leaks and thus reducing skin overhydration and occlusion. 20,44,46 Materials with increased stretchiness are being used for comfortable fit and reduced friction. 2,3,8 A surface layer of barrier emollient transferred to the skin during normal diaper wear can prevent skin barrier damage when skin is exposed to irritants. ...
Diaper dermatitis (DD) is one of the most common skin conditions that infants suffer from and their caregivers manage in the first months post-birth. As such, questions of effective prevention and treatment of the condition often arise. Nonmedical skincare practices that support healthy skin barrier function can prevent DD manifestation or alleviate the condition in many cases. The usage of barrier emollients and improved diaper technology contributes to keeping moisture and irritants away from an infant's delicate skin. This paper addresses facts behind commonly asked questions from caregivers regarding DD and discusses effective measures to prevent and treat the condition.
... The trial provided the opportunity to test, appraise, and learn from several scales previously used to assess DD severity (10)(11)(12)(13)(14)(15)(16)(17)(18). In several phases, study personnel from nursing, medicine, and health care research used scales previously used in several studies to attribute severity scores to trial participants (11,15,18). ...
Background:
One methodologic challenge in conducting research relating to diaper dermatitis (DD) is the absence of a reliable, objective, validated scale for assessing severity. The aim of this study was to develop and validate such a scale.
Methods:
Scale development was based on experience of DD assessment and clinical and photographic data collected during the early stages of a randomized controlled trial of two DD treatments. The severity score is the sum of scores of four domains: severity of erythema and irritation, area with any DD, papules or pustules, and open skin. Possible scores range from 0 (clear skin) to 6 (extensive DD including intense erythema, papules or pustules, and open skin with damage to the dermis). Assessors used the scale to attribute severity scores using high-definition photographs of infants and babies with DD. Interrater reliability (IRR), internal consistency, and test-retest reliability were considered using intraclass correlation coefficients (ICCs), Cronbach's ?, and Cohen ? statistics.
Results:
IRR was very good between assessors familiar with the scale (ICC = 0.949, p < 0.001) and between assessors unfamiliar with the scale (ICC = 0.850, p < 0.001). Test-retest reliability at 2 weeks was good (? = 0.603, p < 0.001). Cronbach's ? for internal consistency was 0.702. Collation of photographs according to severity score revealed a visible continuum of DD severity, suggesting good construct validity.
Conclusion:
The newly developed scale appears to be easy to use, reliable, and effective in detecting increasing or lessening DD severity.
... surface layer of barrier emollient, which is transferred to the skin during use; 17 topsheet to absorb urine and liquid feces; acquisition layer immediately below the topsheet that spreads urine laterally; storage layer containing superabsorbent gel that has been shown to absorb 30 times its own weight of urine; 18 outer breathable backsheet, which reduces the occlusive effect of the nappy; 19 stretchiness for comfortable fit. ...
Irritant napkin dermatitis (IND, often referred to as irritant diaper dermatitis) is an exceedingly common problem in the first 2 years of life. It is now established that a number of factors are considered important in the etiology of IND. The principal irritants are fecal enzymes, which damage infant skin and are further amplified by a number of factors, including skin maceration and friction, high pH, the presence of urine, and the duration of contact with feces. In recent years, the decreasing incidence and severity of IND reflects improvements in the design and performance of diapers, diaper skin care products, and overall awareness about maintaining infant skin health.
... It is also associated with reduction in severity of diaper dermatitis and Candida albicans infection by 38-50%. [6,13] There are also recent innovated diapers that are designed to deliver petrolatum-based formulation to child's skin. In these diapers, petrolatum or zinc oxide are added to the outer layer in light strips without disturbing the absorbing capacity. ...
... 102,103 Some of these principles have been creatively integrated into diaper designs in the past decades including lotion-impregnated inner liners and water permeable outer covers, which contribute to lower relative humidity in the diaper. 77,78,83,92 Emollients The practice of emollient application to infant skin varies globally. For example, oil massage is common in India. ...
... A Pediatric Dermatology article based on a series of double-blind clinical trials concluded that infants wearing breathable disposable diapers experienced significantly fewer episodes of diaper dermatitis, including infection with Candida albicans, compared with infants wearing standard nonbreathable disposable diapers. 6 In recent years, some diaper designs have incorporated the application of small amounts of lotion or ointment to help maintain skin health in the diapered area. In these diapers, a thin layer of mild lotion transfers from the topsheet to the baby's skin to help avoid overhydration, without compromising the absorbency of the diaper. ...
Disposable diapers today employ dramatically better fitting, less bulky, and more environmentally friendly features that deliver better performance and help provide protection for infant skin. Continuous innovations in technology and materials have resulted in new generations of disposable diapers that provide extended dryness and reduced leakage. Driven by studies on the skin's response to inherent influences, such as overhydration and irritation, the qualities of disposable diapers today present significant enhancements for skin health compared with earlier disposable versions and even cloth diapers. Over the years, these enhancements in disposable diapers have helped lead to a reduction in incidence and severity of diaper dermatitis.
... However, the new breathable disposable diaper technology has proved to reduce Candida prevalence in 35-80 %. This is important because airing the diaper area undoubtedly reduces yeast development in a significant way [26]. ...
Aim
Diaper dermatitis (DD) is an inflammatory irritating condition that is common in infants. Most cases are associated with the yeast colonization of Candida or diaper dermatitis candidiasis (DDC), and therefore, the signs and symptoms improve with antimycotic treatment. Sertaconazole is a broad-spectrum third-generation imidazole derivative that is effective and safe for the treatment for superficial mycoses, such as tineas, candidiasis, and pityriasis versicolor. Our goal was to assess the efficacy and safety of sertaconazole cream (2 %) in DDC.
Materials and methods
Twenty-seven patients with clinical and mycological diagnosis of DDC were enrolled and treated with 2 daily applications for 14 days and were followed-up for 2 further weeks.
Results
Three etiologic agents were isolated: Candida albicans in 88.8 %, Candida parapsilosis in 7.3 %, and Candida glabrata in 3.2 %. There was an average symptom reduction from 7.1 to 3.2 in the middle of treatment and to 1.2 and 0.4 units at the end of treatment and follow-up, respectively. The treatment evaluation at the end of the follow-up period showed a total clinical and mycological cure in 88.8 %, improvement in 3.7 %, and failure in 7.4 %. There was side effect (3.7 %) of skin irritation, but the drug was not discontinued.
Conclusions
Based on its safety and effectiveness, sertaconazole cream may be considered a new alternative for DDC treatment.
In this study, it is aimed to produce and characterize antibacterial polyurethane (PU)/Zinc oxide (ZnO) nanofibers by electrospinning method. Firstly, polymer solutions were prepared at various ZnO concentrations such as 0, 0.2, 0.4, 0.6, 0.8, 1. Then solution properties (conductivity, viscosity, surface tension) were determined and analysed the effects of ZnO concentration on the solution properties. PU/ZnO nanofibers produced via electrospinning under the optimum process parameters (voltage, distance between electrodes, feed rate and atmospheric conditions). Finally, the nanofibers were characterized in terms of fibre morphology, thermal stability, permeability and antibacterial activity using SEM-EDS, DSC-TGA, water vapour permeability and disk diffusion methods. According to the solution results; it was observed that conductivity and surface tension decrease significantly with ZnO addition. On the other hand, solution viscosity increases as the ZnO concentration increases. From the SEM images, it has been seen clearly that average fibre diameter increases with ZnO concentration and incorporation of ZnO particles to the fibre structure was verified by SEM-EDS. According to the thermal analyse result, nanofibers begin to degrade between 271.94 ºC and 298.73 ºC. In addition, water vapour permeability increases as the ZnO concentration increase. Lastly antibacterial activity against gram negative (E.coli) and gram positive (S. aureus) was determined with specific zone diameter.
In this study, it was achieved that crosslinking of PVP/GEL nanofibers with two-steps. Crosslinking is a process highly important for water-soluble polymers in terms of application areas and mechanical properties. Firstly, crosslinking of PVP polymers experimental studies were carried out via heat treatment at different temperatures and times. Then, GEL polymers were crosslinked with GTA vapour at different times. Morphological analysis was carried out via SEM images and chemical characteristics were determined via FT-IR analysis. Moreover, after the crosslinking process, SD and WL values were calculated. All results showed that before crosslinking of SEM images, nanofibers were smooth, fine and without beads. The average fiber diameter is 196 nm and the fiber diameter distribution is quite uniform. After crosslinking of SEM images, it is expected that all nanowebs will turn from fibrous surfaces to membranous. Generally, SD and WL values decrease with crosslinking time increase. According to all of the SEM images, SD and WL values, optimum conditions were determined for PVP as 4 hours at 180oC and for GEL as 24 hours. Lastly, the presence of PVP and GEL polymers in the nanofiber structure was verified chemically with FT-IR analysis.
Purpose
This study aims to understand the prevalence and factors associated with diaper dermatitis in infants to contribute to disseminating to nurses the characteristics of infants predisposed to developing diaper dermatitis through a research review.
Methods
A search was conducted using the Ichushi Web, version 5, of the Japan Medical Abstracts Society and MEDLINE databases from search engine PubMed using the following combinations of key words: infant and diaper rash. Two authors reviewed the articles based on the inclusion and exclusion criteria. Results were limited to original articles in Japanese and English within the past 30 years up to May 27, 2019. Statistically significant factors associated with the development and prevention of diaper dermatitis were extracted from the selected articles.
Results
Thirteen articles were selected. The point prevalence of diaper dermatitis ranged between 11.5 and 70.6%, while its period prevalence was between 15.2 and 90.6%, both showing a wide range. The definition of diaper dermatitis included whether diaper dermatitis was present and the evaluation of its degree of severity was performed. Diaper dermatitis was identified by the evaluator when certain symptoms were present or a case of dermatitis was clear, regardless of the type of symptoms and their severity (as well as without defining symptoms). Factors associated with the development and prevention of diaper dermatitis were attributed to infants, skin condition, digestive condition, health condition, nutrition method, skin care method, and childcare environment. Many risk factors were associated with infants' digestive or skin conditions, and a few studies focused on skin care, such as apply products as preventives.
Conclusion
Further studies are needed to standardize the methods for evaluating diaper dermatitis because of the wide range of prevalence caused by disagreements in methods of symptom evaluation. Few studies have indicated the relationship between diaper dermatitis and skin care methods used at home, and further research is required in this regard.
Objectives:
To compare prevalence and severity of diaper dermatitis (DD) in infants and toddlers (babies) across three countries (China, USA, and Germany), including diapered skin measures and caregiver practices.
Methods:
A cross-sectional study of 1791 babies (~600 from each country) was recruited at each clinical site. Based on regional toilet-training habits, exclusively diaper-wearing infants were recruited between ages 2-8 months in China and 2-18 months in the USA and Germany. DD was measured, as well as skin pH, transepidermal water loss (TEWL), and relative humidity (RH) in the diapered region. Caregiver habits were collected via a questionnaire and included information on hygienic practices.
Results:
Diaper dermatitis was highest in the perianal area, followed by the intertriginous, genital, and buttock regions. In general, DD was significantly lower in babies in China, highest in Germany, and intermediate in the USA. This rank ordering of DD by geography was also observed in baby age 2-8 months. The lower DD observed in China was associated with lower skin pH and TEWL on diapered skin and decreased RH in the diaper. Chinese caregivers had the highest rate of prophylactic topical product usage, the most robust cleaning of the diapered area, lack of cleansing after urine-only diaper changes, and Chinese infants spent the least time in an overnight diaper.
Conclusions:
These data suggest caregiver behaviors including prophylactic use of topical products, thorough cleaning after stooling and reduced time in an overnight diaper are associated with less DD, lower superficial skin pH, and enhanced skin barrier.
This chapter reviews studies whose results have advanced our knowledge about the effects of fiber-based materials on human skin with the use of bioengineering instrumentation. The emphasis is on how fiber-based materials change properties of the skin they cover and/or contact. Readers are referred to sources of information about the bioengineering instrumentation used [28-30]. Our purpose is to encourage further work in this area.
SCCS OPINION ON Phenoxyethanol
The SCCS adopted this Opinion at its plenary meeting on 6 October 2016 (102 pages)
https://ec.europa.eu/health/sites/health/files/scientific_committees/consumer_safety/docs/sccs_o_195.pdf
This chapter reviews studies whose results have advanced our knowledge about the effects of Fiber-based materials on human skin with the use of bioengineering instrumentation. The emphasis is on how Fiber-based materials change properties of the skin they cover and/or contact. Readers are referred to sources of information about the bioengineering instrumentation used [28-30]. Our purpose is to encourage further work in this area.
Conclusion of the opinion:
(1)Does SCCS consider Phenoxyethanol safe for use as a preservative with a maximum concentration of 1.0 %, taking into account the information provided?
The SCCS considers 2-phenoxyethanol safe for use as a preservative with a maximum concentration of 1.0%, taking into account the information provided.
(2) The SCCS is asked, when making the assessment, to take into account the specific age groups who might be particularly susceptible to the effects of Phenoxyethanol used as preservatives in cosmetic products.
The toxicokinetics default factor of 4.0 can be reduced to 1.0 yielding a minimum Margin of Safety (MoS) of 25 instead of 100 for the safety assessment of 2-phenoxyethanol. Therefore, the MoS of about 50 for children also covers this specific age group who might be higher exposed to 2-phenoxyethanol than adults.
(3) Does the SCCS have any further scientific concerns with regard to the use of Phenoxyethanol in cosmetic products?
This Opinion does not take into account exposure from sources other than cosmetics.
Keywords:
SCCS, scientific opinion, Phenoxyethanol, Regulation 1223/2009, CAS No. 122-99-6, EC No. 204-589-7
Overall safety assessment of 2-phenoxyethanol
Haematotoxicity is a predominant toxicological feature of 2-phenoxyethanol in vivo and in vitro. Comparison of oral studies in rats, mice and rabbits indicates that rabbits are the test species most sensitive to haematotoxic effects by 2-phenoxyethanol. The main metabolite 2-phenoxyacetic acid is formed in rabbit liver at much lower rates than in humans > rats > mice. Rabbit erythrocytes were found less resistant to 2-phenoxyethanol toxicity than erythrocytes from humans > rats > mice, whereas 2-phenoxyacetic acid did not show a haematotoxic potential. Systemic availability of 2-phenoxyethanol after oral exposure of rats is very low due to a strong first pass effect in rat liver and the rapid formation of the main metabolite 2-phenoxyacetic acid, which may accumulate in the kidney and may be responsible for kidney toxicity in rats after oral exposure. In contrast, dermal exposure of rats to 2-phenoxyethanol revealed much higher concentrations of the parent compound in blood than after oral exposure. This may also be true for other species such as humans. For these reasons and because dermal exposure is the relevant route of exposure of humans to 2-phenoxyethanol in cosmetic products, preference is given to dermal studies in rabbits, the most sensitive species tested, whereas the oral route is considered of questionable relevance.
Given the much higher capacity of humans to metabolise 2-phenoxyethanol compared with rabbits, the toxicokinetic default factor of 4.0 can be reduced to 1.0 yielding a minimum Margin of Safety (MoS) of 25 instead of 100 for the safety assessment of 2-phenoxyethanol. Using an adjusted NOAEL of 357 mg/kg bw/day from a 90-day dermal RDT study in rabbits and the aggregate exposure for preservatives in cosmetics, for adult humans a MoS of 130 was derived. The large span of this MoS to the MoS of 25 selected by the SCCS for the safety assessment also covers the safety of infants and babies to 2-phenoxyethanol exposure in cosmetic products.
CONCLUSION
1. Does SCCS consider Phenoxyethanol safe for use as a preservative with a maximum concentration of 1.0 %, taking into account the information provided?
The SCCS considers 2-phenoxyethanol safe for use as a preservative with a maximum concentration of 1.0%, taking into account the information provided.
2. The SCCS is asked, when making the assessment, to take into account the specific age groups who might be particularly susceptible to the effects of Phenoxyethanol used as preservatives in cosmetic products.
The toxicokinetics default factor of 4.0 can be reduced to 1.0 yielding a minimum Margin of Safety (MoS) of 25 instead of 100 for the safety assessment of 2-phenoxyethanol.
Therefore, the MoS of about 50 for children also covers this specific age group who might be higher exposed to 2-phenoxyethanol than adults.
3. Does the SCCS have any further scientific concerns with regard to the use of Phenoxyethanol in cosmetic products?
This Opinion does not take into account exposure from sources other than cosmetics.
Disposable diapers are the most common diaper care practice in Western societies today, and their use continues to increase globally. Improvements in disposable diaper technology have helped to reduce the prevalence and severity of diaper dermatitis (DD) over the course of the last few decades. This article reviews how changes in disposable diaper technology interact with the various etiological factors in DD, thus helping to improve overall diaper area skin health for children around the world.
It is essential to examine the mechanical properties of disposable diapers that contact the skin and affect the dermatitis of babies and infants. Until now, the KES-F system has been used to determine the mechanical properties of disposable diapers. In this study, alternative methods are used to measure the mechanical properties of disposable diapers. We examined, in both dry and wet conditions, the coefficient of friction (MIU), the mean deviation of coefficient of friction (MMD), and the surface roughness (SMD) obtained from the friction tests, the compressional energy (WC), the compressional resilience (RC), and the linearity of compression curve (LC) obtained from the compression tests, the coefficient of heat transfer (K), and the maximum value of heat flux (q) obtained from the heat transfer tests, and the thickness (T) and the weight (W) obtained from the construction tests. The KES-F system has also been used for compression and friction tests for comparative reason. The contents of leakage performance were tested with wetback, absorption area, absorption capacity and retention capacity tests. After wetting, it appeared that while the MIU, MMD, SMD, and LC values increase, the RC values decrease in both the KES-F system and alternative methods. The results obtained from the KES-F system and the alternative methods demonstrate different characteristics, due to the differences in measurement techniques.
This article presents an overview of diaper dermatitis for the pediatric community. The pathogenesis, differential diagnosis, and management of this common condition in infancy are reviewed. This information will assist in making the appropriate diagnosis and managing this irritant contact dermatitis of the diaper area. With conservative management, most cases of irritant diaper dermatitis are self-limited. When the condition persists, one must consider other diagnoses.
Diaper dermatitis is considered to be one of the most common skin disorders of infancy. In spite of its frequency, preventive measures and practical treatment strategies have not been extensively studied. The pathogenesis is complex, and the term diaper dermatitis encompasses several disorders occurring in the diaper area. Very frequent problems, such as an irritant diaper dermatitis caused directly by the wearing of diapers, but also rare disorders, such as Langerhans` cell histiocytosis, can present in this location. The exact diagnosis is not always evident and must be based on the topography and the semeiology of the skin lesions. In this review, the pathophysiology of diaper dermatitis is outlined, differential diagnosis is discussed and practical prevention and management strategies are given.
Skin disorders in the neonate Disorders caused by transplacental transfer of maternal autoantibodies Disorders caused by transfer of toxic substances in maternal milk ‘Collodion’ baby Eczematous eruptions in the newborn Infantile psoriasis and napkin psoriasis ‘Blueberry muffin’ baby (dermal erythropoiesis) Neonatal purpura fulminans Acute haemorrhagic oedema of childhood Disorders of subcutaneous fat Infections Primary immunodeficiency disorders References
xxi, 217 p. : ill. ; 30 cm. PolyU Library Call No.: [THS] LG51 .H577P ITC 2008 Ho Background Low back pain (LBP) is the most common musculoskeletal problem during pregnancy. Pregnant women traditionally wear maternity support belts for back discomfort and have experienced pain relief. However, the designs of these maternity support garments lack scientific research and their clinical efficacy remains elusive. Limited evidence is available to substantiate its putative beneficial effects. Aims This study aims to investigate the garment needs of pregnant women in terms of physical and psychological comfort, based on which to establish design criteria, to develop a maternity support garment, and to evaluate the effect in the maternity garment treatment for the relief of LBP. Methods This study was conducted in three phases: a) an exploratory phase, b) a developmental phase, and c) an evaluative phase. In the exploratory phase, a longitudinal study of 29 pregnant women was undertaken to investigate which biomechanical measures should be used to specify the functional requirements of the maternity support garment. In-depth interviews and wear trials were completed to elicit responses of pregnant women (10 in personal interviews and 14 in wear trials) on 8 maternity support garments. Fabric objective measurements of the same 8 tested garments and 16 alternative samples were conducted before material selection for the first garment prototype. In the developmental phase, the functional garment design criteria were determined and several prototypes were made based on DeJonge’s design framework. In the evaluative phase, the garment prototype was assessed in a pilot clinical study on 9 patients with LBP Results The interviews generated five main themes of garment needs including supportive function, comfort, ease to put on and take off, aesthetics and safety. The wear trials showed that the most preferred garment consisted of a thin cotton fabric with soft and smooth handfeel which was invisible in fitting, allowed easy movements and convenience for toileting. The material tests identified the characteristics of the most favorable sample. The longitudinal study found that the centre of pressure and sagittal lumbar curvature can be used to determine the biomechanical effect. Based on these findings, four garment prototypes were developed to ii satisfy the design criteria developed under five main themes. The pilot clinical study suggested that the maternity support vest is feasible and comfortable to wear as an adjunct therapy to exercises and has promising effects on pregnancy-related low back pain. Conclusions The research deliverables not only improve the garment treatment for LBP in pregnant women, but also provide a new scientific basis for therapeutic garment design. The methodologies and the results in the interviews, wear trials, biomechanical study, prototyping and clinical trials contribute to future research on the effect of garment therapy. Ph.D., Institute of Textiles and Clothing, The Hong Kong Polytechnic University, 2008
The antibacterial, antifungal and probable anti-inflammatory effects of menthol were evaluated in the treatment of napkin dermatitis (ND).
A pilot clinical trial was conducted in Iran at the Tehran University of Medical Sciences. Eligible neonates with a diagnosis of candidial ND who did not require critical care or systematic antifungal and anti-inflammatory drugs were included in the study. Overall, 84 patients were randomly allocated into two groups: menthol group (n=42) receiving standard therapy (topical clotrimazole) plus menthol drops applied topically and control group (n=42) receiving standard therapy plus a placebo. Thirty-five neonates in each group finished the course of study and were analyzed for skin rash using Munz and Concannon rash scoring methods before therapy and on the 1st, 3rd, 5th and 7th day after the treatments.
Demographic data and the baseline total skin rash score were not significantly different between the menthol and control groups. The total course of therapy for complete healing was found to be shorter in the menthol group (4.3±1.6 vs. 6.9±1.8 days, P=0.0001) and erythema and pustules had a significant (P=0.0001) relief in this group. During the study no severe adverse effects of the drug were observed.
Topical application of menthol may be effective in treatment of candidial ND.
The Journal of Investigative Dermatology publishes basic and clinical research in cutaneous biology and skin disease.
The effects of prolonged occlusion on the normal microbial skin flora, pH, transepidermal water loss (TEWL) and carbon dioxide emission rate (CDER) were studied. The total average counts before occlusion were 1.8 X 10(2)/cm(2) and increased to 4.5 X 10(6) on day 5. The highest counts were noted on day 4(9.8 X 10(7)/cm(2)). The composition changed: controls comprised of 63% coagulase negative staphylococci, 6% micrococci, 17% diphtheroids and 6% bacilli. After 5 days of occlusion, the percent compositon was: 63% coagulase negative staphylococci, 11% micrococci, 4% diphtheroids, 19% lipophilic diphtheroids and less than 0.003% gram negative rods. The pH of the skin before occlusion was 4.38 and increased to 7.05 on day 5. After 5 days of occlusion TEWL increased from 0.56 mg/cm2/hr to 1.87 mg/cm2/hr and CO2 emmission increased from 25 nl/cm2/min to 118 nl/cm2/min.
Occlusion of the skin renders it susceptible to acute fungal skin infections (dermatophytosis and candidiasis). Occlusion also raised carbon-dioxide (CO2) tensions at the skin's surface. Comparable CO2 tnesions have a pronounced effect on the morphology and metabolism of dermatophytes in vitro. It is postulated that dermatophyte conida and hyphae produce infective units under conditions of raised CO2 tensions, and that occlusion of the skin produces the concentrations of CO2 required for the conversion. Fungal skin infections might be prevented or controlled by interference with the action of CO2 or by prevention of its accumulation under wet, occlusive clothing.
The effect of occlusion on the carbon dioxide (CO2) emission rate (CDER) of human skin was determined. Occlusive plastic tape elevated the CDER 4.5 times (90nl/cm2/hr) over the normal CDER (20nl/cm2/hr). This increase was noted within a 3-hour period. Non-occlusive paper tape had no effect on CDER. Quantitation of the amount of CO2 under plastic tape revealed that CO2 was present at a concentration of 8-10%. Removal of the plastic tape after 24 hours allowed the CDER to return to approximately normal values within 2 hours. The mechanism by which occlusive plastic tape mediates this dramatic effect on CDER as well as the significance of elevated CO2 concentrations under occlusion are discussed.
Diaper dermatitis results from the action of a number of physical and chemical factors on the skin. While its etiology is complex, there is agreement that prolonged contact between wet diapers and the skin leading to excessive hydration of the stratum corneum and reduced barrier function is a primary factor. Recent research also indicates that pH elevation resulting from ammonia production increases the probability of skin damage due to fecal enzyme activity. New diapers containing absorbent polymers blended with cellulose fluff in the absorbent core have been developed. The absorbent polymer binds fluids and controls pH in the diaper environment. To assess the effectiveness of these diapers, a clinical study was conducted with approximately 150 infants over 15 weeks, using fluff diapers and absorbent polymer diapers. The results clearly showed that the diapers with absorbent polymer provide a better skin environment than those with fluff only with respect to lower skin wetness and pH control (instrumental measurements). In addition, the clinicians' grades indicated a directional reduction in diaper rash severity.
Diaper dermatitis is a term used to encompass a wide range of inflammatory processes that occur in the area covered by the diaper. The term "diaper dermatitis" is thus simply a description of the location of a rash. Numerous factors can be involved in the pathogenesis of dermatitis in the diaper area. These factors, including the role of the diaper, of friction and contact irritation, of urine and ammonia, of feces, of infection, and of underlying dermatologic conditions, are discussed with an emphasis on management of the rash.
Disposable infant diapers with absorbent gelling material (cross-linked sodium polyacrylates) incorporated into the core were clinically evaluated for their effect on infant skin condition. Absorbent gelling materials tightly hold water and provide pH control by a buffering capacity as well as by helping to segregate urine apart from feces. Four clinical studies were conducted with each following a rigid protocol that controlled for variables of diet and age in addition to the diaper material that may influence the development of diaper dermatitis and helped to control for any inherent bias in the study. This allowed for the controlled assessment of skin condition with respect to diaper type. Absorbent gelling material-containing disposable, conventional (100% cellulose core) disposable, and home-laundered cloth diapers were test products. In these studies 1614 infants were initially enrolled with 522 of them assigned to absorbent gelling material disposable, 738 to conventional disposable, and 354 to home-laundered cloth diapers. Objective measurements of skin wetness (transepidermal water loss) and skin pH, as well as double-blind grading of diaper dermatitis, were the measures of skin condition. Absorbent gelling material disposable diapers were associated with significantly reduced skin wetness, closer to normal skin pH, and lower degrees of diaper dermatitis when compared to conventional disposable or home-laundered cloth diapers. The results are consistent with the hypothesis that better control in the diaper area of skin wetness, skin pH, and the prevention of the mixing of urine and feces produces a better diaper environment.
Wearing dry and wet cloth and disposable diaper materials has certain effects on the degree of skin wetness. These, in turn, affect the coefficient of skin friction, the skin's susceptibility to abrasion damage, its permeability, and its support of microbial growth. These effects were explored using an adult model wearing forearm patches. The adult model was validated by comparisons of skin wetness and friction values for infants and adults determined under similar conditions. Skin wetness was proportional to diaper wetness. With increased skin wetness, there were increased coefficients of friction and increased abrasion damage, skin permeability, and microbial growth. Cloth diaper material produced wetter skin than did disposable diaper material at equivalent loadings.
Individual blastospores of Candida albicans were deposited on the surface of 50-mm membranes (Millipore Corp.) and placed within sealed glass chambers at various relative humidities (RH). After 48 hr, virtually all cells maintained at 100 and 10% RH had survived, but 84% of the cells maintained at 60% RH failed to develop into colonies when transferred to Sabouraud medium. No morphological abnormalities could be observed in cells surviving low RH values, but their initial rate of multiplication after transfer to Sabouraud medium was greatly reduced, compared to that demonstrated by cells maintained at 100% RH. At 60% RH, the exposure time required to kill 50% of the blastospores was 2 to 3.5 days. The inimical effect of 60% RH was confirmed in a total of 21 isolates of C. albicans. No deleterious effect was noted when 12 other species of yeasts were subjected to 10, 60, and 100% RH. The single isolate of Candida brumptii and 1 out of the 20 isolates of Cryptococcus neoformans tested also failed to grow after blastospores had been exposed to 60% RH for 4 days.
Dampness, maceration, fecal enzymes, chemicals, and other irritants lead to diaper dermatitis in infants. Most cases can be cleared with frequent diaper changes, use of superabsorbent disposable diapers (which contain gelling material in their core), and a low-potency topical corticosteroid. If the eruption lasts for more than 3 days or classic erythematous satellite lesions are present, addition of an antifungal agent should help resolve the condition. Recalcitrant or clinically atypical eruptions may signify rarer disorders, such as psoriasis, Langerhans' cell histiocytosis, Leiner's disease, or acrodermatitis enteropathica. Patients with these conditions should be referred to a dermatologist, if possible, for further evaluation and treatment.
The purpose of this study is to determine whether the use of the Goretex Pantaloon cast liner for children's spica casts reduces urine excoriation of the skin under the cast and reduces the incidence of unplanned cast changes necessitated by cast soilage. Between 1988 and 1993, 72 consecutive children who had 147 hip spica casts applied were followed. The first 36 patients had 77 spica casts applied without the Goretex Pantaloon, and the last 36 patients had 70 spica casts with a Goretex liner. In the group of patients without Goretex, 22% of casts were associated with urine excoriation of the skin compared to 1.4% in the group of patients who had a Goretex liner applied. This was statistically significant (p = 0.0005). The incidence of unnecessary cast changes due to soiling of the cast was 14% in the non-Goretex group compared to 2.9% in the Goretex group (p = 0.05). The use of the Goretex liner in our series resulted in a savings of $38 per cast including the cost of the liners ($75). The Goretex Pantaloon cast liner used for children's spica casts prevents urine excoriation of the skin and is cost effective.
Diaper dermatitis is the most common dermatologic disorder of infancy. This study evaluates the frequency of outpatient visits resulting in this diagnosis, specialties of physicians providing services, demographics of patients, and leading agents used in treatment.
Records of 272,841 encounters from the National Ambulatory Medical Care Survey (1990-1997) were examined for visits in which diaper dermatitis was diagnosed in children. The likelihood of diagnosis in the general pediatric population was calculated and the leading treatment agents were ranked.
There were approximately 8.2 million visits in which diaper dermatitis was diagnosed. For the pediatric population in the at-risk age range, there was a 1 in 4 likelihood of being diagnosed with the skin disorder. Pediatricians provided 75% of services for the treatment of diaper dermatitis; the demographics of patients were similar to those of comparably aged individuals in the general population. Nystatin was the leading treatment agent prescribed (27% of visits), followed by clotrimazole (16%), a combination product of nystatin and triamcinolone (16%), hydrocortisone (8%), and a combination product of clotrimazole and betamethasone dipropionate (6%).
Visits for diaper dermatitis are frequent, and pediatricians are the physicians most often called on to provide treatment. No portion of the pediatric population is disproportionately diagnosed. The frequent use of potent corticosteroids contained in combination agents is a potential target for improving the management of diaper dermatitis.