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The goal of this study was to instrumentally evaluate the skin of healthy infants and to compare it to adult skin. A total of 70 infants, 45 girls and 25 boys, ages 8-24 months, and 30 healthy women were studied by means of transepidermal water loss (TEWL), capacitance, and pH measurements at two different skin sites, the volar forearm and the buttocks. No significant differences in TEWL were found between infants and adults, either on the buttocks or on the volar forearm. On the contrary, capacitance values were higher in infants. Their skin also appeared less acid than that of adults, with high statistical significance. No TEWL, capacitance, or pH variations were observed in infants according to sex and age. On the basis of the above data, the skin of infants 8-24 months of age shows functional signs of immaturity. This may lead to an increased permeability and a reduced capacity for defense against chemical and microbial aggression.
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Skin Barrier, Hydration, and pH of the Skin
of Infants Under 2 Years of Age
Francesca Giusti, M.D., Alessandro Martella, M.D., Laura Bertoni, Ph.D., and
Stefania Seidenari, M.D.
Department of Dermatology, University of Modena, Modena, Italy
Abstract: The goal of this study was to instrumentally evaluate the skin
of healthy infants and to compare it to adult skin. A total of 70 infants, 45
girls and 25 boys, ages 8–24 months, and 30 healthy women were studied
by means of transepidermal water loss (TEWL), capacitance, and pH mea-
surements at two different skin sites, the volar forearm and the buttocks.
No significant differences in TEWL were found between infants and
adults, either on the buttocks or on the volar forearm. On the contrary,
capacitance values were higher in infants. Their skin also appeared less
acid than that of adults, with high statistical significance. No TEWL, ca-
pacitance, or pH variations were observed in infants according to sex and
age. On the basis of the above data, the skin of infants 8–24 months of age
shows functional signs of immaturity. This may lead to an increased per-
meability and a reduced capacity for defense against chemical and mi-
crobial aggression.
Infant skin is thought to be more sensitive than that of
adults. It follows that the cosmetic industry engages in
studying, producing, and introducing “delicate” products
into the market exclusively for the care and hygiene of
the youngest individuals. However, we should reflect on
whether the presumed higher cutaneous sensitivity to ex-
ternal agents early in life really does exist. Owing to the
difficulty of performing irritation tests on infant skin, we
have to use instrumental methodologies to evaluate
physiologic cutaneous conditions. Besides the advantage
of being noninvasive, these methods enable us to pro-
duce numerical data which are objective, reproducible,
and suitable for statistical processing. Moreover, they
provide a morphologic and functional evaluation of the
skin, which is more informative than mere inspection.
Whereas data referring to transepidermal water loss
(TEWL), capacitance, and pH in patients affected by
skin diseases such as atopic dermatitis, psoriasis, or al-
lergic or irritant contact dermatitis are available in the
literature, little is known about these parameters in
healthy infants (1–7).
The goal of this study was to instrumentally evaluate
the skin of healthy infants and to compare it to adult skin.
Moreover, it was also possible to collect data from dif-
ferent skin sites for an eventual comparison with refer-
ence to certain dermatologic diseases.
Study Population
The study was carried out on 70 healthy infants, 25 boys
and 45 girls, ages 8–24 months (mean ± SD 14.30 ±
6.66 months) and on 30 healthy women, ages 25–35
years (mean ± SD 28.34 ± 4.60 years). None of the
Address correspondence to Stefania Seidenari, M.D., Department
of Dermatology, University of Modena, Via del Pozzo 71, 41100
Modena, Italy.
Pediatric Dermatology Vol. 18 No. 2 93–96, 2001
subjects had any skin disease. The subjects were asked to
avoid using any skin care product for at least 12 hours
before the measurements were obtained. All infants wore
diapers of the two most common Italian brands. The
instrumental measurements were performed on each sub-
ject at two body sites: the left volar forearm and the
Instruments and Study Procedure
This study was carried out in May, June, and September
1999. During that period, in Modena, the average tem-
perature ranged between 20.4°C and 24°C, and the rela-
tive humidity between 37 and 55.5%. Moreover, all
evaluations were performed after a 10-minute acclima-
tion period in a room with temperature set at 21°C–22°C
and humidity at 45–50% to prevent external influences
from affecting the results.
TEWL was measured using an evaporimeter (EP1;
Servomed, Stockholm, Sweden), which is based on the
vapor pressure gradient estimation (8). During all mea-
surements the probe was hand-held using an insulating
glove to avoid heating the probe. The probe was held in
place for each measurement until a steady TEWL value
was established, approximately 30 seconds.
Skin surface hydration was determined by a corneom-
eter (CM820; Courage, Khazaka, Germany). The instru-
ment measures the electrical capacitance of the stratum
corneum. Since water has the highest dielectric constant
in the skin, an increase in water content will raise ca-
pacitance values, which are displayed in arbitrary units
by the instrument (9).
A pH meter with a flat-surface glass electrode (pH 90,
Schwarzhaupt Medizintechnik, Germany), based on the
electrochemical method, was used to measure the pH of
the test sites (10).
Means and standard deviations were calculated. Stu-
dent’s ttest for unpaired values was used to evaluate the
differences between values referring to different skin
sites, age groups, and sexes. A p < 0.05 was considered
TEWL measurements, either at the buttocks or the volar
forearm, did not show significant differences between
the values of infants and adults (Figs. 1 and 2). More-
over, in both populations, differences between the volar
forearm and the buttocks were not noticeable.
Capacitance values, corresponding to stratum corneum
hydration, were higher in infants than in adults at both
tested sites (Figs. 1 and 2). This difference was highly
significant on the volar side of the forearm. Capacitance
values were significantly higher on this area than at the
buttocks in infant skin.
Infant skin appeared less acid than that of adults, both at
the buttocks and at the volar forearm, with high statistical
significance (Figs. 1 and 2). Significantly higher pH val-
ues were noticeable at the buttocks in infants.
No differences were noticeable for TEWL, capaci-
tance, or pH values according to the infant’s sex, nor
were differences observable between values referring to
8- to 12-month-old infants and 12- to 24-month-old in-
fants (Tables 1 and 2).
The epidermal barrier function resides in the stratum
corneum, which becomes functionally mature at 32–34
weeks of gestational age (11,12). TEWL is considered
the best indicator of skin barrier function. A correlation
between this parameter and percutaneous absorption of
acetylsalicylic acid, caffeine, benzoic acid, sodium salt,
and hydrocortisone has been noted previously (13,14).
Skin barrier function, as assessed by TEWL, is altered in
various diseases and after experimental exposure to irri-
Figure 2. (A) TEWL, (B) capacitance, and (C) pH values
(mean ± SD) in infants and adults at the volar forearm.
*Significant with respect to adult skin.
Figure 1. (A) TEWL, (B) capacitance, and (C) pH values
(mean ± SD) in infants and adults at the buttocks. *Sig-
nificant with respect to adult skin.
94 Pediatric Dermatology Vol. 18 No. 2 March/April 2001
tants. Topical treatment for relief of inflammation leads
to normalization of TEWL, which can be used as a mea-
surement to assess response to therapy. In patients with
atopic dermatitis, an increase in TEWL has been found
also on dry, but otherwise normal, noneczematous skin
(1,4). Again, in atopic patients, and also in those with
psoriasis, an inverse correlation has been noted between
TEWL and capacitance (4,15), indicating that skin with
an impaired barrier does not hold enough water to main-
tain optimal hydration of the stratum corneum.
TEWL values are higher in premature infants than in
term newborn infants and adults (16). Most authors agree
that normal infants and adults have similar TEWL values
(5). In fact, according to our data, at the age of 8–24
months, both in boys and girls, the skin has already
achieved a barrier efficacy similar to an adult’s. More-
over, when we subdivided our population into two dif-
ferent age groups, TEWL values did not show differ-
ences either between the infants, age 8–12 months, and
those, ages 12–24 months, or between both subgroups
and adults.
In accordance with literature data, in our study the
highest TEWL values were found in the diaper area (17).
However, in this area evaluations may be biased by the
necessity of performing instrumental measurements
shortly after removing the diaper, when the skin may not
be completely dry. Therefore the amount of water mea-
sured by the evaporimeter may also include water evapo-
rating from the upper epidermis after occlusion (4).
Capacitance quantifies the water content of the stra-
tum corneum, which influences barrier function, percu-
taneous absorption, reactivity to irritants, and the skin’s
mechanical properties. Its evaluation is useful for study-
ing and monitoring skin diseases that are associated with
variations of stratum corneum hydration.
Capacitance values are influenced by humidity and
environment temperature (18). Moreover, variations be-
tween different body sites are observable (7,18): in adults
the highest values are detected on the forehead, the soles,
and the palms and the lowest values on the legs. Signifi-
cant variations, according to sex, have also been ob-
served in adults on some skin areas, with higher values in
females (7). On the contrary, we found no differences in
capacitance values between male and female infants.
In atopic skin a significant decrease in capacitance,
both in unaffected and eczematous areas (1,4), has been
described. On the contrary, diaper occlusion induces a
local increase in water content (19). In the development
of diaper dermatitis, an important role is played by ex-
cessive hydration of the stratum corneum, which com-
promises the skin’s integrity, both increasing its fric-
tional coefficient and permeability to irritants and
promoting microbial growth (20). In fact, in infants we
found higher capacitance values than in adults. This ob-
servation is not substantiated by the anatomic character-
istics of infant skin: at birth the thickness of the stratum
corneum is similar to an adult’s (21). The elevation of pH
in the diaper area also helps to induce dermatitis by
enhancing the activity of fecal enzymes and increasing
skin permeability (17).
According to the so-called acid mantle hypothesis,
maintenance of the pH in the 4.5–6 range is considered a
mechanism of skin defense against infections. Korting et
al. (22) confirmed the influence of skin pH on the com-
position of the cutaneous bacterial flora. Moreover, it
was noticed that many enzymes in the upper epidermis
have a pH optimum at 5.6 (23), suggesting that, in the
course of human evolution, certain enzymes have
adapted to the low pH of the human epidermis.
The acid pH of the skin depends on the presence of
lactic acid and free amino acids, and on the amount of
fatty acids in sebum and sweat. The cutaneous acidity
can be altered by the application of alkaline soaps (22) or
by occlusion. Laube reported that a decrease in skin pH
leads to an increase in the permeability of the skin sur-
face (24). It is well known that various cutaneous inflam-
matory diseases are associated with an increase in pH,
which is normalized when recovery occurs (10,25). In
infants affected by atopic dermatitis, the cutaneous acid-
ity is significantly lower in comparison with that of
healthy control infants, both in eczematous areas and in
nonlesional ones (1). The acid mantle develops during
the first weeks of life, and high pH values are noticeable
in the newborn, probably caused by a different chemical
composition of skin surface lipids (26). In our popula-
TABLE 1. TEWL, Capacitance, and pH (Mean ± SD) at the
Buttocks in Relation to Sex and Age
TEWL Capacitance pH
Male infants 9.12 ± 2.77 63.57 ± 12.58 5.97 ± 0.65
Female infants 9.04 ± 2.43 59.65 ± 9.27 5.93 ± 0.64
8–12 months 8.82 ± 2.30 60.00 ± 9.65 6.06 ± 0.54
12–24 months 9.27 ± 2.70 62.20 ± 11.58 5.83 ± 0.72
TABLE 2. TEWL, Capacitance, and pH (Mean ± SD) at the
Volar Forearm in Relation to Sex and Age
TEWL Capacitance pH
Male infants 8.57 ± 2.52 70.04 ± 9.95 5.46 ± 0.61
Female infants 8.17 ± 2.20 67.34 ± 9.50 5.45 ± 0.68
8–12 months 8.67 ± 2.49 66.51 ± 8.61 5.45 ± 0.71
12–24 months 8.00 ± 2.10 68.20 ± 10.89 5.47 ± 0.58
Giusti et al: Biophysical Parameters of Infant Skin 95
tion, skin pH values were still significantly higher in
infants than in adults, especially on the buttocks.
To summarize, in spite of the seemingly normal ap-
pearance and normal TEWL values, the skin of infants,
ages 8–24 months still presents functional signs of im-
maturity consisting of higher hydration and pH values.
This may lead both to an increased permeability and a
reduced capacity of defense against chemical and micro-
bial aggression.
1. Giusti G, Seidenari S. Objective assessment of the skin of
children affected by atopic dermatitis: a study of pH, ca-
pacitance and TEWL in eczematous and clinically unin-
volved skin. Acta Derm Venereol 1995;75:429–433.
2. Wilson DR, Maibach H. A review of transepidermal water
loss. In: Maibach H, Boisits EK, eds. Neonatal skin. New
York: Marcel Dekker, 1982:83–100.
3. Tollesson A, Frithz A. Transepidermal water loss and wa-
ter content in the stratum corneum in infantile seborrhoeic
dermatitis. Acta Derm Venereol 1993;73:18–20.
4. Berardesca E, Fideli D, Borroni G, Rabbiosi G, Maibach
H. In vivo hydration and water-retention capacity of stra-
tum corneum in clinically uninvolved skin in atopic and
psoriatic patients. Acta Derm Venereol (Stockh) 1990;70:
5. Wilson DR, Maibach H. An in vivo comparison of skin
barrier function. In: Maibach H, Boisits EK, eds. Neonatal
skin. New York: Marcel Dekker, 1982:101–110.
6. Saijo S, Tagami H. Dry skin of newborn infants: functional
analysis of the stratum corneum. Pediatr Dermatol 1991;
7. Conti A, Schiavi ME, Seidenari S. Capacitance, transepi-
dermal water loss and casual level of sebum in healthy
subjects in relation to site, sex and age. Int J Cosmet Sci
8. Pinnagoda J, Tupker RA, Agner T, Serup J. Guidelines for
transepidermal water loss (TEWL) measurement. A report
from the standardization group of the European Society of
Contact Dermatitis. Contact Dermatitis 1990;22:164–178.
9. Barel AO, Clarys P. Measurement of epidermal capaci-
tance. In: Serup J, Jemec GBE, eds. Handbook of non-
invasive methods and the skin. Boca Raton, FL: CRC
Press, 1995:165–170.
10. Dikstein S, Zlotogorsky A. Skin surface hydrogen ion con-
centration (pH). In: Leveque JL, eds. Cutaneous investiga-
tion in health and disease—noninvasive methods and in-
strumentation. New York: Marcel Dekker, 1989:59–72.
11. Nopper AJ, Horii KA, Sookdeo-Drost S, Wang TH, Man-
cini AJ, Lane AT. Topical ointment therapy benefits pre-
mature infants. J Pediatr 1996;128(5 pt 1):660–669.
12. Thijs H, Massawe AW, Okken A, et al. Measurement of
transepidermal water loss in Tanzanian cot-nursed neo-
nates and its relation to postnatal weight loss. Acta Paediatr
13. Rougier A, Lotte C, Maibach HI. In vivo relationship be-
tween percutaneous absorption and transepidermal water
loss. In: Bronaugh RL, Maibach HI, eds. Percutaneous
absorption. New York: Marcel Dekker, 1989:182–187.
14. Aalto-Korte K, Turpeinen M. Transepidermal water loss
and absorption of hydrocortisone in widespread dermatitis.
Br J Dermatol 1993;128:633–635.
15. Loden M, Olsson H, Axell T, Werner Linde Y. Friction,
capacitance and epidermal water loss (TEWL) in dry
atopic and normal skin. Br J Dermatol 1992;126:137–141.
16. Lund CH, Nonato LB, Kuller JM, Franck LS, Cullander C,
Durand DJ. Disruption of barrier function in neonatal skin
associated with adhesive removal. J Pediatr 1997;131:367–
17. Berg RW, Milligan MC, Sarbaugh FC. Association of skin
wetness and pH with diaper dermatitis. Pediatr Dermatol
18. Rogiers V, Derde MP, Verleyl G, Roseeuw D. Standard-
ized conditions needed for skin surface hydration measure-
ments. Cosmet Toilet 1990;105:73–82.
19. Davis JA, Leyden JJ, Grove GL, Raynor WJ. Comparison
of disposable diapers with fluff absorbent and fluff plus
absorbent polymers: effects on skin hydration, skin pH and
diaper dermatitis. Pediatr Dermatol 1989;6:102–108.
20. Zimmerer RE, Lawson KD, Calvert CJ. The effect of wear-
ing diapers on skin. Pediatr Dermatol 1986;3:95–101.
21. Fairley JA, Rasmussen JE. Comparison of stratum cor-
neum thickness in children and adults. J Am Acad Derma-
tol 1983;8:652–657.
22. Korting HC, Kober M, Mueller M, Braun-Falco O. Influ-
ence of repeated washings with soap and synthetic deter-
gents on pH and resident flora of the skin of forehead and
forearm. Acta Derm Venereol (Stockh) 1987;67:41–47.
23. Öhman H, Vahlquist A. In vivo studies concerning a pH
gradient in human stratum corneum and upper epidermis.
Acta Derm Venereol (Stockh) 1994;74:375–379.
24. Gfatter R, Hackl P, Braun F. Effects of soap and detergents
on skin surface pH, stratum corneum hydration and fat
content in infants. Dermatology 1997;195:258–262.
25. Dikstein S, Zlotogorski A. Measurement of skin pH. Acta
Derm Venereol (Stockh) 1994;74(suppl 185):18–20.
26. Ramasastry P, Downing DT, Poche PE, Strauss JS. Chemi-
cal composition of human skin surface lipids from birth to
puberty. J Invest Dermatol 1970;54:139–144.
96 Pediatric Dermatology Vol. 18 No. 2 March/April 2001
... The vernix caseosa and the amniotic fluid are reported to be mildly alkaline (pH > 7) [31,32,53]. It has been suggested that both the vernix caseosa and the amniotic fluid impart a neutral pH (6.6-7.5) to the newborn skin surface [14,34,47,54]. However, as noted, the skin pH remains a topic of considerable debate. ...
... In addition, the TEWL values from lower dorsal and upper ventral arms in infants (n = 50) were reported to be significantly higher than in adults (p < 0.01) [13]. In another study, older infants (aged 8 to 24 months) exhibited TEWL values that were similar to adults, (p < 0.05), based on measurements of the volar forearm and buttock [14]. ...
... However, renal and hepatic metabolism develops rapidly during the first month after birth, and thus the pharmacokinetic and metabolic profiles of drugs become comparable to adults [81]. hydration and pH were measured periodically (1,4,7,14,21, and 28 days) on the diaper area and non-diaper area. For the diaper area, the site of measurement was the area above the symphysis pubis (below the waistband of the diaper). ...
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A good understanding of infant skin should provide a rationale for optimum management of the health of this integument. In this review, we discuss the skin barrier function of infants, particularly with reference to the use of diapers and baby wipes. The skin barrier of newborns continues to develop with age. Two years after birth, the barrier properties of infant skin closely resemble those of adult skin. However, several risk factors may contribute to impaired skin barrier and altered skin permeability in infants. Problems may arise from the use of diapers and baby wipes. The skin covered by a diaper is effectively an occluded environment, and thus is vulnerable to over-hydration. To date there has been no published information regarding dermal absorption of ingredients contained in baby wipes. Similarly, dermal absorption of topical ingredients in infants with underlying skin conditions has not been widely explored. Clearly, there are serious ethical concerns related to conducting skin permeation studies on infant skin. However, the increasing availability of non-invasive methods for in vivo studies is encouraging and offers new directions for studying this important patient group.
... In short, skin surface pH in infants immediately after birth is higher and less acidic around 6.5 [60] than the pH in adult skin [70], which ranges from 4-6 [72]. The pH then decreases within 7-14 days and can normalize by 6 months [73]. Moreover, it appears similar to adults [62,73] in later infancy. ...
... The pH then decreases within 7-14 days and can normalize by 6 months [73]. Moreover, it appears similar to adults [62,73] in later infancy. While skin pH is not currently in the model, this review provides information that may be used in future. ...
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The higher skin surface area to body weight ratio in children and the prematurity of skin in neonates may lead to higher chemical exposure as compared to adults. The objectives of this study were: (i) to provide a comprehensive review of the age-dependent anatomical and physiological changes in pediatric skin, and (ii) to construct and evaluate an age-dependent pediatric dermal absorption model. A comprehensive review was conducted to gather data quantifying the differences in the anatomy and physiology of child and adult skin. Maturation functions were developed for model parameters that were found to be age-dependent. A pediatric dermal absorption model was constructed by updating a MoBi implementation of the Dancik et al. 2013 skin permeation model with these maturation functions. Using a workflow for adult-to-child model extrapolation, the predictive performance of the model was evaluated by comparing its predicted rates of flux of diamorphine, phenobarbital and buprenorphine against experimental observations using neonatal skin. For diamorphine and phenobarbital, the model provided reasonable predictions. The ratios of predicted:observed flux in neonates for diamorphine ranged from 0.55 to 1.40. For phenobarbital, the ratios ranged from 0.93 to 1.26. For buprenorphine, the model showed acceptable predictive performance. Overall, the physiologically based pediatric dermal absorption model demonstrated satisfactory prediction accuracy. The prediction of dermal absorption in neonates using a model-based approach will be useful for both drug development and human health risk assessment.
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The article covers modern concepts of the influence of calcineurin inhibitors on formation and liberation inflammatory cytokines and their immunomodulating ability. Goal: to estimate efficiency and bearableness of 0,1 % Tacrolimus ointment (Protopik) at treatment of atopic dermatitis of moderate severity and eczema of hands as supporting therapy, and also influence of a preparation on microcirculation in skin. Materials and methods. In research took part 35 patients having atopic dermatitis (ATD) of moderate severity. The preparation Protopik (0,1% ointment) was used externally by daily thin layer on well cleared skin 2 times a day before clinical improvement, but not less than 2 weeks. Further, at achievement of clinical remission, it was recommended to use a preparation 2 times a week on the sites of skin which are usually struck at aggravations. In other days it was recommended to patients to use a relipidant. To patients with atopic dermatitis before the beginning of treatment and in 1 month from the beginning of application of a preparation by means of Doppler monitoring research microcirculation level in skin (volume speed of a blood-groove) was estimated. Results. High activity of a preparation as means of long supporting therapy is shown. Continuous application of a preparation within 2 weeks allows to reach in most cases almost complete remission. According to Doppler monitoring research, microcirculation in skin at patients with ATD after external application of 0,1% Tacrolimus ointment (Protopik) amplified that it is possible to explain decrease in an infiltration in a dermis. Use of a preparation differs sufficient comfort, and individual complaints to local irritation in the area where the ointment was applied were transient by nature.
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V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russian Federation The skin of a newborn is a delicate structure that is the first barrier protecting from exposures. Skin conditions in newborns are common due to adaptation to novel environment. The choice of an adequate moisturizing and skincare product is still an important issue. This paper discusses the structural and functional specificity of the skin of newborns and the role of lipids in the healthy functioning of skin barrier. Inadequate acid mantle and skin microbiome, gradual maturation of immune defense account for the frequent occurrence of infective inflammatory skin disorders, in particular, in skincare defects. Fatty oils are commonly used as emollients or the basis of care products, while essential oils and aromatic compounds are widely applied in perfume and cosmetic industries (including the production of skincare products for babies and toddlers). The effects of natural oils (e.g., olive, sunflower-seed, mustard-seed oil etc.) on skin hydration and permeability and their abil ity to induce inflammation. A single standard for certifying natural cosmetics including skincare products for babies is highlighted. Keywords: skin, newborn, care product, natural oil, essential oil. For citation: Ryumina I.I. Natural oils for skincare of newborns and infants. Russian Journal of Woman and Child Health. 2021;4(2):178–183. DOI: 10.32364/2618-8430-2021-4-2-178-183.
... Además, es esencial para el sentido del tacto y la síntesis de vitamina D. [1][2][3][4] En el niño, la piel es frágil, delgada y más propensa a dermatitis e infecciones. 2,5,6 En el adolescente, la piel experimenta cambios secundarios al alza en los andrógenos circulantes, que se traducen en mayor producción de sebo y predisposición al acné. 7 Las medidas generales son un conjunto de cuidados universales de la piel que favorecen su aspecto saludable y previenen la aparición de diversas dermatosis. ...
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I Generalidades La piel funciona como barrera entre el cuerpo y el medio ambiente al prevenir la pérdida de líquidos y electrolitos, regular la temperatura corporal y proteger contra infecciones y diversos estímulos mecánicos, térmicos, y ambientales. Además, es esencial para el sentido del tacto y la síntesis de vitamina D.1-4En el niño la piel es frágil, delgada y más propensa a dermatitis e infecciones.2,5,6 Mientras que en el adolescente, la piel experimenta cambios secundarios al alza en los andrógenos circulantes, que se traducen en mayor producción de sebo y predisposición al acné.7
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Purpose: This study aimed to evaluate whether bathing newborns within 36 hours after birth has a temporary negative impact on skin barrier metrics and relates to atopic dermatitis (AD) development. Methods: 55 newborns were bathed with water at 24-36 hours after birth, while 102 newborns did not have bath. Skin barrier metrics, including facial and underarm transepidermal water loss (TEWL), stratum corneum hydration (SCH), and skin humidity, were evaluated 1 hour before and after bath (T0 and T1, respectively), as well as on the next day (T2). A follow-up questionnaire via telephone was conducted 12-month later (T3). AD screening was determined based on the questionnaire. Results: In the non-bathed newborns, no significant alteration in skin barrier function was observed. In the bathed newborns, the underarm SCH significantly deteriorated from 16.60±21.74 at T0 to 8.16±12.27 at T2 (51% deterioration, p=0.009). Deteriorations were also observed for the facial and underarm humidity right after bath (-5%, p=0.017 and -4%, p=0.012) as well as on the next day (-6%, p=0.003 and -5%, p=0.001). At T3, 5% non-bathed newborns were determined to have developed AD during the past 12-month, while this number increased by 4-fold (21%) in the bathed newborns (p=0.010). Conclusion: This study demonstrated a temporary negative impact on newborn’s skin barrier function caused by bathing within 36 hours after birth. Deteriorated skin barrier function in the temporary window may still leave the newborn susceptible to infection and allergy, increasing the risk of triggering AD onset.
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Skin is a key organ maintaining internal homeostasis by performing many functions such as water loss prevention, body temperature regulation and protection from noxious substance absorption, microorganism intrusion and physical trauma. Skin ageing has been well studied and it is well known that physiological changes in the elderly result in higher skin fragility favouring the onset of skin diseases. For example, prolonged and/or high-intensity pressure may suppress local blood flow more easily, disturbing cell metabolism and inducing pressure injury (PI) formation. Pressure injuries (PIs) represent a significant problem worldwide and their prevalence remains too high. A higher PI prevalence is correlated with an elderly population. Newborn skin evolution has been less studied, but some data also report a higher PI prevalence in this population compared to older children, and several authors also consider this skin as physiologically fragile. In this review, we compare the characteristics of newborn and elderly skin in order to determine common features that may explain their fragility, especially regarding PI risk. We show that, despite differences in appearance, they share many common features leading to higher fragility to shear and pressure forces, not only at the structural level but also at the cellular and molecular level and in terms of physiology. Both newborn and elderly skin have: (i) a thinner epidermis; (ii) a thinner dermis containing a less-resistant collagen network, a higher collagen III:collagen I ratio and less elastin; (iii) a flatter dermal–epidermal junction (DEJ) with lower anchoring systems; and (iv) a thinner hypodermis, resulting in lower mechanical resistance to skin damage when pressure or shear forces are applied. At the molecular level, reduced expression of transforming growth factor β (TGFβ) and its receptor TGFβ receptor II (TβRII) is involved in the decreased production and/or increased degradation of various dermal extracellular matrix (ECM) components. Epidermal fragility also involves a higher skin pH which decreases the activity of key enzymes inducing ceramide deficiency and reduced barrier protection. This seems to be correlated with higher PI prevalence in some situations. Some data also suggest that stratum corneum (SC) dryness, which may disturb cell metabolism, also increases the risk of PI formation. Besides this structural fragility, several skin functions are also less efficient. Low applied pressures induce skin vessel vasodilation via a mechanism called pressure-induced vasodilation (PIV). Individuals lacking a normal PIV response show an early decrease in cutaneous blood flow in response to the application of very low pressures, reflecting vascular fragility of the skin that increases the risk of ulceration. Due to changes in endothelial function, skin PIV ability decreases during skin ageing, putting it at higher risk of PI formation. In newborns, some data lead us to hypothesize that the nitric oxide (NO) pathway is not fully functional at birth, which may partly explain the higher risk of PI formation in newborns. In the elderly, a lower PIV ability results from impaired functionality of skin innervation, in particular that of C-fibres which are involved in both touch and pain sensation and the PIV mechanism. In newborns, skin sensitivity differs from adults due to nerve system immaturity, but the role of this in PIV remains to be determined.
The problems of clinical efficiency and safety of application of tacrolimus (Protopik) at various skin diseases are discussed in this review. High efficiency of this drug, allows to use it in treatment of different dermatosis. The clinical effect is comparable with topical corticosteroids, and the rate of adverse effects is lower. It is possible to use long applications of calcineurin inhibitors in patients with resistant forms of atopic dermatitis. Positive effects of application of tacrolimus in vitiligo, balanitis, alopecia areata etc. are described.
Over time biological skin properties change with age, which is caused by both external and internal factors such as UV and hormone balance. In particular, skin parameters of growing children differ depending on when they are measured. Many reports have been presented of the skin characteristics of adults and children from measurements on the inner arm or face. But there have been very few studies on scalps. Recently the importance of microbiome on the skin has been discussed and it seems to be highly related with skin parameters. In this report, we examined the biophysical measurements and analyzed the microbiome on the scalps of a group of three-year-old girls and their mothers. We discovered many differences in their microbiome between the children and the mothers who lived in same environment. In skin parameters, the amounts of sebum and pH of children's scalp were significantly lower than those of mothers, while the volume of sweat was remarkably higher and skin conductance also tended to be higher than for mothers. From our microbiome analysis, children have many varieties of genera existing on the scalp compared with mothers. Principal component analysis (PCA) from our microbiome data suggested that different bacteria contribute to the microbiome on the scalps of children and mothers: Streptococcus for children and Cutibacterium for mothers.
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Point-of-Care Detection Devices for Healthcare
To determine normal levels of transepidermal water loss (TEWL), capacitance and sebum according to different sex and age groups, 93 healthy subjects were studied at 14 different anatomical locations with three different instruments: the Evaporimeter EP 1, the Corneometer CM 820, and the Sebumeter SM 810, evaluating respectively the transepidermal water loss, the capacitance and the causal level of sebum. Differences depending on the anatomical site were noticed. Unlike the capacitance, the transepidermal water loss and the causal level of sebum significantly decreased according to age. Furthermore, in some sites, male subjects showed a significantly higher transepidermal water loss than females, while hydration of the horny layer expressed by the capacitance showed an opposite trend. Correlations between the above-mentioned skin parameters were calculated: a positive correlation between TEWL and hydration was observed only at plantar and palmar areas. Afin d'évaluer les niveaux de ‘transepidermal water loss’(TEWL), de capacitance et du sébum, nous avons examiné 93 sujets sains à niveau de 14 différentes zones cutanées, en utilisant trois instruments: l'Evaporimeter EP 1, le Corneometer CM820 et le Sebumeter SM810. Nous avons relevé beaucoup de variations de ces paramètres en fonction des sites anatomiques. Contrairement à la capacitance, la TEWL et le niveau du sébum ont montré une réduction significative au cours du vieillissement. En outre, à niveau de certaines sites anatomiques, les sujets de sexe masculin ont montré des valeurs de TEWL plus hautes que celles de sexe féminin; par contre l'indice de hydratation de la peau mesuré par le Corneometer CM 820 a montré une tendence opposée. Enfin, nous avons considéré les rapports entre les différents paramètres cutanés, en relevant des corrélations significatives parmi la TEWL et la capacitance seulement aux sites palmaires et plantaires.
The biophysical properties of non-eczematous skin at three locations in atopics and non-atopics were characterized using non-invasive physical methods. Skin friction was measured with a newly developed sliding friction instrument, the degree of hydration with a capacitance meter (Corneometer CM 820), and the transepidermal water loss (TEWL) was determined using an Evaporimeter EP1. The areas examined (dorsum of the hand, volar forearm and lower back) showed lower values of friction and capacitance in the atopic patients than did corresponding sites in the normal controls. In most areas a significant correlation between friction and capacitance was found. The TEWL was increased in atopic skin, but TEWL seems to correlate neither to friction nor to capacitance.
Our clinical observations disclosed that most newborn infants showed scaling on at least some parts of the body. To clarify the mechanism for such xerosis, we performed measurements of high-frequency conductance (Gx), which assesses the skin surface hydration and evaporative water loss from the skin. The skin of newborns showed surprisingly lower Gx values and evaporative water loss than those of adults or 1- to 6-month-old infants in a warm environment. These findings may be explained partly by low eccrine activity, which has been reported as characteristic of newborn skin. However, defective stratum corneum function, such as reduced water-holding capacity as demonstrated by the in vivo water sorption-desorption test, also seems to be responsible for the development of dry skin in newborns.
Hydration and the water-retention capacity of stratum corneum have been investigated in uninvolved psoriatic and atopic skin and compared with that of healthy controls. Thirty-three subjects of either sex and matched for age entered the study. The subjects were free from all signs of skin disease and skin dryness. Hydration was evaluated by means of transepidermal water loss and skin capacitance measurements. Water-retention capacity was investigated using the plastic occlusion stress test. Atopic skin differed significantly from uninvolved psoriatic and control skin which had a reduced water content and an increased transepidermal water loss. Furthermore, the skin surface water loss profile representing the stratum corneum water-retention capacity was significantly lower in normal atopic skin. The data suggest that clinically normal skin may be functionally abnormal, resulting in a defective barrier that could lead to higher risk of irritant or contact dermatitis.
This report reviews individual-related variables, environment-related variables and instrument-related variables, with a focus on the Evaporimeter EP1 (ServoMed). Start-up and use is described, and guidelines for good laboratory practice given.
Ten healthy individuals washed their forehead and forearm twice a day over consecutive periods of four weeks with soap and synthetic detergents or vice versa (cross-over design). In general the pH values were higher during the period when soap was applied (the mean pH differed by 0.3 units, p less than 0.01). As a rule the counts of coagulase-negative staphylococci were not much altered. The number of propionibacteria, however, was markedly higher when soap was used (p = 0.02 and 0.01 resp.). At the forehead there was a clear correlation between bacterial counts and skin pH both with propionibacteria (0.56, p less than 0.001) and staphylococci (0.51, p less than 0.001). At the forearm only the former proved true (0.24, p less than 0.05). Thus the skin pH seems to be open to long-standing changes according to the preferred washing habits which may also be of major influence on the composition of the cutaneous bacterial flora.
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.