Cutaneous tolerance of baby wipes by infants with atopic dermatitis, and comparison of the mildness of baby wipe and water in infant skin

Skin Barrier Function in Infants: Update and Outlook

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.

Approaches to Safety Evaluation of Baby Wipes

Disposable baby wipes manufactured by Procter & Gamble, soft sheets bearing lotion that is balanced to maintain natural skin pH, are convenient for cleaning the diaper area and a quick cleanup on baby’s face and hands.

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

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

Balancing the decomposable behavior and wet tensile mechanical property of cellulose-based wet wipe substrates by the aqueous adhesive

With the current global outbreak of novel coronaviruses, the fabrication of decomposable wet wipe with sufficient wet strength to meet daily use is promising but still challenging, especially when renewable cellulose was employed. In this work, a decomposable cellulose-based wet wipe substrate is demonstrated by introducing a synthetic N-vinyl pyrrolidone-glycidyl methacrylate (NVP-GMA) adhesive on the cellulose surface. Experimental results reveal that the NVP-GMA adhesive not only significantly facilitates the chemical bonding between cellulose fibers in the wet state, but also increase the surface wettability and water retention. The as-fabricated cellulose-based wet wipe substrate displays a superb water retention capacity of 1.9 times, an excellent water absorption capacity (completely wetted with 0° water contact angle), and a perfect wet tensile index of 3.32 N.m.g⁻¹. It is far better than state-of-the-art wet toilet wipe on the market (non-woven). The prepared renewable and degradable cellulose-based substrate with excellent mechanical strength has potential application prospects in diverse commercially available products such as sanitary and medical wet wipes.

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A decomposable wet wipe substrate was prepared from the bio-based materials.

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Synthetic adhesive enhanced the wet strength of the cellulose sheet.

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Enhancement of cellulose-based material was achieved under aqueous conditions.

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As-prepared cellulose substrate balanced the dispersibility and wet strength.

The science behind wet wipes for infant skin: Ingredient review, safety, and efficacy

In the diapered area, the continuous exposure to excess moisture and irritants from urine and feces weakens the stratum corneum, making the skin more susceptible to irritation. The use of wet wipes for infants (baby wipes) is a common practice to clean skin after urine or a bowel movement, and this practice even extends to cleaning the hands and face, resulting in repeated daily use. Therefore, ensuring that baby wipes contain ingredients that are safe and mild on skin is important to help minimize skin irritation and discomfort. While disposable baby wipes have been shown to be effective and gentle at cleaning infant skin, even the skin of premature infants, there is growing public concern regarding their safety and tolerability. Not all products are made the same, as differences exist in manufacturing processes, ingredients, materials, safety, and quality testing. Therefore, it is important that healthcare professionals have accessible evidenced-based information on the safety and tolerability of common ingredients found in baby wipes to optimally educate their patients and families. Herein, we provide a review on best practices for ingredient selection, safety, and efficacy of baby wipes.

Prevention and Management of Incontinence-Associated Dermatitis in the Pediatric Population: An Integrative Review

An integrative review was conducted to synthesize evidence on prevention and management of incontinence-associated dermatitis (IAD) in the pediatric population. A 5-step integrative process was used to guide the review. Articles published from January 2000 to April 6, 2017, were identified and retrieved from CINAHL, PubMed, ProQuest (MEDLINE), and Scopus; key terms were associated with IAD, pediatric, prevention, and management. Supplemental and manual searches were carried out to identify other relevant studies. The studies' findings were extracted and summarized in a table of evidence, with their quality evaluated using the Joanna Briggs Institute's Critical Appraisal Checklist. Sixteen articles were included in the review. Articles explored prevention and management strategies including skin cleansing technique, diaper selection, and the application of topical skin care products. Inconsistent and limited evidence was found regarding the benefits of using disposable wipes in preference to water-moistened washcloths in the cleansing process and on the use of superabsorbent polymer diapers with breathable outer lining in IAD prevention. Findings were inconclusive with regard to the best topical skin care product for IAD care. However, the application of skin protectants was encouraged by the authors, as well as promoted in various clinical guidelines. The development of a structured skin care regimen supplemented by a comprehensive patient education program was advised to enhance the prevention and management of IAD.

Benefits of Using an Appropriately Formulated Wipe to Clean Diapered Skin of Preterm Infants

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.

Assessment Effect of Breast Milk on Diaper Dermatitis

Diaper dermatitis is the most common dermatological disease of infancy, which occurs and caused by the combined effect of irritants such as diaper, urine and faces. In this study, we intend to evaluate the effect of breast milk on the healing of diaper dermatitis. This study was a clinical trial of 30 infants between 0-12 months of age that were suffering from diaper dermatitis and referred to the Health Centers in Tehran, Iran. The subjects were selected by open study. Infants were divided into two matched groups: case and control. Data-gathering tools were the questionnaire that contained two parts: the demographic characteristics of infants and the status of care and condition of the lesion. Data analysis was performed using SPSS/18 software and Mann-Whitney and Chi-Square tests were used. The findings revealed a significant difference between the case and control groups in the number and lesion score of the rashes at the first and third day (P=0.013, P=0.005), these differences were more significant at the fifth day (P=0.004, P=0.001). Because of positive effects of breast milk on healing of diaper dermatitis, it is proposed that educational programs in health centers should be considered by health officials, and the managers would play a key role in increasing knowledge behavior changes in mothers.

Recommendations from a European Roundtable Meeting on Best Practice Healthy Infant Skin Care

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.

Diaper Dermatitis in Infants Admitted to Social Pediatrics Health Center: Role of Socio-demographic Factors and Infant Care

OBJECTIVE

To determine infant diaper dermatitis (DD) at pediatrics health center; its relation to socio-demographic factors and infant care.

METHODS

The study included 113 infants aged 0-24 mo. Data on infants' age, sex, weight, mothers' education, nutrition, diaper change frequency, cleaning methods and prophylactic cream use were recorded. Infants with minimum one time rash, were accepted to have DD.

RESULTS

Seventy six (67.3 %) infants had DD [32 girls (42.1 %), 44 boys (57 %), mean age: 6.5 mo]. Infants with DD had significantly higher age than those without (p 0.001). DD frequency in infants ≥4.5 mo-old was 5.8(2.4-13.7) times more than in infants ≤4.5 mo. Cleaning material types did not affect DD frequency. No significant difference was observed in DD with diaper change of ≤3 times and ≥4 times. Significant difference in DD increase was observed with supplementary food intake vs. without it (p 0.000). DD frequency in infants with supplementary food intake was 6.4 times (2.4-17.1) more than in those without it. Human milk intake was statistically significant in causing less occurrence of DD as shown in univariate model (p < 0.05). Rash incidence was significantly lower with cream use compared to without its use (p < 0.001). DD prevalence was decreased 0.203 (0.087-0.477) times by cream usage.

CONCLUSIONS

Age, supplementary food intake and lack of cream use seem to be accountable for DD whereas human milk intake lessened the occurrence of DD. Mothers should be informed on dermatitis care and encouraged for breastfeeding.

Newborn infant skin: physiology, development, and care

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.

Clinical approaches to skin cleansing of the diaper area: practice and challenges

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.

Market trends in baby skin care products and implications for clinical practice

Although the U.S. pediatric skin care market is a $1.7 billion industry, little is known regarding the usage pattern of skin care products in very young children. We have begun to recognize that common over-the-counter skin care products may have positive or negative effects on skin barrier function. Thus, knowing what and how skin care products are used early in life is important. The goal of the current study was to better understand skin care product use in the United States using market research data. We found that the prevalence of use was greater than 50% for all skin care product categories and age groups. Premoistened cleansing wipes and cloths were the most frequently used product, followed by baby oil and lotion and body and baby powder. Baby bath and shampoo products were used at least five times per week per household, and caregivers generally preferred products that were fragrance-free and made for sensitive skin. Lower-income households reported a higher frequency of product use and were less likely to purchase fragrance-free products or ones that were made for sensitive skin. Our findings suggest that the prevalence of pediatric skin care product use is high and conflicts with current recommended skin care guidelines. Product use and preferences may also vary according to race and ethnicity and household income level.

Prevention of diaper dermatitis in infants--a literature review

Diaper dermatitis (DD) is one of the most common skin conditions in neonates and infants, with a peak between the ages of 9 and 12 months. Appropriate skin care practices that support skin barrier function and protect the buttocks skin from urine and feces are supposed to be effective in the prevention of DD. Despite many recommendations for parents and caregivers on proper diaper skin care, there is no up-to-date synthesis of the available evidence to develop recommendations for DD prevention practice. Therefore we performed a systematic literature review on the efficacy of nonmedical skin care practices on the diapered area of healthy, full-term infants ages 0 to 24 months. We identified 13 studies covering skin care practices such as cleansing, bathing, and application of topical products. DD prevalence and incidence and physiologic skin parameters were used as efficacy parameters. The results of this review indicate that cleansing of the diaper area using baby wipes or water and a washcloth have comparable effects on diapered skin. Bathing with a liquid baby cleanser twice weekly seems comparable with water alone. The application of ointments containing zinc oxide or petrolatum with or without vitamin A seems to have comparable effects on DD severity. There seems to be no information on whether single skin care practices such as cleansing, bathing, and application of topical preparations can prevent DD. High-quality randomized clinical trials are needed to show the effectiveness of skin care practices for controlling and preventing DD.

Diagnosis and management of diaper dermatitis

This article presents an overview of diaper dermatitis for the pediatric community. The pathogenesis, differential diagnosis, and management of this common condition in infancy are reviewed. This information will assist in making the appropriate diagnosis and managing this irritant contact dermatitis of the diaper area. With conservative management, most cases of irritant diaper dermatitis are self-limited. When the condition persists, one must consider other diagnoses.

Diaper dermatitis: etiology, manifestations, prevention, and management

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.

Diaper dermatitis: a survey of risk factors for children aged 1-24 months in China

OBJECTIVES

To measure the prevalence of diaper dermatitis and identify risk factors relating to diaper dermatitis in Chinese children aged 1-24 months.

METHODS

This was a cross-sectional study that used structured questionnaires during face-to-face interviews with parents to determine the risk factors associated with diaper dermatitis. Univariate and multivariate logistic regression analyses were used to test the association between diaper dermatitis and 15 potential risk factors.

RESULTS

A total of 43.8% (454/1036) of infants in the study had experienced diaper dermatitis in the 6 weeks prior to enrolment. Multivariate logistic regression analyses showed that the risk of diaper dermatitis was significantly decreased by solid foods (eggs), home location (urban) and frequency of diaper changing (≥ 6 changes/day), whereas the risk was increased by diarrhoea.

CONCLUSIONS

Diarrhoea was a major risk factor for diaper dermatitis. Confirmation of the risk factors could lead to better understanding of the aetiology of diaper dermatitis and to new prevention strategies in Chinese infants.

Effect on skin hydration of using baby wipes to clean the napkin area of newborn babies: assessor-blinded randomised controlled equivalence trial

BACKGROUND

Some national guidelines recommend the use of water alone for napkin cleansing. Yet, there is a readiness, amongst many parents, to use baby wipes. Evidence from randomised controlled trials, of the effect of baby wipes on newborn skin integrity is lacking. We conducted a study to examine the hypothesis that the use of a specifically formulated cleansing wipe on the napkin area of newborn infants (<1 month) has an equivalent effect on skin hydration when compared with using cotton wool and water (usual care).

METHODS

A prospective, assessor-blinded, randomised controlled equivalence trial was conducted during 2010. Healthy, term babies (n=280), recruited within 48 hours of birth, were randomly assigned to have their napkin area cleansed with an alcohol-free baby wipe (140 babies) or cotton wool and water (140 babies). Primary outcome was change in hydration from within 48 hours of birth to 4 weeks post-birth. Secondary outcomes comprised changes in trans-epidermal water loss, skin surface pH and erythema, presence of microbial skin contaminants/irritants at 4 weeks and napkin dermatitis reported by midwife at 4 weeks and mother during the 4 weeks.

RESULTS

Complete hydration data were obtained for 254 (90.7 %) babies. Wipes were shown to be equivalent to water and cotton wool in terms of skin hydration (intention-to-treat analysis: wipes 65.4 (SD 12.4) vs. water 63.5 (14.2), p=0.47, 95% CI -2.5 to 4.2; per protocol analysis: wipes 64.6 (12.4) vs. water 63.6 (14.3), p=0.53, 95% CI -2.4 to 4.2). No significant differences were found in the secondary outcomes, except for maternal-reported napkin dermatitis, which was higher in the water group (p=0.025 for complete responses).

CONCLUSIONS

Baby wipes had an equivalent effect on skin hydration when compared with cotton wool and water. We found no evidence of any adverse effects of using these wipes. These findings offer reassurance to parents who choose to use baby wipes and to health professionals who support their use.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN86207019.

Clinical demonstration of skin mildness and suitability for sensitive infant skin of a new baby wipe

BACKGROUND

A cleansing baby wipe with sufficient pH buffering capacity may help to restore the pH balance of skin following exposure to urine and feces in the diaper environment and maintain skin health.

OBJECTIVE

To evaluate the skin effects of a novel baby wipe formulation with increased pH buffering.

SUBJECTS AND METHODS

A series of clinical studies was designed and conducted to evaluate the skin effects of the new baby wipe, including a 21-day cumulative skin irritation patch study in adults (n = 31), a 4-week study in babies with medically confirmed atopic dermatitis (n = 32), a 2-week study comparing skin pH of babies (n = 15) following use of wipes compared with water and wash cloth, a series of clinical skin pH measurements following fecal exposure and subsequent cleaning with different products (n = 50) and a study evaluating comfort of product application on irritated skin (n = 31).

RESULTS

The wipes formulation was well-tolerated, even in babies with atopic dermatitis, and was more comfortable versus water and washcloth. Increased buffering capacity of a wet wipes lotion helps to maintain a physiologically balanced skin pH value in the diaper region.

Recent advances in diaper dermatitis: etiology and treatment

Diaper dermatitis is a highly prevalent condition that causes discomfort and stress for patients and frustration for healthcare staff. Diaper technology has evolved to substantially lessen the severity of diaper dermatitis, but additional improvements are needed. Premature infants and incontinent adults are particularly at risk for developing diaper dermatitis and its potential consequences. Contributing factors include overhydration, irritants, friction, increased skin pH, diet, gestational age, antibiotic use, diarrhea and medical condition. Treatments aim to reduce hydration, provide a semipermeable ‘layer’ to facilitate skin barrier repair, shield the skin from irritants, deactivate specific fecal components and maintain skin surface contact. The published research on the effects of diaper dermatitis treatments is especially sparse. Controlled clinical trials are needed to provide definitive evidence for selection of effective treatments. This article discusses the incidence and etiology of diaper dermatitis in infants and adults. It provides the scientific basis for repair of diaper skin barrier damage and describes recent developments that will be available in the future.

Skin care of the diaper area

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.

Diaper dermatitis that does not quit

Diaper dermatitis is one of the most common skin disorders in infants. The humid, moist environment under the diaper makes the skin more susceptible to injury from exposure to irritants particularly related to urine and feces. A gentle cleansing routine, frequent diaper changes, and a thick barrier cream help control this condition. Irritant diaper dermatitis should be distinguished from other skin conditions that may develop in this sensitive area.