Infant skincare

06 November 2018

First published October 2010

What is the correct skincare reigime for an infant?

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Common myths about baby skincare

Maintaining baby skin hygiene and health is of key importance. In doing so, most parents’ and caregivers’ intention is to do good, or at least to do no harm. This explains why there have been some efforts either to minimise exposure to cleansing products or to use products or emollients that appear to be most natural or harmless. However, some of these practices are being unveiled in the evidence-based world as unfounded myths, or even causes of skin problems. Let’s look at three widespread myths.

Is water alone best to care for baby skin?

We’ve lived our lives with abundant water and use it more and more. Water-based cleaning is second nature to all of us and is the basis of almost all cleansing (even liquid soaps would not work best without the help of water to make them spread, foam or be removed from the skin). However, water used on its own is not an effective cleanser. It only removes about 65% of all impurities (Walters, 2008) and, importantly, does not remove fat-soluble substances such as faeces and sebum. Furthermore, many scientists question the ability of water to buffer skin pH, as it might shift pH levels to basic levels. In fact, research has shown that hard, chlorinated water or overexposure to it has an irritation effect (Tsai and Maibach, 1999). So, used on its own, water is not as innocuous as one might think: it can actually dry the skin!

There may be a better way though – it is hypothesised and shown in some studies that short and not too frequent baths in warm water, in conjunction with a mild baby liquid cleanser, might reach the objective of appropriate skin hygiene while not harming the skin barrier, and with added benefits in certain cases (Dizon et al, 2010)

The ideal baby skincare regimen will be enhanced by the use of a mild baby cleanser. Many skin impurities are fat-soluble, and a mild baby cleanser can be more helpful than water alone in releasing impurities, especially oily and/or fatty substances (Kuehl et al, 2003). Surfactants (surface­active agents) reduce the surface tension of water by absorbing at the liquid-gas interface. Thus, there is a need not only to change perceptions about bathing, but also to emphasise how important it is to bathe, moisturise and take care of infant skin with the proper products. This will result in effective cleaning and – just as important – cleaning without damaging baby skin.

The ideal baby skincare regimen will be enhanced by the use of a mild baby cleanser. Many skin impurities are fat soluble and a mild baby cleanser can be more helpful than water alone

Is olive oil appropriate for baby skin?

Olive oil is widely reported as being beneficial in the use of cosmetic skin preparations due to, mainly, its benefits as a food ingredient (antioxidant properties, and so on). Olive oil is often used as a homemade remedy to massage or moisturise baby skin.

However, evidence suggests that olive oil can be damaging to the skin barrier. The main constituent of olive oil is oleic acid, which comprises 55% to 83% of the oil (Cork, 2010a). Even small amounts of oleic acid have been found to induce skin barrier breakdown (Jiang and Zhou, 2003).

It is suspected that oils containing oleic acid disorganise the lipid layers of the skin by a process called emulsification, which weakens the stratum corneum (the top layer of the skin) and makes it more susceptible to attack. In fact, several studies have shown that oleic acid breaks down the stratum corneum, increasing epidermal permeability. As the skin barrier is being compromised, transepidermal water loss (TEWL) values increase, dryness is more likely to occur and allergen penetration can increase as a consequence (Stamatas et al, 2008).

Variable amounts of oleic acid can also be found in almond oil, sunflower oil and avocado oil. However, mineral oil, which is not a vegetable oil, contains no oleic acid and thus avoids all of the oleic acid­related risks associated with a wide range of vegetable oils (see Figure 1.) Further research is still needed to determine the right proportion of other components in the oil, compared to oleic acid levels, to fully understand the effect on the skin barrier.

It is worth noting that olive oil is useful for treating cradle cap. Olive oil should be applied to the scalp and gently massaged to loosen the scales and encourage them to separate. Depending on the severity of the cradle cap, the oil can be left on for between 30 minutes and overnight. A medicated or mild shampoo should be used to remove the oil (Husband and Trigg, 2000).

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Do preservatives in skincare products have a negative impact on baby skin?

Contrary to some popular thinking, preservative-free skincare products can be unsafe and potentially hazardous to the skin (Cork, 2010b). Preservatives are a necessary ingredient in certain products. They ensure the integrity, purity and quality of the product during its use. They also protect against the development of microorganisms, including bacteria, mould and fungi.

When it comes to the preservation of topical products, creams that contain water must contain preservatives to prevent contamination. Ointments with no or very little water content, or ointments packaged in air-tight containers, however, do not necessarily need to contain preservatives.

Is mineral oil safe to use on baby skin?

In contrast to some vegetable oils, medicinal grade mineral oil is safer for baby skin and is actually used in the management of skin diseases such as atopic dermatitis. It is non-irritating to skin, an effective emollient and is one of the safest cosmetic ingredients known, having been in use for over 100 years (DiNardo, 2005).

Medicinal-grade mineral oil is significantly purer and goes through a more comprehensive purifying process than any other grade of mineral oil to ensure its extremely low allergic potential. Clinical studies have shown that medicinal-grade mineral oils have exactly the same penetration profile as some common vegetable oils without skin barrier disruption (DiNardo, 2005). It is also more stable in comparison with the majority of plant oils and has exceptional chemical inertness, which makes it less likely to cause skin reactions.

KEY POINTS

  • Water is the basis for almost all cleaning procedures, but water-only bathing is not an effective cleansing method and can dry or irritate the skin.
  • If cleansing products are used, they should be specially formulated for infant skin and have been clinically tested to ensure they are appropriate for infant skin.
  • Many vegetable oils, such as olive oil, can break down the skin barrier.
  • Medicinal-grade mineral oil is chemically inert, has an extremely low allergenic potential and is safe for baby skin.
  • Preservative-free skin products can be unsafe because they lack protection against the development of microorganisms, including bacteria, mould and fungi.

THE ANATOMY OF SKIN

The skin is the largest organ in the human body. Its vital role is the protection of internal organs and structures from the environment. This article explains that baby skin is not the same as adult skin, but a more delicate and vulnerable structure, and thus requires different care from mature skin.

Skin contains three main layers: the epidermis, the dermis and the subcutaneous layer. The outermost layer of the epidermis is the stratum corneum (SC) – commonly called the ‘skin barrier’, which consists of flattened dead skin cells that shed every two weeks or so (see Figure 2). Of the three main skin layers, it is the SC that provides protection and serves as the all-important first line of defence for the skin.

 

 

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How is baby skin different from adult skin?

The skin of infants is physiologically different from that of older children and adults in terms of structure, composition and function. At birth, baby skin undergoes a dramatic transition from an aqueous to a dry terrestrial environment. After birth and over time, neonatal skin continues to develop.

Baby skin is structurally different to adult skin; the cells are smaller and the collagen fibres are thinner (Stamatas et al, 2010a). According to recent clinical findings, infant SC is 30%, and infant epidermis 20% thinner than in adults (Stamatas et al, 2010a). Consequently, baby skin is more permeable and more prone to dryness than adult skin. Furthermore, a baby’s body surface to volume/weight ratio is higher than that of adults (Nikolovski et al, 2008), which increases baby skin’s vulnerability to applied substances and to sun exposure.

It is not just the dimensions of baby skin that differentiates it from adults. The composition of baby skin is also different from that of adult skin, containing less natural moisturising factors (NMFs), less lipids and less melanin (Chiou and Blume-Peytavi, 2004). The lower amounts of NMFs in baby skin could contribute to its faster rate of water desorption (Chiou and Blume-Peytavi, 2004).

Baby skin also has a higher pH than adult skin, another indication that the baby skin barrier is less mature than that of adult skin. In a clinical study involving a large number of newborns, the skin was found to have an average pH of 6.34 immediately after birth. Within four days, the pH decreased to a mean of 4.95, and between 7 and 30 days it further decreased to 4.7 (Kenner and Lott, 2007). The acid nature of skin is important because it has antimicrobial properties that make the skin resist colonisation by harmful bacteria; it also buffers the activity of proteases, those enzymes that break-down the corneodesmosomes (holders of the skin cells). Therefore, higher pH contributes to the weakening of the skin barrier.

These differences in structure and composition lead to differences in the function of the skin as a barrier. One of the main measurements of skin barrier is the rate of TEWL. Baby skin has a higher rate of TEWL than adult skin (Chiou and Blume-Peytavi, 2004). Additionally, water-handling properties such as absorption and desorption are different. So although infant skin is able to absorb more water than adult skin, it loses water at a faster rate (Chiou and Blume-Peytavi, 2004). We hypothesise that these differences leave baby skin more prone to dryness; as a baby’s immune system is developing, there is a greater chance of developing irritations and infections.

For these reasons, baby skin is more vulnerable to the environment than adult skin, and if not properly cared for, the skin becomes susceptible to dryness, conditions such as atopic dermatitis and nappy dermatitis, or even infections.

When does baby skin become mature?

The notion that skin development occurs only during pregnancy and that the organ is fully mature and capable of fulfilling all of its functions has been challenged and revised (Stamatas, 2010). Today, scientists understand that baby skin continues to develop and change through the first years of life. When it comes to skin maturation, scientists have taken a particularly close look at how baby skin functions compared with adult skin, especially the SC water barrier function. Low values of TEWL are indicative of good barrier function while high values are associated with compromised or poor barrier, such as in diseases with skin barrier abnormalities, for example atopic dermatitis or psoriasis (Stamatas, 2010). Clinical studies show that TEWL rates are highest in younger infant age groups (three to six months old) and continue to show higher levels than mature skin through the first year of life (Chiou and Blume-Peytavi, 2004).

Why is the SC important?

The skin is the first line of defence for babies. It acts as a barrier against attack from outside pathogens, irritants and allergens, and environmental attack, thereby protecting the body against infection and diseases. For babies that are still developing their immune system, a healthy skin barrier serves a vital purpose in preserving their wellbeing.

The structure of the SC can be compared to a brick wall. The skin cells are the ‘bricks’, the lipid layers are the ‘mortar’ and the corneodesmosomes within the SC are the ‘iron rods’ for support (see Figure 3). It is this SC ‘wall’ that acts as a barrier that protects the body from the outside environment.

Until about 40 years ago, scientists thought that the SC was more or less biologically inactive – acting like an inert plastic sheet that protects the lower layers of the skin. However, recent research has discovered that the skin barrier undergoes both chemical and biological activity that either weakens the protective elements in the 'brick wall’ or strengthens it.

[INSERT FIGURE 3] [caption:] Brick wall model of the skin barrier. Skin cells are analogous to the bricks and lipid layers to the mortar. In tall brick walls, iron rods are passed down through holes in the bricks to give the wall greater strength. These iron rods are analogous to the corneodesmosomes that lock the skin cells together (adapted from Cork et al, 2005).

How does a break in the skin barrier affect infants?

Atopic dermatitis means inflammation of the skin from an unknown cause. Scientists found that genetic changes increase protease activity, causing a premature breakdown of the skin barrier. Environmental factors such as dust mites or soap also play a role in weakening the skin barrier. When the barrier is broken, contaminants can enter and cause inflammations, allergies or other diseases. A broken barrier also allows water to leave, making the skin feel dry to the touch. Infants are born with a thinner SC than that in adults, which makes infants more vulnerable to attack from outside environmental influences (for example, bacteria, allergens, dust mites).


KEY POINTS

  • The SC acts as a barrier
  • Baby skin is not mature at birth and continues to develop over the first year of life
  • Baby skin SC is thinner and more permeable than in adults
  • Baby skin loses water more quickly than adult skin
  • Baby skin needs special – and different – care compared to adult skin
  • Baby skin hydration is higher and more variable during the first year of life than in adults but decreases overtime
  • Preserving the health and integrity of the infant skin barrier is crucial; it is known that an SC breakdown can lead to atopic dermatitis, which can trigger other allergies.

 

ALLERGIES, ATOPIC DERMATITIS AND THE IMPORTANCE OF CORRECT SKINCARE

In a background of rising allergic diseases, it is worth examining how healthy skin can be compromised. Just as important is an understanding of the effect on skin of cleansers, and how to choose a mild product that is appropriate for baby skin.

Background

Allergic diseases are an increasing problem both in the industrialised world and in developing countries. In many industrialised countries, approximately one-third of the population is affected by allergic disease at some point in their lives. (Palomares et al, 2010). The prevalence of atopic dermatitis (AD) has been steadily increasing since 1945 around the world. For children, in particular, the prevalence has increased from 4% to 5% in the 1940s to greater than 25% today (Cork et al, 2005).

There are many theories about why atopic diseases are becoming increasingly problematic. These theories can be divided into two main hypotheses. One is that new risk factors connected to nutrition, environmental factors or lifestyle have affected the development of allergic diseases among the population. The second hypothesis is that protective factors connected to how people once lived have been lost, resulting in an increased vulnerability to the development of allergic diseases (Ballardini, 2010).

Despite intensive worldwide research, it's difficult to determine the connection of causes and a lot of the research is hypothesis generating. However, scientists agree that the background of allergic diseases is multifactorial. There is a strong consensus that heredity plays an important role. If a child has one parent with AD then they have a 20% chance of developing AD, but if both parents have/had AD, the risk increases to 50% (Cork et al, 2005).

Beyond genetic factors, the environment also plays an important role in the development of allergic diseases and AD. The sensitivity of the skin barrier to damage by environmental agents and harsh surfactants has also been on the rise for the past 50 years. Products can have a positive or a negative effect on the skin barrier. This is why it's important to understand how environmental agents and surfactants affect the skin and therefore choose products appropriately.


What causes skin barrier disruption?

Healthy skin is soft, smooth and flexible. But various environmental agents such as excess water, hard water, alkaline soap, inappropriate detergents and other substances can threaten healthy skin by increasing protease activity. Although these enzymes are natural and needed for the exfoliation of skin cells, if their activity is increased beyond normal levels, they can wear down the skin barrier. This can sometimes lead to disruption of the skin barrier. When the barrier is compromised, contaminants can enter and cause inflammation, allergies and other disease (Cork et al, 2006).

AD is a chronic inflammatory skin disease associated with cutaneous hyper-reactivity to environmental triggers that are not offensive to normal, non-atopic individuals (Leung and Bieber, 2003). AD is of multifactorial origin and arises as a result of the interaction of many genes with environmental factors (Cork et al, 2009). Heredity is a strong indication when predicting the likelihood of an infant developing AD. A baby is more at risk when genetically pre-disposed.

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But preventing AD may be possible. There exists a window of opportunity in the first few months after birth to change the environment to prevent the development of AD. Preventing the development of AD may be possible by taking special care of baby skin from birth (Cork et al, 2008). Everything that is used on a baby’s skin from birth should be designed to enhance the skin barrier rather than damage it. Wash products should strike the ideal balance between cleansing efficacy and their effect on the integrity of baby skin. The ideal properties of a baby wash product should respect the natural pH of the stratum corneum (SC), effectively cleanse without damaging the SC, respect skin hydration levels and prove to be cosmetically acceptable (Cork, 2010). Not all cleansing products are appropriate for baby skincare and cleansers not specially formulated for infant care should be avoided (see panel, What makes a cleanser mild?).

Although water does hydrate the skin, the effect is temporary, lasting only about 30 seconds. Once the water evaporates, skin begins to dry. Water-alone bathing can increase TEWL and surface irritation while also damaging the skin. It also has no buffering capacity which can cause skin pH levels to rise, leading to enhanced protease activity and skin barrier breakdown (Cork, 2010).

A complete baby skincare regimen involves optimally formulated products to enhance the skin barrier. In a recent clinical study on baby skincare regimens, Garcia-Bartels et al (2010) investigated the long-term effect of specially formulated baby products twice-weekly on skin barrier in newborns. They found that the skin barrier develops either better or equally using a twice-weekly skincare regimen compared to bathing with water alone.

 

 

 


BOX 1: WHAT MAKES A CLEANSER MILD?

A mild cleanser is one that successfully removes impurities (water-soluble and fat-soluble impurities) yet does not harm or weaken the skin barrier, as measured in certain assessments such as TEWL or erythema measurements, or clinically observable signs such as dryness, itchiness, redness.

Water alone is not an effective cleanser for baby skin as it cannot remove all of the impurities found on baby skin. Therefore, for hygienic purposes, it is recommended to use a cleanser, or a surfactant, on baby skin. However, not all cleansers are alike. There is a difference in mildness. Because surfactants have both hydrophobic and hydrophilic properties, they form sphere-like structures in solution, called micelles. Micelles can interact and disrupt the skin structure reducing barrier function.1 The smaller the micelle is, the greater the risk of it penetrating and irritating the skin barrier. Therefore, a mild cleanser should be comprised of micelles that are large in size. 2 This can be achieved by modulating the proportion of surfactant types.

The importance of micelle size

Cleansers contain surfactants, which remove fat­soluble impurities from the skin. In solution, surfactants form micelles; cleansers containing large micelles are mild and less likely to penetrate the skin. The result is that different surfactant formulations have different levels of mildness. Figure 4 illustrates how mildness increases with micelle size in cleansers. As infant skin continues to develop through the first year of life, it requires gentler cleansing than adult skin (Walters et al, 2008). While water alone is insufficient, some cleansers are not appropriate for baby skin. Only cleansers which are clinically proven to be mild and specifically designed for baby skin should be used on baby's sensitive skin. 

 

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KEY POINTS

  • Allergic diseases are on the rise
  • Both genetics and the environment play a role in the rise of allergic disease
  • Contaminants can pass through a damaged skin barrier
  • Using specifically designed skin-cleaning products protects the infant skin barrier
  • A cleanser for infant skin should be mild but be able to remove both water- and fat-soluble impurities
  • Specially-designed cleansers intended for baby skin utilise large micelle technology to be mild and avoid compromising the skin barrier.

IMPLICATIONS FOR PRACTICE

The skin barrier is a baby’s first line of defence. Its vulnerability means that there is a fine line between a healthy baby and a baby with skin problems requiring medical care. To understand how the barrier works, it is also necessary to recognise those factors that cause it to break down, how to avoid such problems and, just as important, to pass on this information to parents.

Looking after skin is important at all ages, but it is particularly important in babies. What should be straightforward has been complicated by changes in hygiene habits and routines over the last decades. It is important to go back to the science and see if certain care regimens are myth or reality.

Infant skin is not the same as adult skin

At birth, newborn skin pH is more basic than adult skin and it takes a few hours or days for it to reach the protective acidic pH levels of adult skin. Acidic pH has antimicrobial properties and can keep enzymatic activity low. On the other hand, measurements of the skin barrier function such as TEWL, show that baby skin barrier is not mature for at least a year. The combination of all these factors and the slow maturation process of baby skin points to the fact that infant skin is more vulnerable to the environment. This vulnerability can lead to breaks in the skin barrier, which in turn can lead to contamination that causes inflammations, allergies or other diseases.

Allergy and atopic dermatitis

Allergic diseases are an increasing problem worldwide. Their causes are difficult to determine, but scientists tend to agree that the background of allergic diseases is multifactorial. Genetic factors are considered important, but environmental factors play an important role in the development of allergic diseases and atopic dermatitis. The sensitivity of the skin barrier to damage by environmental agents, products such as adult soap and harsh surfactants has also been on the rise over the last 50 years. Products can have a positive or negative effect on the skin barrier, so it's important to understand how environmental agents affect the skin and to choose products appropriately.

Evidence, not myths

Caregivers and parents have the best intentions, and wish to protect their babies’ skin. However, giving advice based on skin myths can have the opposite effect. Therefore, it is important to examine the science and the evidence to understand what really is the best advice and practice.

Protecting the skin barrier through appropriate skincare is vital. The easiest way to compromise infant skin is through inappropriate washing and moisturising – especially as the rates of infant washing rise. Although washing appears to be straightforward, it is easy to get the basics wrong by following received wisdom. For example, water may seem like the most natural and harmless way to clean infant skin. However, used on its own, not only is it an ineffective cleanser, but its use can quickly dry out infant skin.

The frequency and duration of bathing is important. Recent research shows that bathing every other day for up to eight or 10 minutes is fine (Blume-Peytavi et al, 2009).

The use of oil to moisturise baby skin is recommended; however, some vegetable oils with high oleic acid content should be avoided. One of the key components of many vegetable oils is oleic acid, which has been shown to disrupt the skin barrier. Consequently, oleic acid increases epidermal permeability, thereby allowing external substances such as allergens, irritants or bacteria to be absorbed into the skin. It is worth pointing out that not all vegetable oils are the same in this regard. Although olive oil contains 55% to 83% oleic acid, other vegetable oils contain much less. For example, soy contains around 22%, and coconut oil typically 5%. Unfortunately, this figure is rarely indicated on product labels, which makes an informed choice difficult for both the professional and consumer.

A safe and easy choice appears to be medicinal-grade mineral oil (paraffinum liquidum), which contains no oleic acid and has been used in many baby products (even treatment creams for atopic skin) for many years. Its extreme chemical inertness makes it less likely to irritate sensitive skin. It is an effective emollient and has the same skin penetration profile/performance as vegetable oils. As such, it does not occlude the skin or block pores.

Last, a common myth holds that preservatives in skincare products are to be avoided. In fact, the opposite can be true: preservative-free skincare products can be hazardous. In certain products, preservatives are a necessary ingredient that ensure the integrity, purity and quality of the product during use by suppressing microorganism development (bacteria, mould and fungi).

Conclusion

A complete baby skincare regimen involves optimally formulated products to enhance the infant's delicate skin barrier. Bathing with just water should be avoided, and the choice of oil for moisturising/massage should be carefully selected to meet the needs of babies’ developing skin.


KEY POINTS

  • Baby skin is different to and more delicate than adult skin.
  • Protecting infant skin can help protect from allergies/atopic dermatitis.
  • Skin moisturisation supports a healthy skin barrier by increasing skin hydration and decreasing TEWL.
  • Washing in just water is inadequate for removing fat-soluble dirt from the skin: use liquid wash products formulated for baby skin.
  • Do not moisturise baby skin with vegetable oil containing high percentages of oleic acid.
  • Medicinal-grade mineral oil is a safe moisturiser for baby skin.

 

Learn more about NMC revalidation here.

 


Useful resources and further reading

  • American Academy of Dermatology: www.aad.org
  • Association of Women’s Health, Obstetric and Neonatal Nurses. (2007) Neonatal skin care: evidence-based clinical practice guideline (second edition). Association of Women’s Health, Obstetric and Neonatal Nurses: Washington.
  • Cork MJ, Murphy R, Carr J, Buttle D, Ward S, Båvik C, Tazi-Ahnini R. (2002) The rising prevalence of atopic eczema and environmental trauma to the skin. Dermatology in Practice 10(3): 22-6.
  • Clark C. (2011) How to choose a suitable emollient. Phamaceutical Journal 273(7316): 351-3.
  • DermNet NZ (sponsored by the New Zealand Dermatological Society): dermnet.org.nz
  • Larrucea E, Arellano A, Santoyo S, Ygartua P. (2001) Combined effect of oleic acid and propylene glycol on the percutaneous penetration of tenoxicam and its retention in the skin. European Journal of Pharmaceutics and Biopharmaceutics 52(2): 113-9.
  • Tsai TF, Maibach HI. (1999) How irritant is water? An overview. Contact Dermatitis 41(6): 311-4.

References

Ballardini N. (2010) The atopic march: who will march and can we stop them?: In: Baby skincare: an evolving science. Frankfurt. CAN’T FIND RESOURCE

Blume-Peytavi U, Cork MJ, Faergemann J, Szczapa J, Vanaclocha F, Gelmetti C. (2009) Bathing and cleansing in newborns from day one to first year of life: recommendations from a European round-table meeting. Journal of the European Academy of Dermatology and Venereology 23(7): 751-9.

Chiou YB, Blume-Peytavi U. (2004) Stratum corneum maturation: a review of neonatal skin function. Skin Pharmacology and Physiology 17(2): 57-66.

Cork MJ. (2017) Preventing skin barrier breakdown: In: Baby skincare: an evolving science. Frankfurt.

Cork MJ. (2010) Skin, babies’ first line of defence: what is at stake? In: Baby skincare: an evolving science. Frankfurt.

Cork MJ, Danby SG, Vasilopoulos Y, Hadgraft J, Lane ME, Moustafa M, Guy RH, MacGowan AL, Tazi-Ahnini R, Ward SJ. (2009) Epidermal barrier dysfunction in atopic dermatitis. Journal of Investigative Dermatology 129(8): 1892-1908.

Cork MJ, Lavender T, Lund, Kurtz. (2008) Infant skincare: the research, the science, the future. Symposium at ICM Congress 2008.

Cork MJ, Robinson DA, Vasilopoulos Y, Ferguson A, Moustafa M, MacGowan A, Duff GW, Ward SJ, Tazi-Ahnini R. (2006) New perspectives on epidermal barrier dysfunction in atopic dermatitis: gene-environment interactions. Journal of Allergy and Clinical Immunology 118(1): 3-21.

Cork MJ, Robinson D, Vasilopoulos Y, Moustafa M, MacGowan A, Ward SJ, Tazi-Ahnini R. (2005) Predisposition to sensitive skin and atopic eczema. Community Practitioner 78(12): 440-2.

DiNardo JC. (2005) Is mineral oil comedogenic? Journal of Cosmetic Dermatology 4(1): 2-3.

Dizon MV, Galzote C, Estanislao R, Mathew N, Sarkar R. (2010) Tolerance of baby cleansers in infants: a randomized controlled trial. Indian Pediatrics 47(11): 959-63.

Garcia Bartels N, Scheufele R, Prosch F, Schink T, Proquitté H, Wauer RR, Blume-Peytavi U. (2010) Effect of standardised skincare regimens on neonatal skin barrier function in different body areas. Pediatric Dermatology 27(1): 1-8.

Hilditch TP. (1949) Triglyceride fats in human nutrition. Proceedings of the Nutrition Society (55th Scientific Meeting). See: cambridge.org/core/journals/british-journal-of-nutrition/article/chemical-constitution-of-natural-fats/72BD0863031D6656C19BB8EFC707570B (accessed 2 August 2018).

Husband S, Trigg E. (2000) Practices in children’s nursing: guidelines for hospital and community. Churchill Livingstone: Edinburgh.

Kenner C, Lott JW. (2007) Comprehensive neonatal care: an interdisciplinary approach (fourth edition). Saunders Elsevier: St Louis, Missouri.

Kuehl BL, Fyfe KS, Shear NH. (2003) Cutaneous cleansers. Skin Therapy Letter 8(3): 1-4.

Leung DY, Bieber T. (2003) Atopic dermatitis. The Lancet 361(9352): 151-60.

Jiang SJ, Zhou XJ. (2003) Examination of the mechanism of oleic acid-induced percutaneous penetration enhancement: an ultrastructural study. Biological and Pharmaceutical Bulletin 26(1): 66-8.

Nikolovski J, Stamatas GN, Kollias N, Wiegand BC. (2008) Barrier function and water-holding and transport properties of infant stratum corneum are different from adult and continue to develop through the first year of life. Journal of Investigative Dermatology 128(7): 1728-36.

Palomares O, Yaman G, Azkur AK, Akkoc T, Akdis M, Akdis CA. (2010) Role of Treg in immune regulation of allergic diseases. European Journal of Immunology 40(5): 1232-40.

Stamatas GN, Nikolovski J, Luedtke MA, Kollias N, Wiegand BC. (2010a) Infant skin microstructure assessed in vivo differs from adult skin in organization and at the cellular level. Pediatric Dermatology 27(2): 125-31.

Stamatas GN. (2010b) The structural and functional development of skin during the first year of life: investigations using non-invasive methods: In: Farage MA, Miller KW, Maibach HI (eds). Textbook of Aging Skin. Springer: Berlin.

Stamatas GN, de Sterke J, Hauser M, von Stetten O, van der Pol A. (2008) Lipid uptake and skin occlusion following topical application of oils on adult and infant skin. Journal of Dermatological Science 50(2): 135-42.

Tsai TF, Maibach HI. (1999) How irritant is water? An overview. Contact Dermatitis 41(6): 311-4.

Walters R, Fevola J, Joseph J, LiBrizzi J, Martin K. (2008) Designing cleansers for the unique needs of baby skin. Cosmetics and Toiletries 123(12): 53-60.

 

 

Image credit | iStock

 

 

 

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