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Atluri S, Jeong C, Rick JW, Dagenet C, Tran KA, De DR, Masson R, Hsiao JL, Shi VY. Allergens and Marketing Claims of Popular Baby Washes. Dermatitis 2024; 35:397-399. [PMID: 37890118 DOI: 10.1089/derm.2023.0175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Affiliation(s)
- Swetha Atluri
- University of Arizona College of Medicine Tucson, AZ USA
| | - Charlotte Jeong
- College of Medicine University of Arkansas for Medical Sciences Little Rock, AR USA
| | - Jonathan W Rick
- Department of Dermatology University of Arkansas for Medical Sciences Little Rock, AR USA
| | | | - Khiem A Tran
- Department of Dermatology University of Arkansas for Medical Sciences Little Rock, AR USA
| | - Devea R De
- Jacobs School of Medicine and Biomedical Sciences University at Buffalo Buffalo, NY USA
| | - Rahul Masson
- Keck School of Medicine University of Southern California Los Angeles, CA USA
| | - Jennifer L Hsiao
- Department of Dermatology University of Southern California Los Angeles, CA USA
| | - Vivian Y Shi
- Department of Dermatology University of Arkansas for Medical Sciences Little Rock, AR USA
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Pagliaro M, Pecoraro L, Stefani C, Pieropan S, Piacentini G, Pietrobelli A. Bathing in Atopic Dermatitis in Pediatric Age: Why, How and When. Pediatr Rep 2024; 16:57-68. [PMID: 38251315 PMCID: PMC10801494 DOI: 10.3390/pediatric16010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/06/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
Atopic dermatitis is a chronic inflammatory skin disease. The treatment plays an important role in influencing the patients' quality of life. The basic management consists of appropriate skin cleansing, including bathing and eventually using bathing additives. Recommendations regarding frequency and duration of bathing, water temperature and usefulness of bathing additives are widely different, often leading to confusion among patients. This review aims to give insights into the best bathing practices and the use of bathing additives in atopic dermatitis in children. Several bathing additives, including bleach baths, commercial baby cleansers, bath baby oils and bath salt, appear to be promising adjunctive therapies for atopic dermatitis due to their anti-inflammatory, anti-bacterial, anti-pruritus and skin barrier repair properties through different mechanisms of action. However, their efficacy and safety are not fully understood in some cases. The usefulness of other bath additives, such as acidic and more natural substances (green tea extracts, pine tar, sodium bicarbonate), is still under investigation. Further studies are needed to determine their optimal use to achieve clinical benefit safely.
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Affiliation(s)
- Margherita Pagliaro
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy (C.S.); (A.P.)
| | - Luca Pecoraro
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy (C.S.); (A.P.)
| | - Camilla Stefani
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy (C.S.); (A.P.)
| | - Sara Pieropan
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy (C.S.); (A.P.)
| | - Giorgio Piacentini
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy (C.S.); (A.P.)
| | - Angelo Pietrobelli
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy (C.S.); (A.P.)
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
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Alsatari ES, AlSheyab N, D'Sa JL, Gharaibeh H, Eid S, Al-Nusour EA, Hayajneh AA. Effects of argan spinosa oil in the treatment of diaper dermatitis in infants and toddlers: A quasi-experimental study. J Taibah Univ Med Sci 2023; 18:1288-1298. [PMID: 37275956 PMCID: PMC10239066 DOI: 10.1016/j.jtumed.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/20/2023] [Accepted: 05/10/2023] [Indexed: 06/07/2023] Open
Abstract
Objectives Diaper dermatitis (DD) is one of the most common dermatological disorders in children. Commonly used drugs for treatment have several adverse effects; therefore, assessment of safe therapeutic strategies is necessary. We, therefore, aimed at comparing the efficacy of argan spinosa oil and 1% hydrocortisone ointment on DD healing. Methods A quasi-experimental study was conducted in Jordan on children 2 years old or younger with mild to severe DD. Initially, 73 participants were enrolled in the argan spinosa oil group, and 74 participants were enrolled in the 1% hydrocortisone ointment group. Participants were assigned to groups randomly after the baseline measurement of DD. Healing was measured on a 5-point scale on days 1, 3, and 7, through home visits. Data were analyzed with Fisher's exact test, the Mann-Whitney U test, and generalized estimating equation (GEE) models in SPSS version 25 software, with a significance level of p < 0.05. Results Of the 147 enrolled children, 140 completed the study. A significant decrease in the DD grades was observed in both groups. After the exclusion of confounding factors, the GEE models revealed that children treated with argan spinosa oil were approximately 0.25 times less likely to have severe DD grades and to show faster improvement than children treated with 1% hydrocortisone (p < 0.025). Multiple logistic regression on the baseline data revealed that the use of barrier cream (OR: 0.35; 95% CI: 0.18, 0.72; p = 0.004) and a frequency of bathing one or fewer times per week (OR: 1.15; 95% CI: 0.65, 2.10; p = 0.002) predicted DD occurrence. Conclusion Argan spinosa oil is more effective than 1% hydrocortisone in healing DD and might be used as a complementary treatment. However, further clinical trials on larger samples will be essential for confirming the results and making a reliable judgment. Trial registration NCT04210674.
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Affiliation(s)
- Eman S. Alsatari
- Department of Nursing Education and Development, King Saud University Medical City, Riyadh, KSA
| | - Nihaya AlSheyab
- Department of Maternal and Child Health Nursing, Faculty of Nursing/Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Juliana L. D'Sa
- Department of Maternal and Child Health Nursing, College of Nursing, King Saud University, Riyadh, KSA
| | - Huda Gharaibeh
- Department of Maternal and Child Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Sami Eid
- Department of Nursing Education and Development, King Saud University Medical City, Riyadh, KSA
| | - Esra'a A. Al-Nusour
- Department of Paramedics, Prince Al Hussein Bin Abdullah II Academy for Civil Protection, AlBalqa Applied University, Salt, Jordan
| | - Audai A. Hayajneh
- Department of Adult Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
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Higuchi S, Yoshida S, Minematsu T, Hatano Y, Notsu A, Ichinose T. Comparison of the Effects of Bathing and the Dry Technique on the Skin Condition of Early Neonates: A Prospective Observational Study. Ann Dermatol 2023; 35:256-265. [PMID: 37550226 PMCID: PMC10407340 DOI: 10.5021/ad.22.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 03/24/2023] [Accepted: 05/02/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND In Japan, neonates have typically been bathed in a bathtub immediately after birth because bathing is a custom for cleansing impurities. However, dry technique has been introduced into many institutions since 2000. There is little scientific evidence on the benefit or harmfulness of either method to neonatal skin, and consequently, opinion remains split on which method is superior. OBJECTIVE The purpose of the present study was to determine whether bathing or the dry technique of cleaning is better in maintaining skin health in the early neonatal period. METHODS Transepidermal water loss (TEWL) and skin pH, considered an index of skin barrier function, were measured in each group. Tumor necrosis factor (TNF)-alpha and interleukin (IL)-6, which are inflammatory cytokines released by keratinocytes, were measured by skin blotting. RESULTS TEWL and skin pH of neonates were lower with the dry technique than with bathing. The expression level of IL-6 and TNF-α in chest skin of neonates was higher with bathing than with the dry technique. CONCLUSION These results suggest that the dry technique may maintain skin health better than bathing in the early neonatal period.
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Affiliation(s)
- Sachi Higuchi
- Department of Midwifery, Oita University of Nursing and Health Sciences, Oita, Japan.
| | - Seiichi Yoshida
- Department of Health Sciences, Oita University of Nursing and Health Sciences, Oita, Japan
| | - Takeo Minematsu
- Department of Adult Nursing, Ishikawa Prefectural Nursing University, Ishikawa, Japan
| | - Yutaka Hatano
- Department of Dermatology, Faculty of Medicine, Oita University, Oita, Japan
| | - Akifumi Notsu
- Clinical Research Promotion Unit, Shizuoka Cancer Center, Shizuoka, Japan
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Thoma G, Duthaler RO, Waelchli R, Hauchard A, Bruno S, Strittmatter-Keller U, Orjuela Leon A, Viebrock S, Aichholz R, Beltz K, Grove K, Hoque S, Rudewicz PJ, Zerwes HG. Discovery and Characterization of the Topical Soft JAK Inhibitor CEE321 for Atopic Dermatitis. J Med Chem 2023; 66:2161-2168. [PMID: 36657024 DOI: 10.1021/acs.jmedchem.2c01977] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The JAK kinases JAK1, JAK2, JAK3, and TYK2 play key roles in cytokine signaling. Activation of the JAK/STAT pathways is linked to many diseases involving the immune system, including atopic dermatitis. As systemic JAK inhibitor pharmacology is associated with side effects, topical administration to the skin has been considered to locally restrict the site of action. Several orally bioavailable JAK inhibitors repurposed for topical use have been recently approved or are in clinical development. Here, we disclose our clinical candidate CEE321, which is a potent pan JAK inhibitor in enzyme and cellular assays. In contrast to repurposed oral drugs, CEE321 does not display high potency in blood and has a high clearance in vivo. Therefore, we consider CEE321 to be a "soft drug". When applied topically to human skin that was stimulated with the cytokines IL4 and IL13 ex vivo, CEE321 potently inhibited biomarkers relevant to atopic dermatitis.
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Affiliation(s)
- Gebhard Thoma
- Global Discovery Chemistry, Novartis Institutes for Biomedical Research, 4002 Basel, Switzerland
| | - Rudolf O Duthaler
- Global Discovery Chemistry, Novartis Institutes for Biomedical Research, 4002 Basel, Switzerland
| | - Rudolf Waelchli
- Global Discovery Chemistry, Novartis Institutes for Biomedical Research, 4002 Basel, Switzerland
| | - Alice Hauchard
- Autoimmunity, Transplantation and Inflammation, Novartis Institutes for Biomedical Research, 4002 Basel, Switzerland
| | - Sandro Bruno
- Autoimmunity, Transplantation and Inflammation, Novartis Institutes for Biomedical Research, 4002 Basel, Switzerland
| | - Ulrike Strittmatter-Keller
- Autoimmunity, Transplantation and Inflammation, Novartis Institutes for Biomedical Research, 4002 Basel, Switzerland
| | - Anette Orjuela Leon
- Autoimmunity, Transplantation and Inflammation, Novartis Institutes for Biomedical Research, 4002 Basel, Switzerland
| | - Sabine Viebrock
- Autoimmunity, Transplantation and Inflammation, Novartis Institutes for Biomedical Research, 4002 Basel, Switzerland
| | - Reiner Aichholz
- PK Sciences, Novartis Institutes for BioMedical Research, 4002 Basel, Switzerland
| | - Karen Beltz
- PK Sciences, Novartis Institutes for BioMedical Research, 4002 Basel, Switzerland
| | - Kerri Grove
- Global Discovery Chemistry, Novartis Institutes for BioMedical Research, 5300 Chiron Way, Emeryville, California 94608, United States
| | - Shaila Hoque
- Global Discovery Chemistry, Novartis Institutes for BioMedical Research, 5300 Chiron Way, Emeryville, California 94608, United States
| | - Patrick J Rudewicz
- Global Discovery Chemistry, Novartis Institutes for BioMedical Research, 5300 Chiron Way, Emeryville, California 94608, United States
| | - Hans-Guenter Zerwes
- Autoimmunity, Transplantation and Inflammation, Novartis Institutes for Biomedical Research, 4002 Basel, Switzerland
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Ciprandi G, Crucianelli S, Grussu F, Spuntarelli G, Marino SFM, Urbani U, Bernaschi P, Sisto A, Rizzo MI, Zama M. Meeting the Challenges in Pediatric Wound Care: Our 15-Year Experience with Dialkylcarbamoyl Chloride-Coated Dressing Technology in Acute and Chronic Wounds. CHRONIC WOUND CARE MANAGEMENT AND RESEARCH 2022. [DOI: 10.2147/cwcmr.s376889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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de Bengy AF, Lamartine J, Sigaudo-Roussel D, Fromy B. Newborn and elderly skin: two fragile skins at higher risk of pressure injury. Biol Rev Camb Philos Soc 2022; 97:874-895. [PMID: 34913582 DOI: 10.1111/brv.12827] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 12/02/2021] [Accepted: 12/06/2021] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
| | - Jérôme Lamartine
- Univ. Lyon, Université Claude Bernard Lyon 1, CNRS, LBTI UMR5305, 7 Passage du Vercors, Lyon Cedex 7, F- 69367, France
| | - Dominique Sigaudo-Roussel
- Univ. Lyon, Université Claude Bernard Lyon 1, CNRS, LBTI UMR5305, 7 Passage du Vercors, Lyon Cedex 7, F- 69367, France
| | - Bérengère Fromy
- Univ. Lyon, Université Claude Bernard Lyon 1, CNRS, LBTI UMR5305, 7 Passage du Vercors, Lyon Cedex 7, F- 69367, France
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Armstrong J, Rosinski NK, Fial A, Ansah S, Haglund K. Emollients to Prevent Eczema in High-Risk Infants: Integrative Review. MCN Am J Matern Child Nurs 2022; 47:122-129. [PMID: 35081552 DOI: 10.1097/nmc.0000000000000809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
METHODS Searches were conducted in September 2021 in PubMed, CINAHL, Cochrane Library, and Web of Science using key word search terms dermatitis, atopic, emollients, petrolatum, and infant, newborn. Inclusion criteria were articles written in English published between 2010 and 2021 that tested emollients in high-risk infants and measured the development of AD. RESULTS Eight primary research articles were included. Six studies were limited by small sample sizes, short-term application of emollients, and short-term follow-up. These studies generated inconclusive results. Two large randomized controlled trials (RCTs) with a combined sample of 3,791 infants found no evidence that early, regular use of emollients prevents AD among high-risk infants. CLINICAL IMPLICATIONS Findings from two high-quality RCTs indicate that clinicians should not recommend use of emollients to prevent AD. Clinicians may provide evidence-based recommendations for infant skin care, including bathe with water or a combination of water and liquid cleanser formulated for infants, and avoid soaps. Products applied to skin should be free of scent and contact allergens. Petroleum jelly or mineral oil is appropriate to moisturize infants' skin as needed.
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Zhao Z, Gao XH, Li W, Wang H, Liang Y, Tang J, Yao X, Zhao H, Luger T. Experts' Consensus on the Use of Pimecrolimus in Atopic Dermatitis in China: A TCS-Sparing Practical Approach. Dermatol Ther (Heidelb) 2022; 12:933-947. [PMID: 35313362 PMCID: PMC9021341 DOI: 10.1007/s13555-022-00696-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/14/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Atopic dermatitis (AD) is a chronic, pruritic, inflammatory skin disease with rising prevalence. Topical corticosteroids (TCS) are recommended as first-line therapy for patients with AD in China; however, corticophobia is a widespread concern, which can manifest as noncompliance: in a previous Chinese study, almost all parents whose children had AD were very concerned about the side effects of TCS and, as a result, nearly half did not use it in the event of recurrence. We propose a TCS-sparing treatment algorithm for the management of infants, children, adolescents, and adults with mild-to-moderate AD, to guide clinical practice in China. Methods A panel of eight experts in AD from China and one expert from Germany formed to develop a practical algorithm for the management of mild-to-moderate AD, focusing on pimecrolimus. Results Irrespective of body location, all patients with mild AD (including acute flares) and infants with moderate AD should apply the topical calcineurin inhibitor (TCI) pimecrolimus twice daily to the affected area until symptoms disappear. For children, adolescents, and adults with moderate AD, pimecrolimus should be applied twice daily to sensitive skin areas, and a TCI (either pimecrolimus or tacrolimus) should be applied twice daily to other body locations. Short-term administration of TCS, followed by TCI twice daily, is recommended for most patients with moderate AD experiencing acute flares, regardless of lesion site. Emollients should be used regularly. Conclusions The algorithm presented intends to simplify treatment of AD in China and guide clinical decision-making.
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Affiliation(s)
- Zuotao Zhao
- Department of Dermatology and Venereology National Clinical Research Center for Skin and Immune Diseases, Peking University First Hospital, 8 Xishiku St, Xicheng District, Beijing, China
| | - Xing-Hua Gao
- Department of Dermatology, The First Hospital, China Medical University, 77 Puhe Rd, Shenbei, Shenyang, Liaoning, China
| | - Wei Li
- Department of Dermatology, Huashan Hospital, Fudan University, 796 Jiangsu Rd, Changning District, Shanghai, China
| | - Hua Wang
- Department of Dermatology, Children's Hospital of Chongqing Medical University, 136 Zhongshan 2nd Rd, Liang Lu Kou, Yuzhong District, Chongqing, China
| | - Yunsheng Liang
- Department of Dermatology, Dermatology Hospital, Southern Medical University, Nanfang Ave, Baiyun, Guangzhou, Guangdong, China
| | - Jianping Tang
- Department of Dermatology, Hunan Children's Hospital, 86 Ziyuan Rd, Yuhua District, Changsha, Hunan, China
| | - Xu Yao
- Department of Allergy and Rheumatology, Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, 9 Dongdan 3rd Alley, Dong Dan, Dongcheng, Beijing, China
| | - Hua Zhao
- Department of Dermatology and Venereology, Chinese PLA General Hospital, 4th Ring Road, Beijing, China
| | - Thomas Luger
- Department of Dermatology, University of Münster, Von-Esmarch-Straße 58, 48149, Münster, Germany.
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Rahma A, Lane ME. Skin Barrier Function in Infants: Update and Outlook. Pharmaceutics 2022; 14:433. [PMID: 35214165 PMCID: PMC8880311 DOI: 10.3390/pharmaceutics14020433] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/23/2022] [Accepted: 01/26/2022] [Indexed: 12/10/2022] Open
Abstract
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.
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Affiliation(s)
- Annisa Rahma
- Pharmaceutics Department, School of Pharmacy, Institut Teknologi Bandung, Bandung 40132, Indonesia
- School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK;
| | - Majella E. Lane
- School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK;
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Yun YE, Calderon-Nieva D, Hamadeh A, Edginton AN. Development and Evaluation of an In Silico Dermal Absorption Model Relevant for Children. Pharmaceutics 2022; 14:pharmaceutics14010172. [PMID: 35057066 PMCID: PMC8780349 DOI: 10.3390/pharmaceutics14010172] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/14/2021] [Accepted: 12/29/2021] [Indexed: 02/04/2023] Open
Abstract
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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12
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Zhong B, Jiang K, Wang L, Shen G. Wearable Sweat Loss Measuring Devices: From the Role of Sweat Loss to Advanced Mechanisms and Designs. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2103257. [PMID: 34713981 PMCID: PMC8728835 DOI: 10.1002/advs.202103257] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/15/2021] [Indexed: 05/22/2023]
Abstract
Wearable sweat sensors have received significant research interest and have become popular as sweat contains considerable health information about physiological and psychological states. However, measured biomarker concentrations vary with sweat rates, which has a significant effect on the accuracy and reliability of sweat biosensors. Wearable sweat loss measuring devices (SLMDs) have recently been proposed to overcome the limitations of biomarker tracking and reduce inter- and intraindividual variability. In addition, they offer substantial potential for monitoring human body homeostasis, because sweat loss plays an indispensable role in thermoregulation and skin hydration. Previous studies have not carried out a comprehensive and systematic review of the principles, importance, and development of wearable SLMDs. This paper reviews wearable SLMDs with a new health perspective from the role of sweat loss to advanced mechanisms and designs. Two types of sweat and their measurement significance for practical applications are highlighted. Then, a comprehensive review of advances in different wearable SLMDs based on hygrometers, absorbent materials, and microfluidics is presented by describing their respective device architectures, present situations, and future directions. Finally, concluding remarks on opportunities for future application fields and challenges for future sweat sensing are presented.
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Affiliation(s)
- Bowen Zhong
- State Key Laboratory for Superlattices and Microstructures, Institution of Semiconductors, Chinese Academy of Sciences, Beijing, 100083, China
- Center of Materials Science and Optoelectronic Engineering, University of Chinese Academy of Sciences, Beijing, 100029, China
| | - Kai Jiang
- Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepatobiliary Surgery, Chinese PLA, Beijing, 100853, China
| | - Lili Wang
- State Key Laboratory for Superlattices and Microstructures, Institution of Semiconductors, Chinese Academy of Sciences, Beijing, 100083, China
- Center of Materials Science and Optoelectronic Engineering, University of Chinese Academy of Sciences, Beijing, 100029, China
| | - Guozhen Shen
- State Key Laboratory for Superlattices and Microstructures, Institution of Semiconductors, Chinese Academy of Sciences, Beijing, 100083, China
- Center of Materials Science and Optoelectronic Engineering, University of Chinese Academy of Sciences, Beijing, 100029, China
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Metallinou D, Lazarou E, Lykeridou A. Pharmacological and Non-Pharmacological Brain-Focused Clinical Practices for Premature Neonates at High Risk of Neuronal Injury. MÆDICA 2021; 16:281-290. [PMID: 34621352 DOI: 10.26574/maedica.2020.16.2.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective:Disruption of smooth intrauterine brain development is a significant consequence of premature birth that may lead to adverse neurological outcomes. Although noteworthy progress has been made in the management of prematurity, the rates of neonatal morbidity and neurodevelopmental disorders remain high, underlining the need to find clinical practices that particularly protect the central nervous system. Aim:To identify recent articles regarding pharmacological and non-pharmacological brain-focused clinical practices (BFCP) for premature neonates at high risk of neuronal injury. Material and methods:We did an extensive search of PubMed and Google Scholar for relevant research published between 2000 and 2020. Results:Nineteen full-length original research papers fulfilled the inclusion criteria and were selected for the purpose of the present review. Non-pharmacological BFCP intend to improve the neonate's experience in the NICU environment and can be applied by a multidisciplinary team, while pharmacological ones are related to novel molecules that aim to quell apoptosis and inflammation or promote neurogenesis. Conclusion:In the future, a combination of pharmacological and non-pharmacological BFCP might be considered as the most promising protection and/or treatment provided in clinical practice to premature neonates at high risk of neuronal injury.
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Affiliation(s)
- Dimitra Metallinou
- Department of Midwifery, Faculty of Health and Caring Sciences, University of West Attica, Greece
| | | | - Aikaterini Lykeridou
- Department of Midwifery, Faculty of Health and Caring Sciences, University of West Attica, Greece
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Medical-Grade Honey for the Treatment of Extravasation-Induced Injuries in Preterm Neonates: A Case Series. Adv Neonatal Care 2021; 21:122-132. [PMID: 32675576 DOI: 10.1097/anc.0000000000000781] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Preterm neonates often depend on peripheral intravenous administration of nutrition and medication. Since their skin is not fully developed and very vulnerable, extravasation injury is a risk. Medical-grade honey (MGH) possesses antimicrobial activity and stimulates wound healing; although its use in neonatal patients is limited. CLINICAL FINDINGS We present a case series of 7 preterm neonates (28-36 weeks of gestation) with extravasation injuries secondary to peripheral intravenous administration of total parental nutrition and medication. PRIMARY DIAGNOSIS Extravasation injury following the unintentional leakage of total parenteral nutrition, and medication into the surrounding tissue. Signs of extravasation include local pain, erythema, burning, pruritus, and/or swelling. INTERVENTIONS All extravasation injuries were treated with daily cleaning and application of MGH. Some of the cases needed additional surgical intervention or assisted debridement. OUTCOMES After treatment, all extravasation injury wounds presented with granulation tissue formation progressed to normal epithelialization and closed in 7 to 67 days (median: 32 days). Upon initial application, peripheral edema and inflammation decreased. When present, necrotic tissue was effectively debrided, slough was removed, and no signs of infection were detected, irrespective of initial wound presentations. Cicatrization was minimal, and the full range of motion was preserved in all cases. PRACTICE RECOMMENDATIONS Continuous and thorough assessment of peripheral intravenous line placement for malposition, leaking, and signs of extravasation is needed for fast discovery and prevention of further damage. CONCLUSION Medical-grade honey possesses antimicrobial, anti-inflammatory, and antioxidative activity, enhancing wound healing. Medical-grade honey was safe and effective for treating extravasation-induced injuries, independent of location and severity. We recommend MGH for treating extravasation wounds and consideration for other types of wounds.
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Shahunja KM, Ahmed T, Hossain MI, Mahfuz M, Kendall L, Zhu X, Singh K, Crowther JM, Singh S, Gibson RA, Darmstadt GL. Topical emollient therapy in the management of severe acute malnutrition in children under two: A randomized controlled clinical trial in Bangladesh. J Glob Health 2021; 10:010414. [PMID: 32509290 PMCID: PMC7243074 DOI: 10.7189/jogh.10.010414] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background Topical emollient therapy can improve neonatal health and growth and potentially provides an additional avenue for augmenting the provision of nutrition to children with severe acute malnutrition (SAM). We hypothesised that topical treatment of hospitalised children with SAM using sunflower seed oil (SSO), in addition to standard-of-care for SAM, would improve skin barrier function and weight gain, reduce risk of infection, and accelerate clinical recovery. Methods We conducted a randomised, two-arm, controlled, unblinded clinical trial in 212 subjects aged 2 to 24 months who were admitted for care of SAM at the ‘Dhaka Hospital’ of icddr,b during January 2016 to November 2017. Enrollment was age-stratified into 2 to <6 months and 6 to 24 months age groups in a 1:2 ratio. All children received SAM standard-of-care, and the SSO group was also treated with 3 g of SSO per kg body weight three times daily for 10 days. Primary outcome was rate of weight gain over the 10-day study period. Secondary endpoints included rate of nosocomial infection, time to recovery from acute illness, skin condition score, rate of transepidermal water loss (TEWL) and C-reactive protein (CRP) level. Results Rate of weight gain was higher in the SSO than the control group (adjusted mean difference, AMD = 0.90 g/kg/d, 95% confidence interval (CI) = -1.22 to 3.03 in the younger age stratum), but did not reach statistical significance. Nosocomial infection rate was significantly lower in the SSO group in the older age stratum (adjusted odds ratio (OR) = 0.41, 95% CI = 0.19 to 0.85; P = 0.017), but was comparable in the younger age stratum and overall. Skin condition score improved (AMD = -14.88, 95% CI = -24.12 to -5.65, P = 0.002) and TEWL was reduced overall (AMD = -2.59, 95% CI = -3.86 to -1.31, P < 0.001) in the SSO group. Reduction in CRP level was significantly greater in the SSO group (median: -0.28) than the control group (median 0.00) (P = 0.019) in the younger age stratum. Conclusions Topical therapy with SSO was beneficial for children with SAM when applied as adjunctive therapy. A community-based trial with a longer intervention period is recommended to validate these results. Trial registration ClinicalTrials.gov: NCT02616289
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Affiliation(s)
- K M Shahunja
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Iqbal Hossain
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mustafa Mahfuz
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Lindsay Kendall
- GlaxoSmithKline R&D, Gunnels Wood Road, Stevenage, Hertfordshire, UK
| | - Xinyi Zhu
- GlaxoSmithKline R&D, Gunnels Wood Road, Stevenage, Hertfordshire, UK
| | - Krishan Singh
- GlaxoSmithKline R&D, Gunnels Wood Road, Stevenage, Hertfordshire, UK
| | | | - Sunita Singh
- GlaxoSmithKline R&D, Gunnels Wood Road, Stevenage, Hertfordshire, UK
| | - Rachel A Gibson
- GlaxoSmithKline R&D, Gunnels Wood Road, Stevenage, Hertfordshire, UK
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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Nepalia A, Singh A, Mathur N, Kamath R, Pareek S, Agarwal M. Skincare Products as Sources of Mutagenic Exposure to Infants: An Imperative Study Using a Battery of Microbial Bioassays. ARCHIVES OF ENVIRONMENTAL CONTAMINATION AND TOXICOLOGY 2021; 80:499-506. [PMID: 33523258 DOI: 10.1007/s00244-021-00814-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 01/08/2021] [Indexed: 06/12/2023]
Abstract
Infant skin is highly absorptive and sensitive to exposure from external agents (microbes, toxicants, heat, cold, etc.). Many specialized infant skincare products are currently commercially available. Although the manufacturers claim that their products are mild enough to suit the infant skin, these products need to be studied for their safety. Using animal models to examine the safety of the ever-increasing number of skincare products is not economically or logistically feasible. To overcome this problem, we suggest using a battery of microbial bioassays as a robust system for monitoring the mutagenic potential of skincare products. We picked popular infant skincare products from the Indian market and assessed them by using a battery of three microbial mutagenicity bioassays. Most of them showed significant and reproducible mutagenic potential. Our study results raise concerns about regular use of infant products and emphasize the need to enforce strict regulations for the manufacturing and safety assessment of infant products.
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Affiliation(s)
- Amrita Nepalia
- Environmental Molecular Microbiology Lab (EMM), Department of Zoology, University of Rajasthan, Jaipur, 302004, India.
- Department of Molecular Reproduction and Developmental Genetics, Indian Institute of Science, Bangalore, 560012, India.
| | - Anuradha Singh
- Environmental Molecular Microbiology Lab (EMM), Department of Zoology, University of Rajasthan, Jaipur, 302004, India
| | - Nupur Mathur
- Environmental Molecular Microbiology Lab (EMM), Department of Zoology, University of Rajasthan, Jaipur, 302004, India
| | - Rajashree Kamath
- Economics and Quantitative Techniques Group, CHRIST (Deemed to be University), Bengaluru, 560074, India
| | - Smita Pareek
- Environmental Molecular Microbiology Lab (EMM), Department of Zoology, University of Rajasthan, Jaipur, 302004, India
| | - Maithili Agarwal
- Environmental Molecular Microbiology Lab (EMM), Department of Zoology, University of Rajasthan, Jaipur, 302004, India
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Wang W, Tang C, Ji QL, Xiu H, Shao H, Yu XM. Use of multiple nursing interventions (cluster nursing) in ABO hemolytic disease of neonates and evaluation of its effect. J Int Med Res 2020; 48:300060519887630. [PMID: 31939321 PMCID: PMC7254602 DOI: 10.1177/0300060519887630] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective This study aimed to create a group of nursing intervention (cluster nursing) strategies of phototherapy for neonates and to evaluate clinical effects of intervention measures on reducing neonatal jaundice in neonates. Methods We performed a prospective study. A total of 141 patients with neonatal ABO hemolytic jaundice were included and randomly divided into two groups: intervention group and control group. The intervention group adopted cluster nursing measures in combination with continuous phototherapy (blue light), while the control group adopted routine nursing together with continuous phototherapy (blue light). Results No differences were observed in general characteristics between the groups. On the seventh day of treatment, percutaneous bilirubin levels were significantly lower in the intervention group than in the control group. On the seventh day of treatment, milk intake was significantly higher and the duration of hospitalization was significantly shorter in the intervention group than in the control group. Conclusion Use of cluster nursing measures in combination with phototherapy in neonatal ABO hemolysis can effectively reduce bilirubin levels, improve symptoms of jaundice, and shorten the course of the disease.
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Affiliation(s)
- Wei Wang
- Department of Neonatology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chi Tang
- Department of Neonatology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qing-Lian Ji
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hong Xiu
- Department of Nursing, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hui Shao
- Department of Neonatology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiao-Man Yu
- Department of Neonatology, The Affiliated Hospital of Qingdao University, Qingdao, China
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Madhu R, Chandran V, Anandan V, Nedunchelian K, Thangavelu S, Soans ST, Shastri DD, Parekh BJ, Kumar RR, Basavaraja GV. Indian Academy of Pediatrics Guidelines for Pediatric Skin Care. Indian Pediatr 2020. [DOI: 10.1007/s13312-021-2133-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Gögele C, Schulze-Tanzil G, Kokozidou M, Gäbel C, Billner M, Reichert B, Bodenschatz K. Growth characteristics of human juvenile, adult and murine fibroblasts: a comparison of polymer wound dressings. J Wound Care 2020; 29:572-585. [PMID: 33052799 DOI: 10.12968/jowc.2020.29.10.572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Fibroblasts are important for the successful healing of deep wounds. However, the influence exerted by Cuticell, a natural polymer on fibroblasts and by the synthetic polymer, Suprathel, made of poly-L-lactic acid, is not sufficiently characterised. This study compared the survival and growth characteristics of human juvenile and adult dermal fibroblasts as well as murine fibroblast cell line L929, on a natural polymer with those of a synthetic polymer using different culture models. METHOD Murine, juvenile and adult human fibroblasts were seeded on both the natural and synthetic polymers using statical slide culture or the medium air interface and dynamical rotatory culture. Cell adherence, viability, morphology and actin cytoskeleton architecture were monitored for 1-7 days. Biomaterial permeability was checked with a previously established diffusion chamber. RESULTS The majority of the murine and adult human fibroblasts survived in slide and rotatory cultures on both wound dressings. The fibroblasts seeded on the synthetic polymer exhibited phenotypically a typical spread shape with multiple cell adhesion sites earlier than those on the natural polymer. The highest survival rates in all tested fibroblast species over the entire observation time were detected in rotatory culture (mean: >70%). Nevertheless, it led to cell-cluster formation on both materials. In the medium air interface culture, few adult fibroblasts adhered and survived until the seventh day of culture on both the natural and synthetic polymers, and no viable juvenile and L929 fibroblasts could be found by day seven. Apart from a significant higher survival rate of L929 in slide culture on the natural polymer compared with the synthetic polymer at the end of the culturing period (p<0.0001), and a higher cell survival of L929 on the natural polymer in medium air interface culture, only minor differences between both materials were evident. This suggested a comparable cytocompatibility of both materials. Permeability testing revealed slightly higher permeance of the natural polymer compared with the synthetic polymer. CONCLUSION Cell survival rates depended on the culture system and the fibroblast source. Nevertheless, the juvenile skin fibroblasts were the most sensitive. This observation suggests that wound dressings used in treating children should be tested beforehand with juvenile fibroblasts to ensure the dressing does not compromise wound healing. Future experiments should also include the response of compromised fibroblasts, for example, from burn patients.
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Affiliation(s)
- Clemens Gögele
- Institute of Anatomy and Cell Biology, Paracelsus Medical University, Salzburg and Nuremberg, Department Nuremberg, Prof.-Ernst Nathan Strasse 1, 90419 Nuremberg, Germany.,Department of Biosciences, Paris Lodron University of Salzburg, Hellbrunnerstr. 34, 5020 Salzburg, Austria
| | - Gundula Schulze-Tanzil
- Institute of Anatomy and Cell Biology, Paracelsus Medical University, Salzburg and Nuremberg, Department Nuremberg, Prof.-Ernst Nathan Strasse 1, 90419 Nuremberg, Germany
| | - Maria Kokozidou
- Institute of Anatomy and Cell Biology, Paracelsus Medical University, Salzburg and Nuremberg, Department Nuremberg, Prof.-Ernst Nathan Strasse 1, 90419 Nuremberg, Germany
| | - Christiane Gäbel
- Leibniz-Institute for Polymer Research, Institute of Polymer Materials, Dresden, Hohe Straße 6, 01069 Dresden, Germany
| | - Moritz Billner
- Department of Plastic, Reconstructive and Hand Surgery, Center of Severe Burn Injuries Nuremberg General Hospital / Paracelsus Medical University Salzburg and Nuremberg, Department Nuremberg, Breslauer Straße 20, 90471 Nuremberg, Germany
| | - Bert Reichert
- Department of Plastic, Reconstructive and Hand Surgery, Center of Severe Burn Injuries Nuremberg General Hospital / Paracelsus Medical University Salzburg and Nuremberg, Department Nuremberg, Breslauer Straße 20, 90471 Nuremberg, Germany
| | - Karl Bodenschatz
- Department of Pediatric Surgery and Urology, Nuremberg General Hospital/Paracelsus Medical University Salzburg, Department Nuremberg, Breslauer Straße 201, 90471 Nuremberg, Germany
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20
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Pediatric contact allergens in the neonatal intensive care unit. J Perinatol 2020; 40:1554-1559. [PMID: 32807911 DOI: 10.1038/s41372-020-00769-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 07/15/2020] [Accepted: 08/03/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The degree of neonatal exposure to potentially sensitizing agents on neonatal intensive care units (NICUs) and the process by which personal care products are selected for use in the NICU are poorly documented. STUDY DESIGN We evaluated personal care products used in three NICUs for potentially sensitizing agents. We interviewed NICU staff to analyze how products are selected and approved for use. RESULTS Twenty-four personal care products were evaluated. 75% contained one or more potential contact allergen, with fragrances being most common. Staff preference, brand loyalty, cost, and small product size were often considered when approving NICU products. CONCLUSIONS The prevalence of potentially sensitizing agents in the products indicates a need for improvement in the evaluation and acquisition process of over-the-counter products used for neonatal skin care. The involvement of dermatology in this process may be beneficial.
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Melo TGD, Rosvailer MSC, Carvalho VOD. BATHING, MAKE-UP, AND SUNSCREEN: WHICH PRODUCTS DO CHILDREN USE? REVISTA PAULISTA DE PEDIATRIA 2020; 38:e2018319. [PMID: 32401944 PMCID: PMC7212586 DOI: 10.1590/1984-0462/2020/38/2018319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/18/2019] [Indexed: 11/29/2022]
Abstract
Objective: To evaluate the hygiene practices and frequency of use of personal hygiene
products, cosmetics, and sunscreen among children and adolescents. Methods: Cross-sectional study with interviews about skincare conducted with
caregivers through closed-ended questions. We included patients up to 14
years of age waiting for consultation in pediatric outpatient clinics of a
tertiary hospital. We performed a descriptive statistical analysis and
applied the Kruskal-Wallis test and Fisher’s exact test to compare the
practices according to maternal schooling. Results: We conducted 276 interviews. The median age of the participants was age
four, and 150 (54.3%) were males. A total of 143 (51.8%) participants bathed
once a day and 128 (46.3%) bathed two or more times a day, lasting up to ten
minutes in 132 (47.8%) cases. Adult soap was used by 103 (37.3%) children
and bar soap by 220 (79.7%). Fifty-three (19.2%) participants used sunscreen
daily. Perfume was used by 182 (65.9%) children, hair gel by 98 (35.5%),
nail polish by 62 (22.4%), and some type of make-up by 71 (25.7%) -
eyeshadow by 30 (10.8%), lipstick by 52 (18.8%), face powder and mascara by
13 (4.7%). Make-up use started at a median age of 4 years. Henna tattoo was
done in eight children. Conclusions: The children studied used unsuitable products for their skin, such as those
intended for adults, used sunscreen inadequately, and started wearing
make-up early, evidencing the need for medical orientation.
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22
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Silva PC, Guimarães RN, Souza RG, Reis ZSN. A quantitative cross-sectional analysis of the melanin index in the skin of preterm newborns and its association with gestational age at birth. Skin Res Technol 2019; 26:356-361. [PMID: 31763716 PMCID: PMC7318316 DOI: 10.1111/srt.12810] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/09/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Estimation of gestational age (GA) is important to make timely decisions and provide appropriate neonatal care. Clinical maturity scales to estimate GA have used skin texture and color to assess maturity at birth facing situations of the uncertainty of pregnancy dating. The size and darkness of the areola around the nipple to grade skin characteristics are based on visual appearance. The melanin index (M-Index) is an optical skin parameter related to the melanin content in the tissue. This study is aimed to associate the M-Index of the skin with the GA. METHODS A cross-sectional study evaluated 80 newborns at birth. A photometer device quantified the skin pigmentation on the areolae, forearms, and soles. Paired average differences of M-Index were compared among the three body sites. The skin M-Indexes were compared between subgroups of newborns until 34 weeks or with 34 and more. RESULTS The skin over the areola had the highest values of M-Index compared with the forearm or sole areas (P < .001 for both). Infants with a GA between 34 and <37 weeks had higher M-Index values over the areola than the group with a GA with 24 to <34 weeks: 41.7 (8.9) and 38.3 (10.5) median (IQR), P = .005. CONCLUSIONS The measurable M-Index values have the potential to improve physical evaluation in assessing GA at birth.
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Affiliation(s)
- Paola Conceição Silva
- Faculty of Medicine, Postgraduate Program in Women's Health, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Rodney Nascimento Guimarães
- Faculty of Medicine, Center of Health Informatics, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Zilma Silveira Nogueira Reis
- Faculty of Medicine, Postgraduate Program in Women's Health, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Nishijima K, Yoneda M, Hirai T, Takakuwa K, Enomoto T. Biology of the vernix caseosa: A review. J Obstet Gynaecol Res 2019; 45:2145-2149. [PMID: 31507021 DOI: 10.1111/jog.14103] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 08/14/2019] [Indexed: 12/16/2022]
Abstract
The vernix caseosa is a complex membranous structure comprising 80% water, 10% protein, and 10% lipids including barrier lipids such as ceramides, free fatty acids, phospholipids and cholesterol, synthesized partly by fetal sebaceous glands during the last trimester of pregnancy in an antero-posterior and dorsoventral manner. Because of its lipid content, vernix is hydrophobic and protects the skin from excessive water exposure during the development of the stratum corneum. The vernix caseosa has various functions during fetal transition from an intrauterine to an extrauterine environment, including lubrication of the birth canal during parturition, barrier function to prevent water loss, temperature regulation, for innate immunity and for intestinal development. This review discusses the evidence supporting the prenatal and postnatal functions of vernix caseosa, along with its structure, composition, and physical and biological characteristics. Understanding the biology of the vernix may facilitate improved care of preterm infants immediately post-partum.
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Affiliation(s)
- Koji Nishijima
- Department of Social Welfare Science, Fukui Prefectural University, Fukui, Japan.,General Center for Perinatal, Maternal and Neonatal Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Makoto Yoneda
- Department of Social Welfare Science, Fukui Prefectural University, Fukui, Japan
| | - Takayoshi Hirai
- Department of Social Welfare Science, Fukui Prefectural University, Fukui, Japan
| | - Koichi Takakuwa
- General Center for Perinatal, Maternal and Neonatal Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Ribet V, Gurdak M, Ferret PJ, Brinio E, Giordano Labadie F, Rossi AB. Stepwise approach of development of dermo-cosmetic products in healthy and atopic dermatitis paediatric population: safety evaluation, clinical development and postmarket surveillance. J Eur Acad Dermatol Venereol 2019; 33:2319-2326. [PMID: 31287596 PMCID: PMC6900091 DOI: 10.1111/jdv.15785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 06/18/2019] [Indexed: 12/22/2022]
Abstract
Background/objectives Paediatric skin, considered sensitive, and infant skin, more susceptible to percutaneous toxicity, require specially formulated cosmetic products. As recently shown, early use of emollients in infants “at risk” of developing atopic dermatitis has shown controversial results in reducing the incidence of atopic dermatitis. Development of dermo‐cosmetic products for this specific population should especially ensure tolerance and safety. In absence of good clinical practice guideline, we propose here a stepwise approach for the development of paediatric cosmetic skincare products. Methods Our stepwise methodology for cosmetics aimed at paediatrics, starts with in vitro assessment of product's ingredients safety, followed by preclinical and clinical evaluations of the final product, including sequentially: (1) Repeated Open Application Test (ROAT), (2) Human Repeated Insult Patch Test (HRIPT), (3) In‐use dermatological and ophthalmological tolerance studies (sequentially in 3a: healthy adults, 3b: healthy paediatric subjects and finally 3c: paediatric patients). We also describe the integrated cosmetovigilance–toxicological surveillance during the clinical development phase and postmarketing. Results As illustrated with one dermo‐cosmetic product intended to be used as a preventative/maintenance treatment for atopic dermatitis in paediatric population, we show that using this stepwise methodology to test a product reduces potential risks of irritation and contact dermatitis in this sensitive population. Conclusion Standardized ethical stepwise development approach is needed to ensure the commercialization of safe and well‐tolerated dermo‐cosmetics for paediatrics. The approach described here could potentially serve as guidance for evaluation of new paediatric cosmetic products.
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Affiliation(s)
- V Ribet
- Cosmetovigilance, Pierre Fabre Dermo-Cosmetics, Toulouse, France
| | - M Gurdak
- Research and Development, Clinical Development Division, Pierre Fabre Dermo-Cosmetics, Toulouse, France
| | - P-J Ferret
- Research and Development, Toxicology Division, Pierre Fabre Dermo-Cosmetics, Toulouse, France
| | - E Brinio
- Cosmetovigilance, Pierre Fabre Dermo-Cosmetics, Toulouse, France
| | - F Giordano Labadie
- Department of Dermatology, Paul Sabatier University and Larrey Hospital, Toulouse, France
| | - A B Rossi
- Research and Development, Clinical Development Division, Pierre Fabre Dermo-Cosmetics, Toulouse, France.,Department of Dermatology, Paul Sabatier University and Larrey Hospital, Toulouse, France
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Hu C, Duijts L, Erler NS, Elbert NJ, Piketty C, Bourdès V, Blanchet-Réthoré S, de Jongste JC, Pasmans SGMA, Felix JF, Nijsten T. Most associations of early-life environmental exposures and genetic risk factors poorly differentiate between eczema phenotypes: the Generation R Study. Br J Dermatol 2019; 181:1190-1197. [PMID: 30869802 PMCID: PMC6916296 DOI: 10.1111/bjd.17879] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2019] [Indexed: 12/23/2022]
Abstract
Background Childhood eczema is variable in onset and persistence. Objectives To identify eczema phenotypes during childhood, and their associations with early‐life environmental and genetic factors. Methods In this study of 5297 children from a multiethnic population‐based prospective cohort study, phenotypes based on parent‐reported physician‐diagnosed eczema from age 6 months to 10 years were identified using latent class growth analysis. Information on environmental factors was obtained using postal questionnaires. Four filaggrin mutations were genotyped and a risk score was calculated based on 30 genetic variants. Weighted adjusted multinomial models were used for association analyses. Results We identified the following five eczema phenotypes: never (76%), early transient (8%), mid‐transient (6%) and late transient (8%) and persistent eczema (2%). Early transient and persistent eczema were most common in first‐born children, those with a parental history of eczema, allergy or asthma and those with persistent wheezing [range of odds ratio (OR): 1.37, 95% confidence interval (CI) 1.07–1.74 and OR 3.38, 95%CI 1.95–5.85]. Early transient eczema was most common in male children only (OR 1·49, 95% CI 1·18–1·89). Children with late transient or persistent eczema were more often of Asian ethnicity (OR 2·04, 95% CI 1·14–3·65 and OR 3·08, 95% CI 1·34–7·10, respectively). Children with early, late transient and persistent eczema more often had a filaggrin mutation or additional risk alleles (range OR: 1.07, 95%CI 1.02–1.12 and OR 2.21, 95%CI 1.39–3.50). Eczema phenotypes were not associated with maternal education, breastfeeding, day care attendance and pet exposure. Conclusions Five eczema phenotypes were identified in a multiethnic paediatric population with limited differences in risk profiles, except for sex and ethnicity. What's already known about this topic? Two previous studies in longitudinal birth cohorts identified four and six different eczema phenotypes, predominantly in children of European ethnicity.
What does this study add? Five eczema phenotypes were identified in a multiethnic paediatric population using latent class growth analysis. Children with early transient and persistent eczema were most often first‐born children and had persistent wheezing, filaggrin mutation or additional risk alleles. Previously known eczema risk factors had limited differentiating capabilities for eczema phenotypes, except for the association of early transient eczema with male children, and late transient and persistent eczema with Asian ethnicity.
https://doi.org/10.1111/bjd.18575 available online https://www.bjdonline.com/article/most-associations-of-early-life-environmental-exposures-and-genetic-risk-factors-poorly-differentiate-between-eczema-phenotypes-the-generation-r-study/
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Affiliation(s)
- C Hu
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - L Duijts
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - N S Erler
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - N J Elbert
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - C Piketty
- CUTIS (Clinical Unit for Tests and Imaging of Skin), Evaluation Department, Nestlé Skin Health/Galderma Research and Development, Sophia-Antipolis, France
| | - V Bourdès
- CUTIS (Clinical Unit for Tests and Imaging of Skin), Evaluation Department, Nestlé Skin Health/Galderma Research and Development, Sophia-Antipolis, France
| | - S Blanchet-Réthoré
- CUTIS (Clinical Unit for Tests and Imaging of Skin), Evaluation Department, Nestlé Skin Health/Galderma Research and Development, Sophia-Antipolis, France
| | - J C de Jongste
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - S G M A Pasmans
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J F Felix
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - T Nijsten
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Zhuang L, Gu H, Huang Y, Li X, Lu Y, Kaku K. Development of a new diaper dermatitis-like reconstructed skin equivalent for testing children atopic dermatitis relieving cosmetics. Skin Res Technol 2019; 25:839-845. [PMID: 31218765 DOI: 10.1111/srt.12731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 04/28/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Diaper dermatitis (DD) is the most common acute inflammatory skin disease. It has a serious effect on children's and families' quality of life. We aimed to screen and evaluate the efficacy of different formulas for relieving the diaper dermatitis symptoms by developing a kind of diaper dermatitis-like reconstructed human skin equivalent in vitro. MATERIALS AND METHOD We developed the human skin equivalent for diaper dermatitis with 0.2% Sodium lauryl sulfate (SLS). The diaper dermatitis-like human skin equivalent was characterized by high level of inflammation, such as overexpression of interleukin-1α (IL-1α), and impaired skin barrier. Four formulas with potential of anti-inflammation and promotion of skin barrier function were topically applied on the diaper dermatitis-like human skin equivalent surface. The afterward protection efficacy was evaluated by endpoints of IL-1α, tissue viability, and skin barrier function. RESULTS The chemical irritant induced high release of IL-1α, impaired tissue viability, and skin barrier function. The cream prepared with potential of anti-inflammation and skin protection could effectively decrease and relive the impact of irritant with decreased level of IL-1α and the higher tissue viability than the placebo exposure. CONCLUSION The results showed that diaper dermatitis-like human skin equivalent induced by SLS can mimic the skin irritation response of the diaper rash.
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Affiliation(s)
- Linyi Zhuang
- Pigeon Manufacturing Shanghai Co., Ltd., Shanghai, China
| | - Hongjian Gu
- Pigeon Manufacturing Shanghai Co., Ltd., Shanghai, China
| | - Yu Huang
- Pigeon Manufacturing Shanghai Co., Ltd., Shanghai, China
| | - Xiao Li
- Guangdong Biocell Biotechnology, Ltd., Dongguan, Guangdong, China
| | - Yongbo Lu
- Guangdong Biocell Biotechnology, Ltd., Dongguan, Guangdong, China
| | - Ken Kaku
- Pigeon Manufacturing Shanghai Co., Ltd., Shanghai, China
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Hughes-Formella B, Wunderlich O, Williams R, Fernández J, Kim YZ, Wigger-Alberti W, Pecquet S, Moodycliffe A. Comparison of Skin Structural and Functional Parameters in Well-Nourished and Moderately Undernourished Infants. Skin Pharmacol Physiol 2019; 32:212-223. [PMID: 31167217 DOI: 10.1159/000499434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 03/05/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Little is known about the impact of nutrition on the development of skin structure and function in infants. METHODS We investigated epidermal, dermal, and subcutis parameters of aged-matched well-nourished and moderately undernourished infants in this single-center, cross-sectional, noninterventional study using noninvasive methods (skin caliper, 20-MHz sonography, transepidermal water loss, skin pH, and corneometry). Plasma fatty acids were determined as an indicator of nutritional differences. 310 infants from different age groups, i.e., 1 week, 4 weeks, and 6, 9, 12, 24, and 36 months were included. Approximately half of each age group was well-nourished (WHO reference values weight-for-height/length Zscore: -0.75 ≤ Z ≤ 0.75) and the other half was moderately undernourished (-3 ≤ Z < -2). RESULTS Structural maturational differences in the deeper dermis and subcutis regions of the skin and subtle functional changes in the epidermis were observed in moderately undernourished infants without notable clinical symptoms. Reduced skin barrier function or skin hydration were not observed in the undernourished infants, and skin pH shifted to more acidic values in this group. CONCLUSION These findings reveal a greater impact of moderate undernutrition on the development of the dermis and subcutis and suggest that critical epidermal functions such as skin barrier and pH are mostly maintained.
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Affiliation(s)
| | | | | | - Josefina Fernández
- El Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo, Dominican Republic
| | - Yun Zyong Kim
- El Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo, Dominican Republic
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Krüger EMM, Sinkos F, Uhry JF, Boni JCBD, Okamoto CT, Purin KSM, Nisihara R. DERMATOSES IN THE EARLY NEONATAL PERIOD: THEIR ASSOCIATION WITH NEONATAL, OBSTETRIC AND DEMOGRAPHIC VARIABLES. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2019; 37:297-304. [PMID: 31166467 PMCID: PMC6868561 DOI: 10.1590/1984-0462/;2019;37;3;00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 04/02/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the prevalence of neonatal dermatoses in the early neonatal period and to associate them with neonatal, demographic and obstetric variables. METHODS A cross-sectional study with neonates and their respective mothers, who were hospitalized in a public maternity hospital in Curitiba, PR, Brazil. Data collection was performed using information present in the medical records and a physical examination of the newborn during the period between April 2015 and May 2016. RESULTS 350 neonates were evaluated. 54.8% were male, and 94.8% (332/350) presented a dermatosis. Among them, 84.6% had, concomitantly, two or more dermatoses. A total of 23 types of dermatoses were diagnosed. The most prevalent were: sebaceous hyperplasia (66%); fluff (42.6%); and salmon patches (41.4%). The mean age of the mothers was 24.9±4.9 years old, and they were predominately white (57.7%). Vernix caseosa was associated with the female gender (p=0.034). Nonwhite mothers were associated with genital hyperpigmentation (p=0.03) and Mongolian spots (p=0.001). Physiological flaking was associated with cesarean deliveries (p=0.03) and a gestational age of over 40 weeks (p=0.054). Salmon patches was associated with primiparity (p=0.0001). CONCLUSIONS There was a high prevalence of neonatal dermatosis in the studied population. Each newborn had, on average, three different dermatoses. Dermatosis in neonates was associated with primiparity, nonwhites, a gestational age of over 40 weeks, and the sex of the newborn.
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Comparison of the Effectiveness of New Material Diapers versus Standard Diapers for the Prevention of Diaper Rash in Chinese Babies: A Double-Blinded, Randomized, Controlled, Cross-Over Study. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5874184. [PMID: 30035123 PMCID: PMC6035815 DOI: 10.1155/2018/5874184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/29/2018] [Accepted: 04/23/2018] [Indexed: 11/17/2022]
Abstract
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.
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Vitral GLN, Aguiar RAPL, de Souza IMF, Rego MAS, Guimarães RN, Reis ZSN. Skin thickness as a potential marker of gestational age at birth despite different fetal growth profiles: A feasibility study. PLoS One 2018; 13:e0196542. [PMID: 29698511 PMCID: PMC5919437 DOI: 10.1371/journal.pone.0196542] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 04/14/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND New methodologies to estimate gestational age (GA) at birth are demanded to face the limited access to obstetric ultrasonography and imprecision of postnatal scores. The study analyzed the correlation between neonatal skin thickness and pregnancy duration. Secondarily, it investigated the influence of fetal growth profiles on tissue layer dimensions. METHODS AND FINDINGS In a feasibility study, 222 infants selected at a term-to-preterm ratio of 1:1 were assessed. Reliable information on GA was based on the early ultrasonography-based reference. The thicknesses of the epidermal and dermal skin layers were examined using high-frequency ultrasonography. We scanned the skin over the forearm and foot plantar surface of the newborns. A multivariate regression model was adjusted to determine the correlation of GA with skin layer dimensions. The best model to correlate skin thickness with GA was fitted using the epidermal layer on the forearm site, adjusted to cofactors, as follows: Gestational age (weeks) = -28.0 + 12.8 Ln (Thickness) - 4.4 Incubator staying; R2 = 0.604 (P<0.001). In this model, the constant value for the standard of fetal growth was statistically null. The dermal layer thickness on the forearm and plantar surfaces had a negative moderate linear correlation with GA (R = -0.370, P<0.001 and R = -0.421, P<0.001, respectively). The univariate statistical analyses revealed the influence of underweight and overweight profiles on neonatal skin thickness at birth. Of the 222 infants, 53 (23.9%) had inappropriate fetal growths expected for their GA. Epidermal thickness was not fetal growth standard dependent as follows: 172.2 (19.8) μm for adequate for GA, 171.4 (20.6) μm for SGA, and 177.7 (15.2) μm for LGA (P = 0.525, mean [SD] on the forearm). CONCLUSIONS The analysis highlights a new opportunity to relate GA at birth to neonatal skin layer thickness. As this parameter was not influenced by the standard of fetal growth, skin maturity can contribute to clinical applications.
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Affiliation(s)
- Gabriela Luiza Nogueira Vitral
- Postgraduation Program of Women’s Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Regina Amélia P. Lopes Aguiar
- Postgraduation Program of Women’s Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Department of Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ingrid Michelle Fonseca de Souza
- Postgraduation Program of Women’s Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Maria Albertina Santiago Rego
- Department of Pediatrics, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rodney Nascimento Guimarães
- Postgraduation Program of Women’s Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Department of Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Zilma Silveira Nogueira Reis
- Postgraduation Program of Women’s Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Department of Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Abstract
The labeling of cosmetic products provides a set of obligations, as reported in the Regulation 1223/2009, which came into force in Europe in July 2013. The indications reported on the label are intended to enable the clear identification of the functionality and proper use of cosmetics, ensure the protection of the consumer from the commercial aspects and, above all, from the safety point of view. Moreover, it should allow quick tracing of the product details and all info of toxicological relevance. However, the misuse of this tool often leads, on one side, to confusion among cosmetics, pharmaceuticals, medical devices, and biocides. On the other side, it gives rise to fanciful interpretations by a huge number of web users, who pretend to be able to judge the quality of a cosmetic product just by reading the ingredients list. This article points out the concrete purpose of cosmetic labels, in order to shed light on the use of certain categories of ‘controversial’ ingredients and on the real quality concepts of cosmetic products. Indeed, when properly interpreted, cosmetic labels represent a good tool for the professional investigation of adverse reactions to cosmetics.
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Felter SP, Carr AN, Zhu T, Kirsch T, Niu G. Safety evaluation for ingredients used in baby care products: Consideration of diaper rash. Regul Toxicol Pharmacol 2017; 90:214-221. [DOI: 10.1016/j.yrtph.2017.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/07/2017] [Accepted: 09/10/2017] [Indexed: 01/14/2023]
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Reis ZSN, Vitral GLN, de Souza IMF, Rego MAS, Guimaraes RN. Newborn skin reflection: Proof of concept for a new approach for predicting gestational age at birth. A cross-sectional study. PLoS One 2017; 12:e0184734. [PMID: 28931040 PMCID: PMC5607181 DOI: 10.1371/journal.pone.0184734] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 08/30/2017] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Current methods to assess the gestational age during prenatal care or at birth are a global challenge. Disadvantages, such as low accessibility, high costs, and imprecision of clinical tests and ultrasonography measurements, may compromise health decisions at birth, based on the gestational age. Newborns' organs and tissues can indirectly indicate their physical maturity, and we hypothesized that evolutionary changes in their skin, detected using an optoelectronic device meter, may aid in estimating the gestational age. This study analyzed the feasibility of using newborn skin reflectance to estimate the gestational age at birth noninvasively. METHODS AND FINDINGS A cross-sectional study evaluated the skin reflectance of selected infants, preferably premature, at birth. The first-trimester ultrasound was the reference for gestational age. A prototype of a new noninvasive optoelectronic device measured the backscattering of light from the skin, using a light emitting diode at wavelengths of 470 nm, 575 nm, and 630 nm. Univariate and multivariate regression analysis models were employed to predict gestational age, combining skin reflectance with clinical variables for gestational age estimation. The gestational age at birth of 115 newborns from 24.1 to 41.8 weeks of gestation correlated with the light at 630 nm wavelength reflectance 3.3 mm/6.5 mm ratio distant of the sensor, at the forearm and sole (Pearson's correlation = 0.505, P < 0.001 and 0.710, P < 0.001, respectively). The best-combined variables to predict the gold standard gestational age at birth was the skin reflectance at wavelengths of 630 nm and 470 nm in combination with birth weight, phototherapy, and adjusted to include incubator stay, and sex (R2 = 0.828, P < 0.001). The main limitation of the study is that it was very specific to the premature population we studied and needs to be studied in a broader spectrum of newborns. CONCLUSIONS A novel automated skin reflectometer device, in combination with clinical variables, was able to predict the gestational age and could be useful when the information is in doubt or is unknown. Multivariable predictive models associated the skin reflectance with easy to obtain clinical parameters, at the birth scenario. External validation needs to be proven in an actual population with the real incidence of premature infants.
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Affiliation(s)
- Zilma Silveira Nogueira Reis
- Center of Health Informatics, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Postgraduation Program of Women’s Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Department of Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- * E-mail:
| | - Gabriela Luiza Nogueira Vitral
- Postgraduation Program of Women’s Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Maria Albertina Santiago Rego
- Department of Pediatrics, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rodney Nascimento Guimaraes
- Postgraduation Program of Women’s Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Bender JK, Faergemann J, Sköld M. Skin Health Connected to the Use of Absorbent Hygiene Products: A Review. Dermatol Ther (Heidelb) 2017; 7:319-330. [PMID: 28667496 PMCID: PMC5574741 DOI: 10.1007/s13555-017-0189-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Indexed: 12/16/2022] Open
Abstract
Over the past 50 years, absorbent hygiene products such as baby diapers and incontinence products have become essential features of modern day life. Through innovation and enhanced technology, their design, composition and performance have been dramatically upgraded from their early forms, and they have transformed the lives of millions of people, improving their quality of life. Skin health related to the use of absorbent hygiene products has accordingly also greatly improved. Still, the wearing of absorbent hygiene products will affect the skin, and for some users the changes in microclimate, mechanical interactions and the exposure to urine and faeces may result in irritant contact dermatitis, i.e. diaper dermatitis (DD) or incontinence-associated dermatitis (IAD). Babies with developing skin and the elderly with deteriorating skin functions who are the most frequent users of absorbent hygiene products are more vulnerable to the causal factors. Although irritant reactions are the most common, allergic contact dermatitis should be considered if a DD/IAD fails to improve by recommended actions. There is also a connection between IAD and pressure ulcer development of which it is important to be aware. A holistic approach of using high-quality absorbent hygiene products in combination with appropriate skin care will help maintaining good skin health.
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Affiliation(s)
| | - Jan Faergemann
- Department of Dermatology, Sahlgrenska University Hospital, Göteborg, Sweden
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The Skin as a Route of Allergen Exposure: Part I. Immune Components and Mechanisms. Curr Allergy Asthma Rep 2017; 17:6. [PMID: 28185161 DOI: 10.1007/s11882-017-0674-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW To highlight recent contributions in the literature that enhance our understanding of the cutaneous immune response to allergen. RECENT FINDINGS Defects in skin barrier function in infancy set the stage for the development of atopic dermatitis (AD) and allergy. Both genetic and environmental factors can contribute to damage of the stratum corneum (SC), with activation of specific protease enzymes under high pH conditions playing a key role. Immune cells and mediators in the dermis and epidermis impair SC repair mechanisms and support allergy development. In barrier-disrupted skin, type 2 innate lymphoid cells (ILC2s), mast cells (MCs), and basophils have been shown to promote AD and pathogenic Th2 responses in murine models. Skin barrier disruption favors induction of systemic Th2-associated inflammatory pathways. A better understanding of the ontogeny and regulation of these complex networks in infant skin is needed to guide future strategies for allergy treatment and prevention.
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Martin NA, Falder S. A review of the evidence for threshold of burn injury. Burns 2017; 43:1624-1639. [PMID: 28536038 DOI: 10.1016/j.burns.2017.04.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/05/2017] [Accepted: 04/02/2017] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Burn injury is common and depth is one measure of severity. Although the depth of burn injury is determined by many factors, the relationship between the temperature of the injurious agent and exposure duration, known as the time-temperature relationship, is widely accepted as one of the cornerstones of burn research. Moritz and Henriques first proposed this relationship in 1947 and their seminal work has been cited extensively. However, over the years, readers have misinterpreted their findings and incorporated misleading information about the time-temperature relationship into a wide range of industrial standards, burn prevention literature and medicolegal opinion. AIM The purpose of this paper is to present a critical review of the evidence that relates temperature and time to cell death and the depth of burn injury. These concepts are used by researchers, burn prevention strategists, burn care teams and child protection professionals involved in ascertaining how the mechanism of burning relates to the injury pattern and whether the injury is consistent with the history. REVIEW METHODS This review explores the robustness of the currently available evidence. The paper summarises the research from burn damage experimental work as well as bioheat transfer models and discusses the merits and limitations of these approaches. REVIEW FINDINGS There is broad agreement between in vitro and in vivo studies for superficial burns. There is clear evidence that the perception of pain in adult human skin occurs just above 43°C. When the basal layer of the epidermis reaches 44°C, burn injury occurs. For superficial dermal burns, the rate of tissue damage increases logarithmically with a linear increase in temperature. Beyond 70°C, rate of damage is so rapid that interpretation can be difficult. Depth of injury is also influenced by skin thickness, blood flow and cooling after injury. There is less clinical evidence for a time-temperature relationship for deep or subdermal burns. Bioheat transfer models are useful in research and becoming increasingly sophisticated but currently have limited practical use. Time-temperature relationships have not been established for burns in children's skin, although standards for domestic hot water suggest that the maximum temperature should be revised downward by 3-4°C to provide adequate burn protection for children. CONCLUSION Time-temperature relationships established for pain and superficial dermal burns in adult human skin have an extensive experimental modeling basis and reasonable clinical validation. However, time-temperature relationships for subdermal burns, full thickness burns and burn injury in children have limited clinical validation, being extrapolated from other data, and should be used with caution, particularly if presented during expert evidence.
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Affiliation(s)
- N A Martin
- St. Andrews Centre for Burns and Plastic Surgery, Broomfield Hospital, Chelmsford, Essex CM1 7ET, UK.
| | - S Falder
- Department of Burns and Plastic Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool L12 2AP, UK.
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Yap FHX, Chua HC, Tait CP. Active sunscreen ingredients in Australia. Australas J Dermatol 2017; 58:e160-e170. [DOI: 10.1111/ajd.12597] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 11/06/2016] [Indexed: 12/18/2022]
Affiliation(s)
- Francis HX Yap
- Department of Dermatology; Royal Perth Hospital; Perth Western Australia Australia
| | - Hock C Chua
- Department of Dermatology; Fiona Stanley Hospital; Perth Western Australia Australia
| | - Clare P Tait
- Department of Dermatology; Royal Perth Hospital; Perth Western Australia Australia
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Kanti V, Günther M, Stroux A, Sawatzky S, Henrich W, Abou-Dakn M, Blume-Peytavi U, Garcia Bartels N. Influence of sunflower seed oil or baby lotion on the skin barrier function of newborns: A pilot study. J Cosmet Dermatol 2017; 16:500-507. [DOI: 10.1111/jocd.12302] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Varvara Kanti
- Department of Dermatology and Allergy; Clinical Research Center for Hair and Skin Science; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - Malise Günther
- Department of Dermatology and Allergy; Clinical Research Center for Hair and Skin Science; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - Andrea Stroux
- Department of Dermatology and Allergy; Clinical Research Center for Hair and Skin Science; Charité-Universitätsmedizin Berlin; Berlin Germany
- Department of Medical Statistics and Clinical Epidemiology; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - Sabine Sawatzky
- Department of Dermatology and Allergy; Clinical Research Center for Hair and Skin Science; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - Wolfgang Henrich
- Department of Obstetrics; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - Michael Abou-Dakn
- Department of Maternity; St. Joseph Clinic Berlin Tempelhof; Berlin Germany
| | - Ulrike Blume-Peytavi
- Department of Dermatology and Allergy; Clinical Research Center for Hair and Skin Science; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - Natalie Garcia Bartels
- Department of Dermatology and Allergy; Clinical Research Center for Hair and Skin Science; Charité-Universitätsmedizin Berlin; Berlin Germany
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Blume-Peytavi U, Tan J, Tennstedt D, Boralevi F, Fabbrocini G, Torrelo A, Soares-Oliveira R, Haftek M, Rossi AB, Thouvenin MD, Mangold J, Galliano MF, Hernandez-Pigeon H, Aries MF, Rouvrais C, Bessou-Touya S, Duplan H, Castex-Rizzi N, Mengeaud V, Ferret PJ, Clouet E, Saint Aroman M, Carrasco C, Coutanceau C, Guiraud B, Boyal S, Herman A, Delga H, Biniek K, Dauskardt R. Fragility of epidermis in newborns, children and adolescents. J Eur Acad Dermatol Venereol 2016; 30 Suppl 4:3-56. [PMID: 27062556 DOI: 10.1111/jdv.13636] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 02/10/2016] [Accepted: 02/17/2016] [Indexed: 12/18/2022]
Abstract
Within their first days of life, newborns' skin undergoes various adaptation processes needed to accommodate the transition from the wet uterine environment to the dry atmosphere. The skin of newborns and infants is considered as a physiological fragile skin, a skin with lower resistance to aggressions. Fragile skin is divided into four categories up to its origin: physiological fragile skin (age, location), pathological fragile skin (acute and chronic), circumstantial fragile skin (due to environmental extrinsic factors or intrinsic factors such as stress) and iatrogenic fragile skin. Extensive research of the past 10 years have proven evidence that at birth albeit showing a nearly perfect appearance, newborn skin is structurally and functionally immature compared to adult skin undergoing a physiological maturation process after birth at least throughout the first year of life. This article is an overview of all known data about fragility of epidermis in 'fragile populations': newborns, children and adolescents. It includes the recent pathological, pathophysiological and clinical data about fragility of epidermis in various dermatological diseases, such as atopic dermatitis, acne, rosacea, contact dermatitis, irritative dermatitis and focus on UV protection.
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Affiliation(s)
- U Blume-Peytavi
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin, Berlin, Germany
| | - J Tan
- Department of Medicine, Faculty of Medicine, Schulich School of Medicine and Dentistry, Western University, Windsor campus, Windsor, ON, Canada.,Windsor Clinical Research Inc., Windsor campus, Windsor, ON, Canada
| | - D Tennstedt
- Department of Dermatology, Saint-Luc University Clinics, Brussels, Belgium
| | - F Boralevi
- Pediatric Dermatology, Pellegrin Hospital, Bordeaux, France
| | - G Fabbrocini
- Department of Dermatology, University Hospital of Naples, Naples, Italy
| | - A Torrelo
- Pediatric Dermatology, Hospital del Niño Jesús, Madrid, Spain
| | | | - M Haftek
- University Lyon 1, Lyon, France.,University Lyon 1, EA4169, "Fundamental, clinical and therapeutic aspects of the skin barrier function", Lyon, France
| | - A B Rossi
- Pierre Fabre Dermo-Cosmétique Research & Development, Clinical Division, Toulouse, France.,Department of Dermatology, Toulouse University hospital, France
| | - M D Thouvenin
- Pierre Fabre Dermo-Cosmétique Research & Development, Clinical Division, Toulouse, France
| | - J Mangold
- Pierre Fabre Dermo-Cosmétique Research & Development, Clinical Division, Toulouse, France
| | - M F Galliano
- Pierre Fabre Dermo-Cosmétique Research & Development, Clinical Division, Toulouse, France.,Pierre Fabre Dermo-Cosmétique Research and Development Center, Pharmacology Division, Toulouse, France.,Pierre Fabre Dermo-Cosmétique, Pierre Fabre Research and Development Center, Pharmacology Division, Toulouse, France
| | - H Hernandez-Pigeon
- Pierre Fabre Dermo-Cosmétique Research & Development, Clinical Division, Toulouse, France.,Pierre Fabre Dermo-Cosmétique, Pierre Fabre Research and Development Center, Pharmacology Division, Toulouse, France
| | - M F Aries
- Pierre Fabre Dermo-Cosmétique Research and Development Center, Pharmacology Division, Toulouse, France.,Pierre Fabre Dermo-Cosmétique, Pierre Fabre Research and Development Center, Pharmacology Division, Toulouse, France
| | - C Rouvrais
- Pierre Fabre Dermo-Cosmétique Research & Development, Clinical Division, Toulouse, France
| | - S Bessou-Touya
- Pierre Fabre Dermo-Cosmétique Research & Development, Clinical Division, Toulouse, France.,Pierre Fabre Dermo-Cosmétique Research and Development Center, Pharmacology Division, Toulouse, France.,Medical Department, Pierre Fabre Research and Laboratoires Dermatologiques A-Derma, Lavaur, France.,Pierre Fabre Dermo-Cosmétique, Pierre Fabre Research and Development Center, Pharmacology Division, Toulouse, France
| | - H Duplan
- Pierre Fabre Dermo-Cosmétique Research & Development, Clinical Division, Toulouse, France.,Pierre Fabre Dermo-Cosmétique Research and Development Center, Pharmacology Division, Toulouse, France.,Pierre Fabre Dermo-Cosmétique, Pierre Fabre Research and Development Center, Pharmacology Division, Toulouse, France
| | - N Castex-Rizzi
- Pierre Fabre Dermo-Cosmétique Research & Development, Clinical Division, Toulouse, France.,Pierre Fabre Dermo-Cosmétique Research and Development Center, Pharmacology Division, Toulouse, France.,Pierre Fabre Dermo-Cosmétique, Pierre Fabre Research and Development Center, Pharmacology Division, Toulouse, France
| | - V Mengeaud
- Pierre Fabre Dermo-Cosmétique Research & Development, Clinical Division, Toulouse, France.,Pierre Fabre Dermo-Cosmétique Research and Development Center, Pharmacology Division, Toulouse, France
| | - P J Ferret
- Pierre Fabre Dermo-Cosmétique Research & Development, Toxicology Division, Vigoulet-Auzil, France.,Pierre Fabre Dermo-Cosmétique Research & Developement Center, Toxicology division, Vigoulet, France
| | - E Clouet
- Pierre Fabre Dermo-Cosmétique Research & Development, Toxicology Division, Vigoulet-Auzil, France.,Pierre Fabre Dermo-Cosmétique Research & Developement Center, Toxicology division, Vigoulet, France
| | | | - C Carrasco
- Pierre Fabre Dermo-Cosmétique Research & Development, Clinical Division, Toulouse, France.,Pierre Fabre Dermo-Cosmétique Research and Development Center, Pharmacology Division, Toulouse, France.,Pierre Fabre Dermo-Cosmétique, Pierre Fabre Research and Development Center, Pharmacology Division, Toulouse, France
| | - C Coutanceau
- Medical Department, Pierre Fabre Research and Laboratoires Dermatologiques A-Derma, Lavaur, France
| | - B Guiraud
- Pierre Fabre Dermo-Cosmétique Research & Development, Clinical Division, Toulouse, France
| | - S Boyal
- Windsor Clinical Research Inc., Windsor campus, Windsor, ON, Canada
| | - A Herman
- Department of Dermatology, Saint-Luc University Clinics, Brussels, Belgium
| | - H Delga
- Pierre Fabre Dermo-Cosmétique, Pierre Fabre Research and Development Center, Pharmacology Division, Toulouse, France
| | - K Biniek
- Department of Materials Science and Engineering, Stanford University hospital, Stanford, CA, USA
| | - R Dauskardt
- Department of Materials Science and Engineering, Stanford University hospital, Stanford, CA, USA
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Franklin G, Harari H, Ahsan S, Bello D, Sterling DA, Nedrelow J, Raynaud S, Biswas S, Liu Y. Residual Isocyanates in Medical Devices and Products: A Qualitative and Quantitative Assessment. ENVIRONMENTAL HEALTH INSIGHTS 2016; 10:175-190. [PMID: 27773989 PMCID: PMC5067089 DOI: 10.4137/ehi.s39149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 07/31/2016] [Accepted: 08/02/2016] [Indexed: 06/06/2023]
Abstract
We conducted a pilot qualitative and quantitative assessment of residual isocyanates and their potential initial exposures in neonates, as little is known about their contact effect. After a neonatal intensive care unit (NICU) stockroom inventory, polyurethane (PU) and PU foam (PUF) devices and products were qualitatively evaluated for residual isocyanates using Surface SWYPE™. Those containing isocyanates were quantitatively tested for methylene diphenyl diisocyanate (MDI) species, using UPLC-UV-MS/MS method. Ten of 37 products and devices tested, indicated both free and bound residual surface isocyanates; PU/PUF pieces contained aromatic isocyanates; one product contained aliphatic isocyanates. Overall, quantified mean MDI concentrations were low (4,4'-MDI = 0.52 to 140.1 pg/mg) and (2,4'-MDI = 0.01 to 4.48 pg/mg). The 4,4'-MDI species had the highest measured concentration (280 pg/mg). Commonly used medical devices/products contain low, but measurable concentrations of residual isocyanates. Quantifying other isocyanate species and neonatal skin exposure to isocyanates from these devices and products requires further investigation.
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Affiliation(s)
- Gillian Franklin
- Department of Environmental and Occupational Health Sciences, University of North Texas Health Science Center, Fort Worth, TX, USA
- Current Affiliation: Postdoctoral Research Fellow, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Homero Harari
- Department of Work Environment, University of Massachusetts at Lowell, Lowell, MA, USA
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samavi Ahsan
- Department of Environmental and Occupational Health Sciences, University of North Texas Health Science Center, Fort Worth, TX, USA
- CACI International Inc., Arlington, VA, USA
| | - Dhimiter Bello
- Department of Work Environment, University of Massachusetts at Lowell, Lowell, MA, USA
| | - David A. Sterling
- Department of Environmental and Occupational Health Sciences, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Jonathan Nedrelow
- Neonatal Intensive Care Unit, Cook Children’s Hospital, Fort Worth, TX, USA
| | - Scott Raynaud
- Research Administration, Cook Children’s Hospital, Fort Worth, TX, USA
| | - Swati Biswas
- Department of Mathematical Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Youcheng Liu
- Department of Environmental and Occupational Health Sciences, University of North Texas Health Science Center, Fort Worth, TX, USA
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Abstract
BACKGROUND Infant skin is susceptible to dryness and irritation from external factors, including topical skin care products not formulated for the infant's skin. This may increase the risk of contact dermatitis. Parents frequently express concern regarding potential harm from ingredients in skin care products and seek information. This is complicated by several skin care myths. PURPOSE The purpose of this literature review was to provide evidence-based information to educate parents on the use of products for preterm and term infants. SEARCH STRATEGY Multiple searches using PubMed were conducted including the search terms "infant skin care," "infant products," "infant bath," "emollients," "diaper skin care," and "diaper wipes." Reference lists of comprehensive reviews were also scanned. Google searches were used to assess consumer information, product information, and regulatory guidelines. FINDINGS There is little scientific evidence to support safety of natural/organic products on infant skin. Raw materials originate from different sources, complicating testing and comparisons of ingredients. Research shows that cleansers formulated for infant skin do not weaken the skin barrier the way harsher soaps and detergents can. Oils with the lowest oleic acid content provide a lower risk of irritant contact dermatitis. IMPLICATIONS FOR PRACTICE Nurses must be informed about natural and organic products, preservatives, and fragrances and know the definition of commonly used marketing terms. IMPLICATIONS FOR RESEARCH Decisions regarding the use of infant products in preterm and term infants should be evidence based. More research is needed to support claims regarding the safety of products used on infant skin.
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Mendes BR, Shimabukuro DM, Uber M, Abagge KT. Critical assessment of the pH of children's soap. J Pediatr (Rio J) 2016; 92:290-5. [PMID: 26844391 DOI: 10.1016/j.jped.2015.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/20/2015] [Accepted: 08/05/2015] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To evaluate the pH value of children's antibacterial soaps and syndets used in children's baths and verify whether there is information regarding pH on the product label. METHODS Quantitative, cross-sectional, analytical observational study that included ninety soap samples, both in bar and liquid presentations, as follows: 67 children's soap (group 1), 17 antibacterial soaps (group 2), and 6 syndets (group 3). Each sample had its pH measured after 1% dilution. In addition to descriptive statistics, the Pearson-Yates chi-squared test and Student's t-tests were applied, considering the minimal significance level of 5%. The Wilcoxon-Mann-Whitney test, Fisher's exact test, and the Kruskal-Wallis test were used for inferential statistics. RESULTS The pH levels varied considerably between liquid and bar presentations, with lower levels (4.4-7.9) found for the liquids (p<0.05). Syndets showed pH levels close to the ideal (slightly acid) and the antibacterial soaps showed the highest pH levels (up to 11.34) (p<0.05). Only two of the soaps included in the study had information about their pH levels on the product packaging. CONCLUSIONS Knowledge of the pH of children's soap by doctors and users is important, considering the great pH variability found in this study. Moreover, liquid soaps, and especially syndets, are the most recommended for the sensitive skin of neonates and infants, in order to guarantee skin barrier efficacy.
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Affiliation(s)
| | | | - Marjorie Uber
- Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
| | - Kerstin Taniguchi Abagge
- Pediatric Dermatology Unit, Department of Pediatrics, Hospital de Clínicas, Curitiba, PR, Brazil.
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Blume-Peytavi U, Lavender T, Jenerowicz D, Ryumina I, Stalder JF, Torrelo A, Cork MJ. Recommendations from a European Roundtable Meeting on Best Practice Healthy Infant Skin Care. Pediatr Dermatol 2016; 33:311-21. [PMID: 26919683 PMCID: PMC5069619 DOI: 10.1111/pde.12819] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 10/19/2015] [Accepted: 12/15/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND European roundtable meeting recommendations on bathing and cleansing of infants were published in 2009; a second meeting was held to update and expand these recommendations in light of new evidence and the continued need to address uncertainty surrounding this aspect of routine care. METHODS The previous roundtable recommendations concerning infant cleansing, bathing, and use of liquid cleansers were critically reviewed and updated and the quality of evidence was evaluated using the Grading of Recommendation Assessment, Development and Evaluation system. New recommendations were developed to provide guidance on diaper care and the use of emollients. A series of recommendations was formulated to characterize the attributes of ideal liquid cleansers, wipes, and emollients. RESULTS Newborn bathing can be performed without harming the infant, provided basic safety procedures are followed. Water alone or appropriately designed liquid cleansers can be used during bathing without impairing the skin maturation process. The diaper area should be kept clean and dry; from birth, the diaper area may be gently cleansed with cotton balls/squares and water or by using appropriately designed wipes. Appropriately formulated emollients can be used to maintain and enhance skin barrier function. Appropriately formulated baby oils can be applied for physiologic (transitory) skin dryness and in small quantities to the bath. Baby products that are left on should be formulated to buffer and maintain babies' skin surface at approximately pH 5.5, and the formulations and their constituent ingredients should have undergone an extensive program of safety testing. Formulations should be effectively preserved; products containing harsh surfactants, such as sodium lauryl sulfate, should be avoided. CONCLUSION Health care professionals can use these recommendations as the basis of their advice to parents.
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Affiliation(s)
- Ulrike Blume-Peytavi
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tina Lavender
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Dorota Jenerowicz
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Irina Ryumina
- Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Healthcare of Russia, Federal State Budget Institution, Moscow, Russia
| | | | - Antonio Torrelo
- Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Michael J Cork
- Academic Unit of Dermatology Research, Department of Infection and Immunity, Faculty of Medicine, Dentistry and Health, University of Sheffield Medical School, Sheffield, UK
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45
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SanMiguel A, Grice EA. Interactions between host factors and the skin microbiome. Cell Mol Life Sci 2015; 72:1499-515. [PMID: 25548803 PMCID: PMC4376244 DOI: 10.1007/s00018-014-1812-z] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/15/2014] [Accepted: 12/19/2014] [Indexed: 01/12/2023]
Abstract
The skin is colonized by an assemblage of microorganisms which, for the most part, peacefully coexist with their hosts. In some cases, these communities also provide vital functions to cutaneous health through the modulation of host factors. Recent studies have illuminated the role of anatomical skin site, gender, age, and the immune system in shaping the cutaneous ecosystem. Alterations to microbial communities have also been associated with, and likely contribute to, a number of cutaneous disorders. This review focuses on the host factors that shape and maintain skin microbial communities, and the reciprocal role of microbes in modulating skin immunity. A greater understanding of these interactions is critical to elucidating the forces that shape cutaneous populations and their contributions to skin homeostasis. This knowledge can also inform the tendency of perturbations to predispose and/or bring about certain skin disorders.
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Affiliation(s)
- Adam SanMiguel
- Department of Dermatology, University of Pennsylvania, Perelman School of Medicine, 421 Curie Blvd, 1007 Biomedical Research Building II/III, Philadelphia, PA 19104 USA
| | - Elizabeth A. Grice
- Department of Dermatology, University of Pennsylvania, Perelman School of Medicine, 421 Curie Blvd, 1007 Biomedical Research Building II/III, Philadelphia, PA 19104 USA
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46
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Abstract
Infant skin is critical to the newborn child's transition from the womb environment to the journey to self-sufficiency. This review provides an integrative perspective on the skin development in full term and premature infants. There is a particular focus on the role of vernix caseosa and on the implications of skin development for epidermal penetration of exogenous compounds. Healthy full-term newborn skin is well-developed and functional at birth, with a thick epidermis and well-formed stratum corneum (SC) layers. Transepidermal water loss is very low at birth, equal to, or lower than adults, indicating a highly effective skin barrier. Vernix facilitates SC development in full-term infants through a variety of mechanisms including physical protection from amniotic fluid and enzymes, antimicrobial effects, skin surface pH lowering, provision of lipids, and hydration. Premature infants, particularly those of very low birth weight, have a poor skin barrier with few cornified layers and deficient dermal proteins. They are at increased risk for skin damage, increased permeability to exogenous agents and infection. The SC barrier develops rapidly after birth but complete maturation requires weeks to months. The best methods for caring for infant skin, particularly in the diaper region, are described and related to these developmental changes.
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Affiliation(s)
- Marty O Visscher
- Skin Sciences Program, Division of Plastic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
| | - Ralf Adam
- The Procter & Gamble Company, Schwalbach, Germany
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Wan DC, Wong VW, Longaker MT, Yang GP, Wei FC. Moisturizing different racial skin types. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2014; 7:25-32. [PMID: 25013536 PMCID: PMC4086530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The skin is a complex organ involved in thermoregulation, gas exchange, protection against pathogens, and barrier function to maintain proper hydration. When dry, the ability for skin to execute these tasks becomes impaired. Dry skin affects almost everyone as we age, but it is also dependent on external factors, such as dry climate, colder temperatures, and repeated washing. In addition, increasing evidence has shown racial variability in the physiological properties of skin, which directly impacts water content of the stratum corneum and sensitivity to exogenously applied agents. A multitude of products have been developed to treat dry skin, and as a group, moisturizers have been designed to either impart or restore hydration in the stratum corneum. Given the large number of moisturizers presently available, depending on individual components, several different mechanisms may be employed to promote skin hydration. As there exists dramatic racial variability in skin properties, certain moisturizers may thus be more effective in some and less effective in others to treat the common condition of dry skin.
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Affiliation(s)
- Derrick C. Wan
- Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University Medical Center, Stanford, California
| | - Victor W. Wong
- Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University Medical Center, Stanford, California
| | - Michael T. Longaker
- Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University Medical Center, Stanford, California
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University Medical Center, Stanford, California
| | - George P. Yang
- Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University Medical Center, Stanford, California
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University Medical Center, Stanford, California
| | - Fu-Chan Wei
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Kuei-Shan, Taoyuan, Taiwan R.O.C
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48
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Lademann J, Köcher W, Yu R, Meinke MC, Na Lee B, Jung S, Sterry W, Darvin ME. Cutaneous carotenoids: the mirror of lifestyle? Skin Pharmacol Physiol 2014; 27:201. [PMID: 24714060 DOI: 10.1159/000357222] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 11/05/2013] [Indexed: 11/19/2022]
Abstract
Carotenoids could serve as marker substances of the antioxidant status of the human skin. In the present study, an optical skin scanner was used to analyse the carotenoid concentration obtained from 4 volunteers over a period of 13 days. The measurements were taken daily at different time points. In addition, the volunteers were asked to keep track of their daily nutritional behaviour and stress situations in a diary. It was found that the carotenoid values reflect clearly the nutritional behaviour and stress situations of the volunteers. While a steady, increased intake of fruit and vegetables resulted in a gradual increase in the dermal carotenoid values for several days, stressful situations entailed an immediate decline in these values. Although the impact of healthy nutrition on the antioxidant protection system is generally known and notwithstanding the small number of cases, the present study clearly demonstrates that the avoidance and/or reduction of stress is similarly important in order not to counteract or nullify the results achieved by healthy nutrition.
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Affiliation(s)
- J Lademann
- Centre of Experimental and Applied Cutaneous Physiology, Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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49
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Gilaberte Y, Carrascosa J. Realidades y retos de la fotoprotección en la infancia. ACTAS DERMO-SIFILIOGRAFICAS 2014. [DOI: 10.1016/j.ad.2013.05.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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50
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Gilaberte Y, Carrascosa J. Sun Protection in Children: Realities and Challenges. ACTA ACUST UNITED AC 2014; 105:253-62. [DOI: 10.1016/j.adengl.2013.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 05/12/2013] [Indexed: 12/18/2022]
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