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Lundgren S, Sonesson A. Effect of Potassium Permanganate on Staphylococcal Isolates Derived from the Skin of Patients with Atopic Dermatitis. Acta Derm Venereol 2024; 104:adv18642. [PMID: 38415865 PMCID: PMC10916795 DOI: 10.2340/actadv.v104.18642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 01/16/2024] [Indexed: 02/29/2024] Open
Abstract
In atopic dermatitis (AD), Staphylococcus aureus frequently colonizes lesions, leading to superinfections that can then lead to exacerbations. The presence of biofilm-producing isolates has been associated with worsening of the disease. Potassium permanganate is used as a topical treatment of infected eczema, blistering conditions, and wounds. Little is known of its effects against microbes in AD skin. The aim of this study was to explore antibacterial and antibiofilm properties of potassium permanganate against staphylococcal isolates derived from AD skin. Viable count and radial diffusion assays were used to investigate antibacterial effects of potassium permanganate against planktonic staphylococcal isolates. The antibiofilm effects were assessed using biofilm assays and scanning electron microscopy. The Staphylococcus aureus isolates were completely killed when exposed to 0.05% of potassium permanganate. In concentrations of 0.01%, potassium permanganate inhibited bacterial biofilm formation. Eradication of established staphylococcal biofilm was observed in concentrations of 1%. Electron microscopy revealed dense formations of coccoidal structures in growth control and looser formations of deformed bacteria when exposed to potassium permanganate. This suggests antibacterial and antibiofilm effects of potassium permanganate against staphylococcal isolates derived from AD skin, when tested in vitro, and a potential role in the treatment of superinfected AD skin.
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Affiliation(s)
- Sigrid Lundgren
- Department of Dermatology and Venereology, Skåne University Hospital, Lund, Sweden; Division of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Biomedical Center B14, Lund, Sweden.
| | - Andreas Sonesson
- Department of Dermatology and Venereology, Skåne University Hospital, Lund, Sweden; Division of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Biomedical Center B14, Lund, Sweden
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2
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Gupta P, Nagesh K, Garg P, Thomas J, Suryawanshi P, Sethuraman G, Hazarika RD, Verma RJ, Kumar CS, Kumari S, Taneja S, Chavhan V, Thakor P, Pandita A. Evidence-Based Consensus Recommendations for Skin Care in Healthy, Full-Term Neonates in India. Pediatric Health Med Ther 2023; 14:249-265. [PMID: 37654800 PMCID: PMC10465361 DOI: 10.2147/phmt.s414091] [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: 04/26/2023] [Accepted: 08/03/2023] [Indexed: 09/02/2023] Open
Abstract
Purpose Neonatal skin care practices guided by personal experience and preferences might be substantially different across different hospital settings. The aim of this consensus recommendation is to provide clinical practice guidance to healthcare practitioners on evidence-based neonatal skin care practices from delivery-to-discharge, in hospital settings. Patients and Methods A Scientific Advisory Board meeting on "Evidence-based Neonatal Skin Care Practices and Protocols" was held in December 2020 with an expert panel comprising neonatologists, pediatricians, obstetricians and gynecologists and pediatric dermatologist. Comprehensive literature search was performed up to 23 March 2021 using PubMed and Google Scholar to retrieve relevant evidence. Results Recommendations were developed on critical aspects of skin care in healthy full-term neonates including cleansing at birth, skin-to-skin care, cord care, diaper area care, initial and routine bathing, cleansers and emollients use, and criteria to choose appropriate skin care products. Recommendations include inclusion of skin assessment in routine neonatal care, first bath timing after cardio-respiratory and thermal stabilization, 6-24 hours after birth; bathing with water alone or adding a mild liquid cleanser could be considered appropriate as it does not impact the developing skin barrier; use of emollients is recommended for neonates with higher risk of development of eczema to maintain and enhance skin barrier function and integrity; and inclusion of skin care advice in neonatal discharge checklist. Importance of rigorous quality control, high-quality clinical trials for assessment of baby products, usage of products that are formulated appropriately for newborns, and full label transparency for baby products were highlighted. The panel identified gaps in literature and discussed the scope for future research. Conclusion These recommendations may help to standardize evidence-based skin care for healthy full-term neonates in Indian hospital settings to improve the quality of care that neonates receive in hospital and facilitate improvement in overall neonatal health outcomes.
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Affiliation(s)
- Piyush Gupta
- Department of Pediatrics, University College of Medical Sciences, New Delhi, India
| | - Karthik Nagesh
- Department of Neonatology, Manipal Hospitals Group (MHEPL), Bangalore, Karnataka, India
| | - Pankaj Garg
- Department of Neonatology, Sir Ganga Ram Hospital, New Delhi, India
| | - Jayakar Thomas
- Department of Dermatology, The Tamil Nadu Dr. M.G.R. Medical University, Chennai, Tamil Nadu, India
| | | | - Giridhar Sethuraman
- Department of Neonatology, Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India
| | - Rashna Dass Hazarika
- Department of Pediatrics & Neonatology, Nemcare Superspecialty Hospital, Guwahati, Assam, India
| | - Rahul J Verma
- Department of Neonatology & General Pediatrics, Sir H.N Reliance Hospital, Mumbai, Maharashtra, India
| | - C Suresh Kumar
- Department of Pediatrics, Apollo Cradle, Jubilee Hills, Hyderabad, Telangana, India
| | - Shantha Kumari
- Department of Obstetrics and Gynecology, Yashoda Hospitals, Hyderabad, Telangana, India
| | - Sunil Taneja
- Sushrut Medical Centre Pvt Ltd, Kanpur, Uttar Pradesh, India
| | - Vaishali Chavhan
- Department of Obstetrics and Gynecology, Sahyadri Superspecialty Hospitals, Pune, Maharashtra, India
| | - Priti Thakor
- Department of Medical Affairs, JNTL Consumer Health (India) Pvt. Ltd., Mumbai, Maharashtra, India
| | - Ankita Pandita
- Department of Medical Affairs, JNTL Consumer Health (India) Pvt. Ltd., Mumbai, Maharashtra, India
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Guarneri F, Belloni Fortina A, Corazza M, Cristaudo A, Foti C, Parodi A, Pigatto P, Stingeni L, DE Pità O. Topical non-pharmacological treatment of eczema: an Italian consensus. Ital J Dermatol Venerol 2022; 157:402-413. [PMID: 36213968 DOI: 10.23736/s2784-8671.22.07283-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Eczematous diseases (contact dermatitis, atopic dermatitis, hand eczema) are among the most frequent findings in dermatological clinical practice. A large body of evidence exists on structural and functional skin barrier damage in eczematous diseases, and on the importance of interventions aimed to repair such damage. While there is substantial agreement on pharmacological treatment, more sparse data are available on role, indications and usefulness of topical non-pharmacological treatments, despite significant research and progress in the composition and technology of emollients, cleansers and barrier creams significantly changed and expanded the functional activities of these products. This often leads to inadequate prescription and/or use, which increase individual and social costs of the disease and make the products useless or, in some cases, even counterproductive. This consensus document, discussed and compiled in a series of meetings by a group of Italian dermatologists experienced in the field of eczematous diseases, summarizes epidemiology and clinical features of the nosological entities of the "eczema family", illustrates the chemical/biochemical structure of emollients, cleansers and barrier creams, and aims to help physicians to exploit the full potential of available products, by providing a detailed but practical guide on characteristics, indications and correct use of non-pharmacological treatments currently available for eczematous diseases.
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Affiliation(s)
- Fabrizio Guarneri
- Unit of Dermatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy -
| | - Anna Belloni Fortina
- Unit of Dermatology, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Monica Corazza
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | | | - Caterina Foti
- Department of Biomedical Sciences and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Aurora Parodi
- Section of Dermatology, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Paolo Pigatto
- Unit of Dermatology, Department of Surgical and Odontoiatric Biomedical Sciences, Galeazzi IRCCS Orthopedic Institute, Milan, Italy
| | - Luca Stingeni
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Ornella DE Pità
- Unit of Clinical Pathology, Inflammatory and Autoimmune Skin Diseases, Cristo Re Hospital, Rome, Italy
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Rahma A, Lane ME. Skin Barrier Function in Infants: Update and Outlook. Pharmaceutics 2022; 14:pharmaceutics14020433. [PMID: 35214165 PMCID: PMC8880311 DOI: 10.3390/pharmaceutics14020433] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [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;
- Correspondence:
| | - Majella E. Lane
- School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK;
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Chin G, Nicholson H, Demirel S, Affleck A. Topical potassium permanganate solution use in dermatology: comparison of guidelines and clinical practice. Clin Exp Dermatol 2021; 47:966-967. [PMID: 34939207 DOI: 10.1111/ced.15076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 12/17/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Gillian Chin
- Department of Dermatology, Ninewells Hospital, Dundee, United Kingdom
| | - Hilary Nicholson
- Department of Dermatology, Ninewells Hospital, Dundee, United Kingdom
| | - Sibel Demirel
- Department of Dermatology, Ninewells Hospital, Dundee, United Kingdom
| | - Andrew Affleck
- Department of Dermatology, Ninewells Hospital, Dundee, United Kingdom
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Nitiyarom R, Anuntarumporn L, Wisuthsarewong W. Skin hydration and transepidermal water loss after bathing compared between immersion and showering. Skin Res Technol 2021; 27:896-903. [PMID: 33769640 DOI: 10.1111/srt.13039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/12/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Various methods of bathing may affect skin properties differently. AIMS To compare the effects of immersion and showering on skin hydration and transepidermal water loss (TEWL). METHOD This experimental study included healthy volunteers whose forearms were immersed and showered for 3 minutes. Skin hydration and TEWL were assessed serially before and after immersion and showering of volunteer forearms. RESULTS Seventy-eight healthy volunteers (49 females, 29 males) were enrolled with an age range of 12-55 years (mean 31.41 ± 10.33). Both methods significantly increased skin hydration and TEWL (P < .001). The capacitance value significantly increased immediately after bathing, and then rapidly decreased within 3 minutes. It returned to baseline by 10 minutes after bathing. There was no statistically significant difference of capacitance between the two methods at any measurement (P > .05). TEWL at every measurement after bathing was significantly increased compared to baseline for both bathing methods (P < .001). The highest TEWL was observed immediately after bathing, but then significantly decreased compared to the previous measurement (P < .001). CONCLUSION Immersion and showering similarly demonstrated significant increase in skin hydration and TEWL. The increment of capacitance after bathing returned to baseline level within 10 minutes.
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Affiliation(s)
- Rattanavalai Nitiyarom
- Division of Dermatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Lillada Anuntarumporn
- Division of Dermatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wanee Wisuthsarewong
- Division of Dermatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Klimaszewska E, Ogorzałek M, Seweryn A, Wasilewski T. Application Properties of Bath Liquids for Children Based on Sodium Laureth Sulfate with Addition of Different Molecular Weight Collagens Derived from Marine Sources. J SURFACTANTS DETERG 2019. [DOI: 10.1002/jsde.12343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Emilia Klimaszewska
- Department of ChemistryKazimierz Pulaski University of Technology and Humanities, 27 Boleslawa Chrobrego Street Radom 26‐600 Poland
| | - Marta Ogorzałek
- Department of ChemistryKazimierz Pulaski University of Technology and Humanities, 27 Boleslawa Chrobrego Street Radom 26‐600 Poland
| | - Artur Seweryn
- Department of ChemistryKazimierz Pulaski University of Technology and Humanities, 27 Boleslawa Chrobrego Street Radom 26‐600 Poland
| | - Tomasz Wasilewski
- Department of ChemistryKazimierz Pulaski University of Technology and Humanities, 27 Boleslawa Chrobrego Street Radom 26‐600 Poland
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8
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Novosel T, Rundle CW, Yu JD, Jacob SE. Art of prevention: The importance of bath time and avoiding extended exposure to irritating and allergenic chemicals. Int J Womens Dermatol 2019; 5:152-154. [PMID: 31360747 PMCID: PMC6637102 DOI: 10.1016/j.ijwd.2019.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
- Tracy Novosel
- Department of Dermatology, Atlantic Dermatology Associates, Virginia Beach, Virginia
| | | | - Jiade D. Yu
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Sharon E. Jacob
- Department of Dermatology, Loma Linda University, Loma Linda, California
- Corresponding Author.
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9
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Vongsa R, Rodriguez K, Koenig D, Cunningham C. Benefits of Using an Appropriately Formulated Wipe to Clean Diapered Skin of Preterm Infants. Glob Pediatr Health 2019; 6:2333794X19829186. [PMID: 30815515 PMCID: PMC6381433 DOI: 10.1177/2333794x19829186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 12/06/2018] [Accepted: 12/14/2018] [Indexed: 11/16/2022] Open
Abstract
The skin of premature infants is underdeveloped rendering it more prone to break down and irritation. Therefore, special care is needed to protect premature skin and ensure it is not adversely affected. Many health care professionals advise using just water and cloth to clean diapered skin after a bowel movement despite evidence that shows improved infant skin health with the use of modern appropriately formulated baby wipes. This article describes the unique physiology of premature infant skin, reviews clinical evidence comparing use of baby wipes to water and cloth, and describes attributes of appropriately formulated baby wipes.
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Zanardo V, Giarrizzo D, Volpe F, Giliberti L, Straface G. Emu oil-based lotion effects on neonatal skin barrier during transition from intrauterine to extrauterine life. Clin Cosmet Investig Dermatol 2017; 10:299-303. [PMID: 28848357 PMCID: PMC5556178 DOI: 10.2147/ccid.s133484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Both appropriate hydration and skin surface pH are fundamental in preventing baby skin barrier damage during transition from intrauterine to extrauterine life. However, effects of topical moisturizers on neonatal stratum corneum temperature, pH, hydration, and elasticity have not been scientifically evaluated in vivo. We checked 31 full-term breastfeeding neonates by non-invasive bioengineering method, which is able to evaluate the basal skin barrier (left heel), and assessed at 6±1 hours after birth, and at 1 and 24 hours after emu oil-based topical treatment. The basal skin barrier of right heel (no oil exposure) of each newborn was considered as control. We found that a single application of an emu oil-based lotion was effective in improving heel stratum corneum hydration, which increases both skin pH and elasticity without any effect on temperature. Further studies are needed to confirm long-term beneficial effects of this treatment in a very sensitive patient population.
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Affiliation(s)
- Vincenzo Zanardo
- Division of Perinatal Medicine, Policlinico Abano Terme, Abano Terme
| | | | - Francesca Volpe
- Division of Perinatal Medicine, Policlinico Abano Terme, Abano Terme
| | - Lara Giliberti
- Division of Perinatal Medicine, Policlinico Abano Terme, Abano Terme
| | - Gianluca Straface
- Division of Perinatal Medicine, Policlinico Abano Terme, Abano Terme
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Abstract
Atopic dermatitis is one of the most common complaints presenting to dermatologists, and patients typically inquire as to appropriate bathing recommendations. Although many dermatologists, allergists, and primary-care practitioners provide explicit bathing instructions, recommendations regarding frequency of bathing, duration of bathing, and timing related to emollient and medication application relative to bathing vary widely. Conflicting and vague guidelines stem from knowledge related to the disparate effects of water on skin, as well as a dearth of studies, especially randomized controlled trials, evaluating the effects of water and bathing on the skin of patients with atopic dermatitis. We critically review the literature related to bathing and associated atopic dermatitis treatments, such as wet wraps, bleach baths, bath additives, and balneotherapy. We aim to provide readers with a comprehensive understanding of the impact of water and related therapies on atopic dermatitis as well as recommendations based upon the published data.
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Affiliation(s)
- Julia K Gittler
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 240 East 38th Street, 11th Floor, New York, NY, 10016, USA
| | - Jason F Wang
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 240 East 38th Street, 11th Floor, New York, NY, 10016, USA
| | - Seth J Orlow
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 240 East 38th Street, 11th Floor, New York, NY, 10016, 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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Cardin AD, Rens L, Stewart S, Danner-Bowman K, McCarley R, Kopsas R. Neuroprotective Core Measures 1–7: A Developmental Care Journey: Transformations in NICU Design and Caregiving Attitudes. ACTA ACUST UNITED AC 2015. [DOI: 10.1053/j.nainr.2015.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Coughlin CC, Frieden IJ, Eichenfield LF. Clinical approaches to skin cleansing of the diaper area: practice and challenges. Pediatr Dermatol 2014; 31 Suppl 1:1-4. [PMID: 25403931 DOI: 10.1111/pde.12461] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cleansing and care of the diaper area require special consideration to maintain barrier function of the skin in this area and repair the barrier when it is compromised. Diaper dermatitis occurs commonly; understanding and modification of predisposing factors are imperative for caregivers. In this paper, we review important factors in diaper area care, including skin pH, the local microbiome, irritant and allergic potential of contactants, and application of topical agents.
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Affiliation(s)
- Carrie C Coughlin
- Division of Dermatology, Department of Medicine, Washington University, St. Louis, Missouri
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Kulthanan K, Maneeprasopchoke P, Varothai S, Nuchkull P. The pH of antiseptic cleansers. Asia Pac Allergy 2014; 4:32-6. [PMID: 24527408 PMCID: PMC3921871 DOI: 10.5415/apallergy.2014.4.1.32] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 01/05/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Daily bathing with antiseptic cleansers are proposed by some physicians as an adjunctive management of atopic dermatitis (AD). As atopic skin is sensitive, selection of cleansing products becomes a topic of concern. OBJECTIVE Our purpose is to evaluate the pH of various antiseptic body cleansers to give an overview for recommendation to patients with AD. METHODS Commonly bar and liquid cleansers consisted of antiseptic agents were measured for pH using pH meter and pH-indicator strips. For comparison, mild cleansers and general body cleansers were also measured. RESULTS All cleansing bars had pH 9.8-11.3 except syndet bar that had neutral pH. For liquid cleansers, three cleansing agents had pH close to pH of normal skin, one of antiseptic cleansers, one of mild cleansers and another one of general cleansers. The rest of antiseptic cleansers had pH 8.9-9.6 while mild cleansers had pH 6.9-7.5. Syndet liquid had pH 7 and general liquid cleansers had pH 9.6. CONCLUSION The pH of cleanser depends on composition of that cleanser. Adding antiseptic agents are not the only factor determining variation of pH. Moreover, benefit of antiseptic properties should be considered especially in cases of infected skin lesions in the selection of proper cleansers for patients with AD.
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Affiliation(s)
- Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pitchaya Maneeprasopchoke
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supenya Varothai
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Piyavadee Nuchkull
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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17
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Stamatas GN, Tierney NK. Diaper dermatitis: etiology, manifestations, prevention, and management. Pediatr Dermatol 2014; 31:1-7. [PMID: 24224482 DOI: 10.1111/pde.12245] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Pediatricians and parents report diaper dermatitis (DD) to be one of the most common skin diseases that affects almost every child at some point during the early months and years of life. Diapered skin is exposed to friction and excessive hydration, has a higher pH than nondiapered skin, and is repeatedly soiled with feces that contains enzymes with high irritation potential for the skin. The combination of these factors frequently results in skin damage, leading to visible erythematous lesions that can be irritating and painful to the child. Behavioral changes such as increased crying and agitation and changes in eating and sleeping patterns indicate emotional distress. Appropriate skin care can help to prevent the occurrence of DD and to speed up the healing of affected skin. This includes frequent diaper changes and aeration, gentle cleansing, and the use of a barrier cream. Mild to moderate cases usually resolve after a few days of following this routine, but the use of harsh cleaning products can exacerbate DD.
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Kulthanan K, Nuchkull P, Varothai S. The pH of water from various sources: an overview for recommendation for patients with atopic dermatitis. Asia Pac Allergy 2013; 3:155-60. [PMID: 23956962 PMCID: PMC3736366 DOI: 10.5415/apallergy.2013.3.3.155] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 06/20/2013] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Patients with atopic dermatitis (AD) have increased susceptibility to irritants. Some patients have questions about types of water for bathing or skin cleansing. OBJECTIVE We studied the pH of water from various sources to give an overview for physicians to recommend patients with AD. METHODS Water from various sources was collected for measurement of the pH using a pH meter and pH-indicator strips. RESULTS Bottled drinking still water had pH between 6.9 and 7.5 while the sparkling type had pH between 4.9 and 5.5. Water derived from home water filters had an approximate pH of 7.5 as same as tap water. Swimming pool water had had pH between 7.2 and 7.5 while seawater had a pH of 8. Normal saline and distilled water had pH of 5.4 and 5.7, respectively. Facial mineral water had pH between 7.5 and 8, while facial makeup removing water had an acidic pH. CONCLUSION Normal saline, distilled water, bottled sparkling water and facial makeup removing water had similar pH to that of normal skin of normal people. However, other factors including benefits of mineral substances in the water in terms of bacteriostatic and anti-inflammation should be considered in the selection of cleansing water.
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Affiliation(s)
- Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
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Iarkowski LE, Tierney NK, Horowitz P. Tolerance of skin care regimen in healthy, full-term neonates. Clin Cosmet Investig Dermatol 2013; 6:137-44. [PMID: 23761977 PMCID: PMC3673859 DOI: 10.2147/ccid.s42559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Purpose To assess the tolerance of a baby cleanser and lotion (both lightly fragranced) on healthy, full-term neonates. Materials and methods Twenty-six infant–mother pairs were enrolled in a 6-week, nonrandomized, controlled-use study that took place in the routine setting of a pediatric clinic and mothers’ homes. During study weeks 1 to 6, neonates were bathed by their mother with water and a test cleanser (JOHNSON’S® HEAD-TO-TOE® Baby Wash). During study weeks 1 to 3, mothers also applied test lotion (JOHNSON’S® Baby Lotion) to the babies’ skin immediately after bathing and one to three times/day on bathing and non-bathing days. During study weeks 4 to 6, no lotion was applied. At baseline and weeks 3 and 6, the infants’ pediatrician or mother or both performed visual skin assessments. Results Twenty-three infant–mother pairs completed the study. The mean age of neonates at enrolment was 17.4 days (range, 13–28 days). Pediatrician observations found no clinical signs of irritation, erythema, or dryness with any significant difference in scores of these parameters compared with baseline throughout the study. Assessment of skin softness, smoothness, dryness, and overall skin condition was very good at baseline and remained so with minimal changes throughout the study. Mothers reported improvements versus baseline (P ≤ 0.05) in overall skin appearance, moisturization, softness, and smoothness on the arms and legs at weeks 3 and 6. A total of four (15.4%) subjects experienced adverse events. For three of the subjects, the investigator suspected that the adverse events were unrelated to either of the test products. In one participant, the cause of the adverse event could not be determined. Conclusion The use of a lightly fragranced nonstinging baby cleanser, with or without a lightly fragranced baby lotion, was well tolerated by newborns and resulted in observable skin benefits per the pediatricians’ and mothers’ assessment.
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Lavender T, Bedwell C, Roberts SA, Hart A, Turner MA, Carter LA, Cork MJ. Randomized, controlled trial evaluating a baby wash product on skin barrier function in healthy, term neonates. J Obstet Gynecol Neonatal Nurs 2013; 42:203-14. [PMID: 23421327 PMCID: PMC3664406 DOI: 10.1111/1552-6909.12015] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To examine the hypothesis that the use of a wash product formulated for newborn (<1 month of age) bathing is not inferior (no worse) to bathing with water only. DESIGN Assessor-blinded, randomized, controlled, noninferiority trial. SETTING A teaching hospital in the Northwest of England and in participants' homes. PARTICIPANTS Three-hundred-and-seven healthy, term infants recruited within 48 hours of birth. METHOD We compared bathing with a wash product (n = 159) to bathing with water alone (n = 148). The primary outcome was transepidermal water loss (TEWL) at 14 days postbirth; the predefined difference deemed to be unimportant was 1.2. Secondary outcomes comprised changes in stratum corneum hydration, skin surface pH, clinical observations of the skin, and maternal views. RESULTS Complete TEWL data were obtained for 242 (78.8%) infants. Wash was noninferior to water alone in terms of TEWL (intention-to-treat analysis: 95% confidence interval [CI] for difference [wash-water, adjusted for family history of eczema, neonate state, and baseline] -1.24, 1.07; per protocol analysis: 95% CI -1.42, 1.09). No significant differences were found in secondary outcomes. CONCLUSION We were unable to detect any differences between the newborn wash product and water. These findings provide reassurance to parents who choose to use the test newborn wash product or other technically equivalent cleansers and provide the evidence for health care professionals to support parental choice.
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Affiliation(s)
- Tina Lavender
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK.
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Furber C, Bedwell C, Campbell M, Cork M, Jones C, Rowland L, Lavender T. The Challenges and Realties of Diaper Area Cleansing for Parents. J Obstet Gynecol Neonatal Nurs 2012; 41:E13-25. [DOI: 10.1111/j.1552-6909.2012.01390.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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The infant skin barrier: can we preserve, protect, and enhance the barrier? Dermatol Res Pract 2012; 2012:198789. [PMID: 22988452 PMCID: PMC3439947 DOI: 10.1155/2012/198789] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 06/15/2012] [Indexed: 12/16/2022] Open
Abstract
Infant skin is different from adult in structure, function, and composition. Despite these differences, the skin barrier is competent at birth in healthy, full-term neonates. The primary focus of this paper is on the developing skin barrier in healthy, full-term neonates and infants. Additionally, a brief discussion of the properties of the skin barrier in premature neonates and infants with abnormal skin conditions (i.e., atopic dermatitis and eczema) is included. As infant skin continues to mature through the first years of life, it is important that skin care products (e.g., cleansers and emollients) are formulated appropriately. Ideally, products that are used on infants should not interfere with skin surface pH or perturb the skin barrier. For cleansers, this can be achieved by choosing the right type of surfactant, by blending surfactants, or by blending hydrophobically-modified polymers (HMPs) with surfactants to increase product mildness. Similarly, choosing the right type of oil for emollients is important. Unlike some vegetable oils, mineral oil is more stable and is not subject to oxidation and hydrolysis. Although emollients can improve the skin barrier, more studies are needed to determine the potential long-term benefits of using emollients on healthy, full-term neonates and infants.
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Willhite CC, Bhat VS, Ball GL, McLellan CJ. Emergency Do Not Consume/Do Not Use concentrations for potassium permanganate in drinking water. Hum Exp Toxicol 2012; 32:275-98. [DOI: 10.1177/0960327112456316] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Over the past decade, regulatory authorities and water purveyors have become increasingly concerned with accidental or intentional adulteration of municipal drinking water. Emergency response guidelines, such as the ‘Do Not Consume’ or use concentration limits derived herein, can be used to notify the public in such cases. Potassium permanganate (KMnO4) is used to control iron concentrations and to reduce the levels of nuisance materials that affect odor or taste of finished drinking water. Manganese (Mn) is recognized an essential nutrient, permanganate (MnO4−) and manganous (Mn+2) ions are caustic, and the acute toxicity of KMnO4 is defined by its oxidant/irritant properties and by the toxicity of Mn. Ingestion of small amounts (4–20 mg/kg) of aqueous KMnO4 solutions that are above 200 mg/L causes gastrointestinal distress, while bolus ingestion has caused respiratory arrest following coagulative necrosis and hemorrhage in the esophagus, stomach, or liver. Dilute KMnO4 solutions (1–100 mg/L) are used as a topical antiseptics and astringents, but >1:5000 (200 mg/L) dilutions can irritate or discolor sensitive mucous membranes and direct skin or ocular contact with concentrated KMnO4 can perforate tissues. Based on clinical experience with 200 mg/L KMnO4, a Do Not Consume concentration of 7 mg/L KMnO4 (equivalent to 2 mg Mn/L) is recommended. Recognizing limited empirical data from which to calculate an ocular reference value, a skin contact ‘Do Not Use’ concentration of 30 mg Mn/L is recommended based on the skin irritation in some patients after a 10-min contact with 100 mg KMnO4/L.
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Affiliation(s)
| | | | | | - CJ McLellan
- NSF International, Dixboro Road, Ann Arbor, Michigan, USA
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Garcia Bartels N, Massoudy L, Scheufele R, Dietz E, Proquitté H, Wauer R, Bertin C, Serrano J, Blume-Peytavi U. Standardized diaper care regimen: a prospective, randomized pilot study on skin barrier function and epidermal IL-1α in newborns. Pediatr Dermatol 2012; 29:270-6. [PMID: 22260233 DOI: 10.1111/j.1525-1470.2011.01590.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Adaptation of skin barrier function and interleukin-1α (IL-1α) content in diapered and nondiapered skin are poorly characterized in newborns receiving standard skin care. In a monocentric, prospective pilot study 44 healthy, full-term neonates were randomly assigned to skin care with baby wipes (n = 21) or water-moistened washcloth (n = 23) at each diaper change. Transepidermal water loss (TEWL), skin hydration, skin-pH, IL-1α, and epidermal desquamation were measured on days 2, 14, and 28 postpartum. Microbiological colonization was evaluated at baseline and on day 28. Significantly lower TEWL was found on the buttock in the group using baby wipes compared to water. IL-1α and skin hydration significantly increased and pH decreased independent of skin care regimen. IL-1α was significantly higher in diapered skin compared to nondiapered skin. Although skin care with wipes seems to stabilize TEWL better than using water, the skin condition and microbiological colonization were comparable using both cleansing procedures. Increase of epidermal IL-1α may reflect postnatal skin barrier maturation. These data suggest that neither of the two cleansing procedures harms skin barrier maturation within the first four weeks postpartum. Longer observations on larger populations could provide more insight into postnatal skin barrier maturation.
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Affiliation(s)
- Natalie Garcia Bartels
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Fernandes JD, Machado MCR, Oliveira ZNPD. Children and newborn skin care and prevention. An Bras Dermatol 2012; 86:102-10. [PMID: 21437530 DOI: 10.1590/s0365-05962011000100014] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Indexed: 11/22/2022] Open
Abstract
Neonatal skin suffers a progressive adaptation to the extrauterine environment and special care is needed during this period. This skin is very sensitive, thin and fragile. Immaturity of the epidermal barrier reduces the defense against the excessive proliferation of microbes and makes the skin more vulnerable to trauma and percutaneous drug toxicity. Because of the peculiar characteristics of newborn, infant and children's skin, the use of cosmetic products designed for hygiene and protection requires caution. In order to preserve the integrity of neonatal and child's skin, this article reviewed basic preventive care practices in relation to hygiene, bathing, cleansing agents, topical products and their percutaneous toxicity.
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Affiliation(s)
- Juliana Dumêt Fernandes
- Department of Dermatology, Clinics Hospital, Faculty of Medicine, University of Sao Paulo, SP, Brazil.
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Blume-Peytavi U, Hauser M, Stamatas GN, Pathirana D, Garcia Bartels N. Skin care practices for newborns and infants: review of the clinical evidence for best practices. Pediatr Dermatol 2012; 29:1-14. [PMID: 22011065 DOI: 10.1111/j.1525-1470.2011.01594.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In recent years, there have been continuing efforts to understand the effects of baby skin care routines and products on the healthy development of baby skin. Such efforts aim ultimately to determine the best infant skin care practices. The pediatric and dermatologic communities have not reached consensus on what constitutes an appropriate cleansing practice. In the United States, guidelines for neonatal skin care have been developed, propagated, and implemented. The accumulated knowledge has promoted evidence-based clinical practices and, therefore, may help to improve clinical outcomes, although these guidelines primarily cover the care of preterm newborns and the treatment of those with other health problems. High-level, long-term clinical evidence of the effective and safe cleansing of healthy, full-term newborns and infants is scarce. This review presents a comprehensive analysis of the scientific literature on baby skin development, cleansing practices, and related products (for healthy newborns and babies) since 1970. The evidence drawn from the reviewed literature can be summarized as follows: Bathing immersed in water seems generally superior to washing alone. Bathing or washing with synthetic detergents (syndets) or mild liquid baby cleansers seems comparable with or even superior to water alone. Nevertheless, larger randomized clinical trials with age-defined cohorts of babies as well as more-defined parameters are required to identify optimal practices and products for skin cleansing of healthy infants. These parameters may include standardized skin function parameters such as transepidermal water loss, stratum corneum hydration, skin surface pH, and sebum production. Clinical skin scores such as the Neonatal Skin Condition Score may be employed as outcome measures.
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Affiliation(s)
- Ulrike Blume-Peytavi
- Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Abstract
The art of cleansing has progressed immensely over several thousand years from simply scraping the skin to an exercise in relaxation and improvement in the skin's health and appearance in the present day. Soaps - the basic cleansing agent has also undergone a sea change in its evolution with many variants and newer constituents being incorporated into it. In dermatological disorders like acne, rosacea, atopic dermatitis, photoaging, 'sensitive skin', occupational dermatosis cleansers may have a beneficial role along with other therapeutic measures. With the advent of aesthetic dermatology, the act of cleansing and the use of various cleansing agents prior to aesthetic procedures has also assumed significance.
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Lavender T, Bedwell C, O'Brien E, Cork MJ, Turner M, Hart A. Infant skin-cleansing product versus water: a pilot randomized, assessor-blinded controlled trial. BMC Pediatr 2011; 11:35. [PMID: 21569487 PMCID: PMC3112109 DOI: 10.1186/1471-2431-11-35] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 05/13/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The vulnerability of newborn babies' skin creates the potential for a number of skin problems. Despite this, there remains a dearth of good quality evidence to inform practice. Published studies comparing water with a skin-cleansing product have not provided adequate data to inform an adequately powered trial. Nor have they distinguished between babies with and without a predisposition to atopic eczema. We conducted a pilot study as a prequel to designing an optimum trial to investigate whether bathing with a specific cleansing product is superior to bathing with water alone. The aims were to produce baseline data which would inform decisions for the main trial design (i.e. population, primary outcome, sample size calculation) and to optimize the robustness of trial processes within the study setting. METHODS 100 healthy, full term neonates aged <24 hours were randomly assigned to bathing with water and cotton wool (W) or with a cleaning product (CP). A minimum of bathing 3 times per week was advocated. Groups were stratified according to family history of atopic eczema. Transepidermal water loss (TEWL), stratum corneum hydration and skin surface pH were measured within 24 hours of birth and at 4 and 8 weeks post birth. Measurements were taken on the thigh, forearm and abdomen. Women also completed questionnaires and diaries to record bathing practices and medical treatments. RESULTS Forty nine babies were randomized to cleansing product, 51 to water. The 95% confidence intervals (CI) for the average TEWL measurement at each time point were: whole sample at baseline: 10.8 g/m(2)/h to 11.7 g/m(2)/h; CP group 4 weeks: 10.9 g/m(2)/h to 13.3 g/m(2)/h; 8 weeks: 11.4 g/m(2)/h to 12.9 g/m(2)/h; W group 4 weeks:10.9 g/m(2)/h to 12.2 g/m(2)/h; 8 weeks: 11.4 g/m(2)/h to 12.9 g/m(2)/h. CONCLUSION This pilot study provided valuable baseline data and important information on trial processes. The decision to proceed with a superiority trial, for example, was inconsistent with our data; therefore a non-inferiority trial is recommended.
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Affiliation(s)
- Tina Lavender
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK.
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Blume-Peytavi U, Cork MJ, Faergemann J, Szczapa J, Vanaclocha F, Gelmetti C. Bathing and cleansing in newborns from day 1 to first year of life: recommendations from a European round table meeting. J Eur Acad Dermatol Venereol 2009; 23:751-9. [PMID: 19646134 DOI: 10.1111/j.1468-3083.2009.03140.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- U Blume-Peytavi
- Department of Dermatology and Allergy, Charité- Universitätsmedizin Berlin, Charitéplatz 1, Berlin, Germany.
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Mochizuki H, Tadaki H, Takami S, Muramatsu R, Hagiwara S, Mizuno T, Arakawa H. Evaluation of out-in skin transparency using a colorimeter and food dye in patients with atopic dermatitis. Br J Dermatol 2009; 160:972-9. [DOI: 10.1111/j.1365-2133.2009.09036.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
The skin of the diaper area has special needs for protection from the irritating effects of urine and feces and prevention of diaper dermatitis. These needs include products such as diapers that absorb the excreta, as well as products for cleansing and conditioning the skin. A number of factors play a role in development of diaper dermatitis, including prolonged exposure to excreta, alterations in skin pH or increased hydration, and changes in skin microbial flora. Recent decades have seen great improvements in our understanding of these factors and our ability to develop new and better products to protect baby skin. Better diaper designs and the development of pH-buffered baby wipes have improved the care of skin in the diaper area. Continuing research offers the promise of new products with additional benefits for caregivers and infants.
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Affiliation(s)
- Ralf Adam
- Procter & Gamble Service GmbH, Schwalbach am Taunus, Germany.
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de Waard-van der Spek FB, Oranje AP. Allergic contact dermatitis to chlorhexidine and para-amino compounds in a 4-year-old boy: a very rare observation. Contact Dermatitis 2008; 58:239-41. [DOI: 10.1111/j.1600-0536.2007.01256.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tilles G, Wallach D, Taïeb A. Topical therapy of atopic dermatitis: Controversies from Hippocrates to topical immunomodulators. J Am Acad Dermatol 2007; 56:295-301. [PMID: 17224373 DOI: 10.1016/j.jaad.2006.09.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2006] [Revised: 09/20/2006] [Accepted: 09/27/2006] [Indexed: 11/19/2022]
Abstract
Although atopic dermatitis can be treated efficiently, there is still much controversy about the risk/benefit ratio of both topical corticosteroids and topical immunomodulators. Conflicting data may be found about the usefulness of bathing, diet regulation, and other therapeutic interventions. These controversies result in part from the persistence of Hippocratic doctrines in modern medical thinking. Humoralist and diathetic doctrines, as they pertain to eczema, are reviewed. The paradoxical worsening of oozing and the deadly hazards of hospitalization before the era of antibiotics are brought to mind. We hope that this historical review will improve the understanding of current controversies and help dermatologists to manage patients with atopic dermatitis and other chronic skin diseases.
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Sreenivasan PK, Gittins E. Effects of low dose chlorhexidine mouthrinses on oral bacteria and salivary microflora including those producing hydrogen sulfide. ACTA ACUST UNITED AC 2004; 19:309-13. [PMID: 15327643 DOI: 10.1111/j.1399-302x.2004.00160.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIMS Clinical studies have demonstrated the considerable effects of chlorhexidine on dental plaque and oral microbiota as well as improvements in indices of oral health. This investigation examined the efficacy of lower concentrations of chlorhexidine. METHODS Mouthrinses with 0.03%, 0.06%, 0.12% chlorhexidine and a control rinse without chlorhexidine were examined. Alamar blue, an oxidation-reduction dye with fluorescent end-points proportional to bacterial viability, was used to determine bacterial viability. Further clinical studies examined the effects of these rinses on salivary bacteria and on bacteria producing hydrogen sulfide (H(2)S) and implicated in halitosis. RESULTS In laboratory tests, a significant dose-dependent effect was observed with Actinomyces viscosus as a model system using the Alamar blue procedure (P < 0.05). Clinical studies examined the effects 1.5 h and 3 h post-treatment on salivary bacteria and bacteria producing H(2)S. The first study compared the control rinse with the 0.03% and 0.06% chlorhexidine rinses; a second study compared the effects of the control rinse and the 0.06% and 0.12% chlorhexidine mouthrinses. In both studies, chlorhexidine rinses demonstrated significant dose-dependent effects post-treatment on salivary bacteria vs. the control rinse (P < 0.05). Significant decreases in H(2)S-producing bacteria were noted with these chlorhexidine rinses vs. the control rinse (P < 0.05). CONCLUSION The results highlight the dose-dependent relationships noted in laboratory and clinical tests which have potential implications for the use of lower doses of chlorhexidine to inhibit oral bacteria, including those implicated in halitosis.
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Affiliation(s)
- Sylvie Hampton
- Dental Practice Board, Compton Place Road, Eastbourne BN20 8AD
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