Skin care for healthy babies at term: A systematic review of the evidence

[Midwives as influencers in skin care for newborns at risk of atopic diseases : Survey of midwives' current recommendations]

INTRODUCTION

The prevalence of atopic diseases remains high. Initial studies suggest that primary prevention with regular basic care may influence the incidence of atopic dermatitis in infants; however, data are unclear. Midwives play an important role in the care of women in the peripartum period and therefore also in providing advice on topics such as skin care, breastfeeding and nutrition of the newborn and young infant. The aim of this study was to determine the care recommendations for newborns by midwives.

METHODS

We conducted a cross-sectional survey among German midwives using questionnaires on the topic of newborn skin care.

RESULTS

A total of 128 questionnaires were analyzed. The most common recommendations were oil-based herbal topicals (34.9%) and plain water (34.0%). Approximately 70% of midwives reported recommending various options when there was a known family history of atopic diathesis. It was remarkable that most of the midwives' recommendations were identical regardless of the presence of an atopic diathesis. Essential care products are only used "when necessary".

CONCLUSION

Training programs for midwives on the topic of "care and strengthening of the skin barrier", taking into account the current guidelines for allergy prevention, should be implemented.

The effect of topical application of breast milk and education on preventing diaper dermatitis in children in rural areas

PURPOSE

This study aimed to ascertain the impact of topical breast milk and diaper-area care instruction on the prevention of diaper dermatitis in rural settings.

DESIGN AND METHODS

This was a pre-test-post-test experimental study with forty-eight 6-18-month-old children and their mothers. Participants were randomly assigned to three groups: two experimental groups (Group A: breast milk, Group B: education) and one control group (Group C). Data were collected face-to-face through home-visits. A sociodemographic data and diaper-area care practices form and The Scale for Assessing the Severity of Uncomplicated Diaper Dermatitis in Infants were used for data collection.

RESULTS

There was a statistically significant difference between children who used breast milk application to prevent dermatitis compared to children whose parents received diaper-area care education and a control group (p = 0.002).

CONCLUSIONS

It was determined that topical breast milk application and diaper-area care education given to mothers were effective in preventing diaper dermatitis, and the application of breast milk was found to be safe and more effective than education.

PRACTICE IMPLICATIONS

These findings highlight the need for education, information and practical solutions to prevent and appropriately treat diaper dermatitis.

Effects of Liquid and Bar Soaps on the Skin of Brazilian Newborns: A Randomized Controlled Trial

INTRODUCTION

Compared to adults, newborns' skin has a thinner epidermis and stratum corneum with decreased hydration levels, higher transepidermal water loss, and a pH variation between 5.5 and 7.5. These characteristics can predispose to the occurrence of dryness, infections, and dermatological conditions. Water and liquid soap with adequate formulation have shown to be beneficial and safe for newborns' skin. However, studies evaluating the effect of bar soap, products widely used in Brazil and Latin America, are unknown. Therefore, the objective of this study was to compare the effects of liquid and bar soaps on the term newborns' skin.

METHODS

This randomized controlled, parallel, single-blind clinical trial was conducted at a public university hospital in São Paulo, Brazil. 100 healthy term newborns with no congenital anomalies, acute diseases, or dermatological conditions were randomized to use liquid soap (experimental group) or bar soap (control group). Skin pH, transepidermal water loss, stratum corneum hydration, sebum content, and skin condition were assessed before and after the first bath, at 48 h, 14 days, and 28 days after birth. These evaluations were performed on the forearm, abdomen, buttocks, and thigh. In addition, the mother's perception of soap use was also evaluated.

RESULTS

Data of 100 newborns were analyzed by intention to treat. The rate of retention was 53%. Newborns exposed to the liquid soap presented significantly better skin acidification (p < 0.001) and significantly better stratum corneum hydration (p < 0.001) than the skin of newborns exposed to the bar soap, regardless of the area evaluated. There were no significant differences in transepidermal water loss, sebum content, dryness, erythema, or skin breakdown and the mother's perceptions of the use of the soaps.

CONCLUSION

Newborns in the experimental group presented better skin acidification and stratum corneum hydration when compared to newborns in the control group.

Evidence-Based Consensus Recommendations for Skin Care in Healthy, Full-Term Neonates in India

Purpose

Neonatal skin care practices guided by personal experience and preferences might be substantially different across different hospital settings. The aim of this consensus recommendation is to provide clinical practice guidance to healthcare practitioners on evidence-based neonatal skin care practices from delivery-to-discharge, in hospital settings.

Patients and Methods

A Scientific Advisory Board meeting on "Evidence-based Neonatal Skin Care Practices and Protocols" was held in December 2020 with an expert panel comprising neonatologists, pediatricians, obstetricians and gynecologists and pediatric dermatologist. Comprehensive literature search was performed up to 23 March 2021 using PubMed and Google Scholar to retrieve relevant evidence.

Results

Recommendations were developed on critical aspects of skin care in healthy full-term neonates including cleansing at birth, skin-to-skin care, cord care, diaper area care, initial and routine bathing, cleansers and emollients use, and criteria to choose appropriate skin care products. Recommendations include inclusion of skin assessment in routine neonatal care, first bath timing after cardio-respiratory and thermal stabilization, 6-24 hours after birth; bathing with water alone or adding a mild liquid cleanser could be considered appropriate as it does not impact the developing skin barrier; use of emollients is recommended for neonates with higher risk of development of eczema to maintain and enhance skin barrier function and integrity; and inclusion of skin care advice in neonatal discharge checklist. Importance of rigorous quality control, high-quality clinical trials for assessment of baby products, usage of products that are formulated appropriately for newborns, and full label transparency for baby products were highlighted. The panel identified gaps in literature and discussed the scope for future research.

Conclusion

These recommendations may help to standardize evidence-based skin care for healthy full-term neonates in Indian hospital settings to improve the quality of care that neonates receive in hospital and facilitate improvement in overall neonatal health outcomes.

Timing of Post-bath Skin Moisturizer Application to Newborn Infants: A Randomized Controlled Study

OBJECTIVE

To investigate whether the timing of postbath moisturizer application affected the skin moisture (SM) and body temperature (BT) of newborn infants.

METHODS

The researchers conducted a randomized controlled study with 80 newborns who were monitored in a university hospital between March 2017 and May 2018. In both the control and experimental groups, newborns were bathed and dried. However, in the control group, moisturizer was applied immediately to the newborn's body, whereas in the experimental group, moisturizer was applied 10 minutes after the completion of the bath. Researchers evaluated the BT and SM of all infants both before and immediately after the bath and at 10, 20, 40, and 60 minutes postbath.

RESULTS

The control and experimental groups were similar according to the descriptive characteristics of the infants (P > .05). In both groups, infants' SM values increased in the first 10 minutes after the bath compared with the prebath values (P < .05). However, the whole-body SM value of the experimental group was significantly higher than that of the control group 60 minutes postbath (P = .027). There was also a statistically significant change in the body temperatures of infants in both groups after bathing (P = .004).

CONCLUSIONS

Waiting 10 minutes postbath before applying moisturizer positively affected newborns' SM and BT. Additional research with a broader age range and a more diverse sample is needed to further clarify the effects of postbath moisturizer application timing on newborns' SM and BT.

Effect of Palmar Grasp Reflex Stimulation on Physiological Parameters and Crying Time During Neonatal Bath: A Randomized Controlled Trial

OBJECTIVE

This study aimed to determine the effect of palmar grasp reflex stimulation during a neonatal bath on the physiological parameters and crying time of the newborn.

DESIGN, SETTING, AND PARTICIPANTS

This study was designed as a parallel randomized clinical trial. Parents fully understood the study procedure at the Neonatal Intensive Care Unit in Turkey (N = 82). Both written and verbal consent was obtained from the parents. Newborns who were ineligible for tub bathing were excluded from the study. The babies in the control group were given baths according to the tub bathing standards. Babies in the experimental group were given palmar grasp reflex stimulation during the baths. The variables examined included body temperature, respiratory rate, pulse, oxygen saturation levels, and crying time. In all analyses, p < 0.05 was accepted as statistically significant.

RESULTS

The heart rate of the experimental group was 5.2 beats per minute slower than the control group (χ2 = 12.272; p < 0.001). The respiratory rate of the experimental group was 1.3 lower per minute compared to the control group (χ2 = 43.219; p < 0.001). In addition, the oxygen saturation level (%) of the experimental group was 0.4 higher than the control group (χ2 = 5.793; p < 0.016). Crying time was higher in the control group during bathing (p < 0.001).

CONCLUSION

The results showed that the palmar grasp reflex in newborn bathing helps to maintain the stability of physiological parameters and shortens the crying time of babies. Palmar grasp reflex stimulation is recommended in interventions that may cause stress.

Skin care interventions in infants for preventing eczema and food allergy

BACKGROUND

Eczema and food allergy are common health conditions that usually begin in early childhood and often occur in the same people. They can be associated with an impaired skin barrier in early infancy. It is unclear whether trying to prevent or reverse an impaired skin barrier soon after birth is effective for preventing eczema or food allergy.

OBJECTIVES

Primary objective To assess the effects of skin care interventions such as emollients for primary prevention of eczema and food allergy in infants. Secondary objective To identify features of study populations such as age, hereditary risk, and adherence to interventions that are associated with the greatest treatment benefit or harm for both eczema and food allergy.

SEARCH METHODS

We performed an updated search of the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, and Embase in September 2021. We searched two trials registers in July 2021. We checked the reference lists of included studies and relevant systematic reviews, and scanned conference proceedings to identify further references to relevant randomised controlled trials (RCTs).  SELECTION CRITERIA: We included RCTs of skin care interventions that could potentially enhance skin barrier function, reduce dryness, or reduce subclinical inflammation in healthy term (> 37 weeks) infants (≤ 12 months) without pre-existing eczema, food allergy, or other skin condition. Eligible comparisons were standard care in the locality or no treatment. Types of skin care interventions could include moisturisers/emollients; bathing products; advice regarding reducing soap exposure and bathing frequency; and use of water softeners. No minimum follow-up was required.

DATA COLLECTION AND ANALYSIS

This is a prospective individual participant data (IPD) meta-analysis. We used standard Cochrane methodological procedures, and primary analyses used the IPD dataset. Primary outcomes were cumulative incidence of eczema and cumulative incidence of immunoglobulin (Ig)E-mediated food allergy by one to three years, both measured at the closest available time point to two years. Secondary outcomes included adverse events during the intervention period; eczema severity (clinician-assessed); parent report of eczema severity; time to onset of eczema; parent report of immediate food allergy; and allergic sensitisation to food or inhalant allergen.

MAIN RESULTS

We identified 33 RCTs comprising 25,827 participants. Of these, 17 studies randomising 5823 participants reported information on one or more outcomes specified in this review.  We included 11 studies, randomising 5217 participants, in one or more meta-analyses (range 2 to 9 studies per individual meta-analysis), with 10 of these studies providing IPD; the remaining 6 studies were included in the narrative results only.   Most studies were conducted at children's hospitals. Twenty-five studies, including all those contributing data to meta-analyses, randomised newborns up to age three weeks to receive a skin care intervention or standard infant skin care. Eight of the 11 studies contributing to meta-analyses recruited infants at high risk of developing eczema or food allergy, although the definition of high risk varied between studies. Durations of intervention and follow-up ranged from 24 hours to three years. All interventions were compared against no skin care intervention or local standard care. Of the 17 studies that reported information on our prespecified outcomes, 13 assessed emollients. We assessed most of the evidence in the review as low certainty and had some concerns about risk of bias. A rating of some concerns was most often due to lack of blinding of outcome assessors or significant missing data, which could have impacted outcome measurement but was judged unlikely to have done so. We assessed the evidence for the primary food allergy outcome as high risk of bias due to the inclusion of only one trial, where findings varied based on different assumptions about missing data. Skin care interventions during infancy probably do not change the risk of eczema by one to three years of age (risk ratio (RR) 1.03, 95% confidence interval (CI) 0.81 to 1.31; risk difference 5 more cases per 1000 infants, 95% CI 28 less to 47 more; moderate-certainty evidence; 3075 participants, 7 trials) or time to onset of eczema (hazard ratio 0.86, 95% CI 0.65 to 1.14; moderate-certainty evidence; 3349 participants, 9 trials). Skin care interventions during infancy may increase the risk of IgE-mediated food allergy by one to three years of age (RR 2.53, 95% CI 0.99 to 6.49; low-certainty evidence; 976 participants, 1 trial) but may not change risk of allergic sensitisation to a food allergen by age one to three years (RR 1.05, 95% CI 0.64 to 1.71; low-certainty evidence; 1794 participants, 3 trials). Skin care interventions during infancy may slightly increase risk of parent report of immediate reaction to a common food allergen at two years (RR 1.27, 95% CI 1.00 to 1.61; low-certainty evidence; 1171 participants, 1 trial); however, this was only seen for cow's milk, and may be unreliable due to over-reporting of milk allergy in infants. Skin care interventions during infancy probably increase risk of skin infection over the intervention period (RR 1.33, 95% CI 1.01 to 1.75; risk difference 17 more cases per 1000 infants, 95% CI one more to 38 more; moderate-certainty evidence; 2728 participants, 6 trials) and may increase the risk of infant slippage over the intervention period (RR 1.42, 95% CI 0.67 to 2.99; low-certainty evidence; 2538 participants, 4 trials) and stinging/allergic reactions to moisturisers (RR 2.24, 95% 0.67 to 7.43; low-certainty evidence; 343 participants, 4 trials), although CIs for slippages and stinging/allergic reactions were wide and include the possibility of no effect or reduced risk. Preplanned subgroup analyses showed that the effects of interventions were not influenced by age, duration of intervention, hereditary risk, filaggrin (FLG) mutation, chromosome 11 intergenic variant rs2212434, or classification of intervention type for risk of developing eczema. We could not evaluate these effects on risk of food allergy. Evidence was insufficient to show whether adherence to interventions influenced the relationship between skin care interventions and eczema or food allergy development.

AUTHORS' CONCLUSIONS

Based on low- to moderate-certainty evidence, skin care interventions such as emollients during the first year of life in healthy infants are probably not effective for preventing eczema; may increase risk of food allergy; and probably increase risk of skin infection. Further study is needed to understand whether different approaches to infant skin care might prevent eczema or food allergy.

Effects of swaddled and traditional tub bathing on stress and physiological parameters of preterm infants: A randomized clinical trial in China

PURPOSE

The present research aims to study the effects of swaddled and traditional tub bathing on premature infants to identify better ways to bathe.

DESIGN AND METHODS

Eligible premature infants (n = 60) were randomly assigned to either swaddled bathing or traditional tub bathing group. Stress scores and physiological indicators were measured 10 min before, immediately after, and 10 min after bathing. Crying times were also recorded for both groups. Data were reported as mean and standard deviation (SD) or frequency (percentage). For analyzing the data, the Student t-test and Chi-square test were employed.

RESULTS

Swaddled bathing has less effect on the respiratory rate, heart rate, and oxygen saturation (p < 0.05). Both bathing methods led to a decrease in the temperature of infants. Still, the temperature of infants 10 min after bathing, in the swaddled bathing group was rose higher than the traditional tub bathing (t = 2.813, p < 0.05). The stress score of the swaddled bathing group, immediately after and ten minutes after bathing was lower than the traditional tub bathing group. The crying time of the swaddled bathing group was 32 ± 24.740(s) lower than the traditional tub bathing group 94.43 ± 41.625(s).

CONCLUSIONS

The advantages of swaddled bathing over traditional tub bathing were validated for feasibility in China's preterm infants. Swaddled bathing is recommended method for bathing technique in the neonatal intensive care unit.

PRACTICE IMPLICATIONS

Swaddled bathing is beneficial for the development of premature infants, as it results in less noxious stimuli and stress on the developing premature neonates.

Baby wipes and nappy rash - what is the relationship? A review

Baby wipes are a commonly used cleansing method for infants. A literature review has been performed to assess if using baby wipes is beneficial or harmful compared to water and cloth in terms of nappy rash. This includes a detailed analysis of baby wipe ingredients, as many skin irritants as well as allergens are identified. MedLine, Embase and PubMed were searched and after 420 titles and abstracts were screened, 21 studies remained for inclusion. Baby wipes are deemed as superior to water and cloth in the majority of the literature. However, no definitive conclusion can be drawn as many studies are also industry funded. The most notable allergens identified are fragrances, such as linalool, cocamidopropyl betaine (surfactant), formaldehyde-releasing preservatives and other preservatives, including methylisothiazolinone and methylchloroisothiazolinone. As not all allergens are listed on the label accurately, this can be misleading for the consumer.

Variation in Newborn Skincare Policies Across United States Maternity Hospitals

OBJECTIVE

Newborn skincare influences levels of beneficial factors from vernix and vaginal secretions but also the emergence of potential skin pathogens. However, evidence-based national guidelines for newborn skincare do not exist, and actual hospital practices for newborn skincare have not been described. In this study, we test the hypothesis that US maternity hospitals follow differing policies with regard to newborn skincare.

METHODS

A 16-question survey querying skin care practices was distributed to nursery medical directors at the 109 US hospital members of the Better Outcomes through Research for Newborns network. Data from free text responses were coded by 2 study personnel. Survey responses were analyzed by using descriptive statistics and compared by region of the United States.

RESULTS

Delaying the first newborn bath by at least 6 hours is a practice followed by 87% of US hospitals surveyed. Discharging newborns without a bath was reported in 10% of hospitals and was more common for newborns born in nonacademic centers and on the West Coast. Procedures and products used for newborn skincare varied significantly. Parental education on tub immersion and soap use was also inconsistent and potentially contradictory between providers. Evidence cited by hospitals in forming their policies is scant.

CONCLUSION

In this study, we identify similar and strikingly different newborn skincare policies across a national network of US maternity hospitals. Research is needed to identify effects of differing skincare routines on skin integrity, infection rates, and childhood health outcomes to improve the evidence base for the care of newborn skin.

The evidence for interventions in early childhood allergy prevention - towards a living systematic review: protocol

Background: Research in early childhood allergy prevention (ECAP) is flourishing and new intervention strategies have proven to be promising. Due to the dynamic nature of ECAP, gaps between what is known and how guidelines inform practice are likely. A living systematic review (LSR) can narrow this gap by incorporating new evidence as it becomes available. No efficacy comparisons across various ECAP interventions for similar outcomes have been carried out. Networks of randomised clinical trials can be evaluated in the context of a network meta-analysis (NMA). We aim to establish a LSR on the efficacy and safety of any intervention investigated in randomised controlled trials (RCT) to prevent the occurrence of allergic sensitisation (AS), symptoms or diagnoses of allergic diseases in infancy and early childhood (0-3 years). Methods: A baseline SR will synthesise the evidence from existing SRs of RCTs as well as RCTs not yet considered in these. After completion of the baseline SR we propose to conduct a LSR. Using this methodology, we aim to undertake constant evidence surveillance, three-monthly search updates, and review updates every three months, should new evidence emerge. Conclusions: The ECAP evidence landscape has undergone dramatic transformations and this process is likely to continue. As a response to this, a LSR offers the potential to allow more timely synthesis of new evidence as it emerges. Long gaps between updates of SRs makes it harder for guidelines and recommendations to be up to date. Users of information, such as parents, may be confused if they encounter new evidence that is not part of a trusted guideline. A LSR approach allows us to continuously search the literature and update the evidence-base of existing ECAP interventions resulting in a decreased timespan from evidence accrual to informing clinical practice.

Application of in vitro methods to evaluate the safety of baby care products

Draize rabbit eye irritation and skin irritation tests are widely used in the chemical industry as traditional methods to evaluate the safety of cosmetics. However, great differences among laboratories have caused great doubt in the industry. In addition, with vigorous development of the global animal protection movement, developed countries have launched the "3R" campaign, and various kinds of in vitro alternative methods have emerged. Hen's egg test on the chorioallantoic membrane (HET-CAM), which is similar to the structure of the human cornea and has a clear and complete vascular system, is based on the characteristics of the chorioallantoic membrane (CAM) in mid-term SPF egg embryos. The reconstructed human epidermis (EpiSkin®) is composed of normal human keratinocytes that are histologically similar to human epidermises seen in vivo, and it is cultured on a collagen matrix. Similar to EpiSkin®, Human Corneal Epithelium (SkinEthic™) is another reconstructed 3D human-corneal structure that is an alternative to the traditional eye irritation test. Three in vitro methods were conducted to evaluate the safety of 12 baby care products, which included the most common types. In addition, a consumer research study was also carried out for two weeks to evaluate the safety. The results of the reconstructed human epidermis model, human corneal epithelium model and consumer research showed that no irritation was found in any test products; however, HET-CAM tests showed positive results.

Effect of education on the readiness levels of primigravida women to hygienic care practices of the newborn with the use of QR code

The researcers planned this study to determine the effect of the education on the hygienic care of the newborn with the use of QR Code on readiness levels of primigravida women to hygienic care practices of the newborn. A total of 68 primigravida women constituted of this interventional study. After the intervention group completed their education on newborn care, mobile application and QR codes were introduced to the pregnant women. The control group received routine newborn care training. It was observed that the education of hygienic care to the newborn, which was provided to pregnant women with the use of QR Code, was effective on their readiness to care. Pediatric nurses can provide QR code supported training to prepare pregnant women for the hygienic care of the newborn.

Skin care interventions in infants for preventing eczema and food allergy

BACKGROUND

Eczema and food allergy are common health conditions that usually begin in early childhood and often occur together in the same people. They can be associated with an impaired skin barrier in early infancy. It is unclear whether trying to prevent or reverse an impaired skin barrier soon after birth is effective in preventing eczema or food allergy.

OBJECTIVES

Primary objective To assess effects of skin care interventions, such as emollients, for primary prevention of eczema and food allergy in infants Secondary objective To identify features of study populations such as age, hereditary risk, and adherence to interventions that are associated with the greatest treatment benefit or harm for both eczema and food allergy.

SEARCH METHODS

We searched the following databases up to July 2020: Cochrane Skin Specialised Register, CENTRAL, MEDLINE, and Embase. We searched two trials registers and checked reference lists of included studies and relevant systematic reviews for further references to relevant randomised controlled trials (RCTs). We contacted field experts to identify planned trials and to seek information about unpublished or incomplete trials.

SELECTION CRITERIA

RCTs of skin care interventions that could potentially enhance skin barrier function, reduce dryness, or reduce subclinical inflammation in healthy term (> 37 weeks) infants (0 to 12 months) without pre-existing diagnosis of eczema, food allergy, or other skin condition were included. Comparison was standard care in the locality or no treatment. Types of skin care interventions included moisturisers/emollients; bathing products; advice regarding reducing soap exposure and bathing frequency; and use of water softeners. No minimum follow-up was required.

DATA COLLECTION AND ANALYSIS

This is a prospective individual participant data (IPD) meta-analysis. We used standard Cochrane methodological procedures, and primary analyses used the IPD dataset. Primary outcomes were cumulative incidence of eczema and cumulative incidence of immunoglobulin (Ig)E-mediated food allergy by one to three years, both measured by the closest available time point to two years. Secondary outcomes included adverse events during the intervention period; eczema severity (clinician-assessed); parent report of eczema severity; time to onset of eczema; parent report of immediate food allergy; and allergic sensitisation to food or inhalant allergen.

MAIN RESULTS

This review identified 33 RCTs, comprising 25,827 participants. A total of 17 studies, randomising 5823 participants, reported information on one or more outcomes specified in this review. Eleven studies randomising 5217 participants, with 10 of these studies providing IPD, were included in one or more meta-analysis (range 2 to 9 studies per individual meta-analysis). Most studies were conducted at children's hospitals. All interventions were compared against no skin care intervention or local standard care. Of the 17 studies that reported our outcomes, 13 assessed emollients. Twenty-five studies, including all those contributing data to meta-analyses, randomised newborns up to age three weeks to receive a skin care intervention or standard infant skin care. Eight of the 11 studies contributing to meta-analyses recruited infants at high risk of developing eczema or food allergy, although definition of high risk varied between studies. Durations of intervention and follow-up ranged from 24 hours to two years. We assessed most of this review's evidence as low certainty or had some concerns of risk of bias. A rating of some concerns was most often due to lack of blinding of outcome assessors or significant missing data, which could have impacted outcome measurement but was judged unlikely to have done so. Evidence for the primary food allergy outcome was rated as high risk of bias due to inclusion of only one trial where findings varied when different assumptions were made about missing data. Skin care interventions during infancy probably do not change risk of eczema by one to two years of age (risk ratio (RR) 1.03, 95% confidence interval (CI) 0.81 to 1.31; moderate-certainty evidence; 3075 participants, 7 trials) nor time to onset of eczema (hazard ratio 0.86, 95% CI 0.65 to 1.14; moderate-certainty evidence; 3349 participants, 9 trials). It is unclear whether skin care interventions during infancy change risk of IgE-mediated food allergy by one to two years of age (RR 2.53, 95% CI 0.99 to 6.47; 996 participants, 1 trial) or allergic sensitisation to a food allergen at age one to two years (RR 0.86, 95% CI 0.28 to 2.69; 1055 participants, 2 trials) due to very low-certainty evidence for these outcomes. Skin care interventions during infancy may slightly increase risk of parent report of immediate reaction to a common food allergen at two years (RR 1.27, 95% CI 1.00 to 1.61; low-certainty evidence; 1171 participants, 1 trial). However, this was only seen for cow's milk, and may be unreliable due to significant over-reporting of cow's milk allergy in infants. Skin care interventions during infancy probably increase risk of skin infection over the intervention period (RR 1.34, 95% CI 1.02 to 1.77; moderate-certainty evidence; 2728 participants, 6 trials) and may increase risk of infant slippage over the intervention period (RR 1.42, 95% CI 0.67 to 2.99; low-certainty evidence; 2538 participants, 4 trials) or stinging/allergic reactions to moisturisers (RR 2.24, 95% 0.67 to 7.43; low-certainty evidence; 343 participants, 4 trials), although confidence intervals for slippages and stinging/allergic reactions are wide and include the possibility of no effect or reduced risk. Preplanned subgroup analyses show that effects of interventions were not influenced by age, duration of intervention, hereditary risk, FLG mutation,  or classification of intervention type for risk of developing eczema. We could not evaluate these effects on risk of food allergy. Evidence was insufficient to show whether adherence to interventions influenced the relationship between skin care interventions and risk of developing eczema or food allergy.

AUTHORS' CONCLUSIONS

Skin care interventions such as emollients during the first year of life in healthy infants are probably not effective for preventing eczema, and probably increase risk of skin infection. Effects of skin care interventions on risk of food allergy are uncertain. Further work is needed to understand whether different approaches to infant skin care might promote or prevent eczema and to evaluate effects on food allergy based on robust outcome assessments.

Bathing or Not Bathing: Which Is Better for Umbilical Cord Separation Time and Bacterial Colonization in Neonates?

Background: Sepsis is the third cause of death in the first month of life, and the umbilical cord is an important source for sepsis Objectives: We compared the effects of bathing or not bathing on bacterial colonization and cord separation time. Methods: A quasi-experimental study assessed term newborns at Golestan hospital, Tehran, Iran, from 2019 to 2020 in three groups. Bath (B) group included neonates who were bathed with tub water every two days (n = 90). Clean product (CP) group neonates were bathed with cleaners every two days (n = 87). Dry care cord (D) group neonates were not bathed during the first 10 days (n = 63). Periumbilical cord swabs were collected on the 10th day and cultured in blood agar and Eosin methylene blue agar. Bacterial sensitivity tests were done by disk diffusion. Results: The average time to cord separation was 8.2 ± 1.74 days (group B: 9.1 ± 2.1 days, group CP: 8.7 ± 1.82 days, group D: 6.8 ± 1.3 days), which was shorter in group D (P= 0.048). The positive culture rates were 77.8% in group B, 78.1% in group CP, and 74.6% in group D, which were not significantly different between the groups (P = 0.073). Staphylococcus aureus was the most common isolated species. Staphylococcus epidermis and Escherichia coli were the other most common species. Conclusions: Bathing with or without cleaners is safe. No-bath and water bath with or without cleaners had no difference in the rate and type of bacterial culture in umbilical cord but the cord separation time was shorter in the no-bath group. Therefore, in the first week, if a mother does not believe in bathing her baby, she should not be denounced and told that she did something wrong with cord hygiene.

What's new in atopic eczema? An analysis of systematic reviews published in 2018. Part 1: prevention and topical therapies

This review is part of a series of annual updates that summarize the evidence base for atopic eczema (AE). The aim is to provide a succinct guide for clinicians on the key findings from 14 systematic reviews on the prevention and topical treatment of AE published or indexed in 2018. Various supplements, including long-chain polyunsaturated fatty acids, vitamin D and the probiotic Lactobacillus rhamnosus GG, given prenatally and postnatally, have not been shown to prevent AE in infants, although mixed strains of probiotics may decrease the risk of AE if given to the mother during pregnancy and to the infant for the first 6 months of life. In the postnatal period, there is no evidence that hydrolysed formula, compared with cow's milk formula (CMF), reduces the risk of AE in partially breastfed infants. However, weak evidence suggests that a specific partially hydrolysed whey formula decreases the risk of AE compared with CMF. No specific skin practices can be recommended to reduce the eczema risk in healthy term babies. There is weak evidence of a low risk of reversible hypothalamic-pituitary-adrenal axis suppression following 2-4 weeks of treatment with low-potency topical steroids, and conflicting evidence as to whether bleach bathing affects skin flora or AE severity. A single study demonstrated that the topical Janus kinase inhibitor tofacitinib at 2% significantly reduces the Eczema Area and Severity Index compared with vehicle. Topical naltrexone cream 1% improves pruritus (measured using a visual analogue scale) by 30% more than placebo. There is weak evidence that topical alternative therapies, including antioxidants, micronutrients and some herbal medicines, may improve AE.

A Randomized Pilot Clinical Assessment Of Three Skincare Regimens On Skin Conditions In Infants

Introduction

Few data are available on the comparison between the effects on infant skin of skin care products and those of water alone.

Patients and methods

In this single-center, evaluator-blind, parallel-group pilot study, healthy infants were randomized to near-daily washing for 12 weeks (starting in the summer and finishing in the winter months) with a mild liquid baby wash followed by use of baby lotion (wash+lotion), water followed by baby lotion (water+lotion), or water alone. Clinical and instrumental assessments of skin moisturization and barrier function were made.

Results

As expected the skin condition in all groups was affected by the change of the season. The skin of infants in all groups was mildly deteriorated (clinical grading) and with reduced moisture levels and increased barrier function. Instrumental measurements indicated that skin moisture and barrier function were better maintained in the wash+lotion and water+lotion groups than in the water-only group at week 12. Clinical assessment scores increased slightly over 12 weeks in all groups (P<0.05). At week 12, the wash+lotion group (n = 44) had significantly less change from baseline in overall skin condition and softness (lower scores) than did the water+lotion (n = 43) or water-only (n = 43) groups. The wash+lotion regimen maintained stable erythema and rash scores with lower mean values over time than in the other groups.

Conclusion

A regimen of a liquid baby wash and a baby skin lotion for 12 weeks resulted in less detrimental changes in instrumental and clinical measures of skin than using water and lotion or water alone.

What's new in atopic eczema? An analysis of systematic reviews published in 2017. Part 1: treatment and prevention

This review forms part of a series of annual updates that summarize the evidence base for atopic eczema (AE). It provides a summary of key findings from 25 systematic reviews that were published or indexed during 2017, and focuses on the treatment and prevention of AE. There is high-quality evidence to demonstrate that dupilumab is better than placebo for the treatment of AE, is not associated with a higher incidence of adverse effects and does not increase the risk of infection compared with placebo; however, comparison studies with other systemic treatments are necessary. Topical tofacitinib is a promising treatment for mild-moderate AE, but currently lacks sufficient evidence from well-designed randomized controlled trials (RCTs) comparing with other active treatments. Topical doxepin may be effective for pruritus in AE, but available studies have short follow-up periods and longer-term outcomes are needed. Bleach baths were no more effective than water baths alone at reducing AE severity. Topical antibiotics cannot be recommended for infected AE, owing to insufficient evidence of benefit. There is little comparison of different emollients in RCTs, but overall evidence indicates that they reduce AE severity, are steroid-sparing and lead to better outcomes in combination with topical corticosteroids (TCS) than TCS alone. No clear benefit was demonstrated for vitamin D/C/E supplementation in pregnancy for eczema prevention.

Evaluation of the Impact of 2 Disposable Diapers in the "Natural" Diaper Category on Diapered Skin Condition

The demand for natural infant care products, including diapers, has increased. However, few disposable diapers have been able to provide the performance caregivers desire while also incorporating ingredients consistent with the "natural" category. In an examiner-blinded clinical study, the performance of a new cotton-enhanced diaper with high-performance materials was compared with an existing natural diaper offering. A total of 131 infants wore 1 of the 2 diapers for a 4-week period. Diaper performance was assessed based on skin marking assessments, scored by a trained grader, and incidence of diaper dermatitis. Skin grading for diaper dermatitis was assessed at 4 sites in the diaper area. The new diaper offering was associated with less skin marking and significantly less diaper rash at the genitals and intertriginous regions versus the comparator. These data suggest that the new diaper provided significant improvement in both skin marking and prevalence of diaper rash.

Cosmetics in use: a pharmacological review

Cosmetics" really comes from its utilization in Ancient Rome. They were commonly delivered by female slaves known as "cosmetae," which is the place "cosmetics" originated from. Cosmetics are utilized to upgrade appearance. Makeup has been around for a long time. The primary known individuals who utilized cosmetics to upgrade their beauty were the Egyptians. Makeup those days was simply basic eye shading or some material for the body. Presently a-days makeup assumes an imperative job for the two men and women. In developmental brain science, social challenge of appearance reinforces women's wants for perfect beauty. As indicated by "The Origin of Species", people have developed to exchange qualities to future ages through sexual determination that respects the body state of perfect beauty as astounding richness. Also, since women's beauty has as of late been viewed as an upper hand to make social power, a body that satisfies the social guidelines of a culture could accomplish restricted social assets. It's hard to believe, but it’s true, even men have turned out to be more beauty cognizant and are worried about their looks. Cosmetics can be delivered in the natural and hypoallergenic structure to fulfill the needs of clients. Makeup is utilized as a beauty help to help develop the self-esteem and certainty of a person. The significance of cosmetics has expanded the same number of individuals need to remain youthful and alluring. Cosmetics are promptly accessible today as creams, lipstick, scents, eye shadows, nail shines, hair showers and so forth. Different cosmetics like face powder offer gleam to the skin subsequent to applying the base cream. At that point we have lipsticks, which are connected by numerous women all things considered. They are produced using wax and cocoa butter in the ideal sum. Cosmetics like creams, gels, and colognes are utilized consistently by the two women and men. Creams go about as a chemical for the face as a rule. All the more as of late enemy of maturing creams have been made which can hold more youthful looking skin for a long time. The best cleansing specialists are cleansing cream, cleanser and water. Cosmetic creams fill in as skin sustenance for hard, dry and dry skin. It fundamentally greases up, diminishes and expels undesirable earth from the skin. Some famous fat creams that are utilized incorporate Vaseline and Lanolin. Dry creams are utilized in the assembling of cleanser and gelatin which is utilized as a base for the skin. Hair care has turned out to be one of the quickest creating markets in the beauty business. Numerous young fellows swing to oils and gels to keep up and style their hair. Items like hair gels, oils, and moisturizers have been acquainted in the market with assistance ensure hair fall and dandruff. A few callings, similar to the entertainment biz industry, center on the significance of the external appearance. Numerous identities and craftsmen have used makeup to beat the brutal lights and the glare of camera flashes. They know the significance of their looks and keep up them by utilizing an assortment of cosmetics. Their appearance is their most profitable resource and they accept each undertaking to show up as the fans need them to show up. Late research has demonstrated that makeup helps in assurance from destructive beams of the sun. Numerous beauty items producers have used the necessities of individuals to shield themselves and their skin from the beams of the sun. This is an extraordinary achievement on the grounds that prior make up and sun assurance could not mix together. Today Cosmetics help to upgrade our appearance and make us feel increasingly certain. With more cosmetics available today than any other time in recent memory, it ends up clear to us that they assume an extraordinary job in our regular daily existence (Figure 1).