Use of "natural" oils for moisturization: Review of olive, coconut, and sunflower seed oil

Non-pharmacological therapies and their efficacy in atopic dermatitis: A narrative review

Atopic dermatitis (AD) is a complex immune-mediated disease characterised by recurrent eczematous lesions and pruritus, which adversely affects the quality of life (QoL). Genetic factors, environmental factors, immune dysregulation, and skin barrier dysfunction contribute to its pathophysiology. Non-pharmacological management strategies aim to preserve the skin barrier, address immune dysregulation, and minimise triggers. In this review, wediscuss various non-pharmacological interventions, including allergen (aeroallergens, food allergens, and contact allergens) avoidance, bathing-related measures, moisturisers, clothing choices, therapies targeting the skin microbiome, and allergen-specific immunotherapy, in addition to education and psychotherapy. Non-pharmacological therapies are essential for the holistic management of AD, but their effectiveness varies, highlighting the need for further research and tailored approaches to individual patient needs.

Evaluation of the therapeutic effect of Sacha inchi oil in atopic dermatitis mice

Atopic dermatitis (AD) is a prevalent inflammatory skin condition characterized by a multifaceted pathogenesis, which encompasses immune system signaling dysregulation, compromised skin barrier function, and genetic influencers. Sacha inchi (Plukenetia volubilis L.) oil (SIO) has demonstrated potent anti-inflammatory and antioxidant properties, however, the mechanism underlying the beneficial effects of SIO on AD remains unclear. This study aims to investigate the anti-AD effect of SIO and its possible molecular mechanism in mice with AD. The results demonstrated that SIO significantly reduced the degree of skin lesions and scratching, and improved the skin thickness and mast cell infiltration in AD mice. Furthermore, SIO significantly reduced the levels of immunoglobulin E, histamine and thymic stromal lymphopoietin in serum of AD mice. Additionally, it inhibited the expression of tumor necrosis factor-γ, interferon-γ, interleukin-2, interleukin-4, interleukin 1β and other inflammatory cytokines in the lesions skin of mice. The Western blotting analysis revealed that SIO exhibited an upregulatory effect on the protein expression of filaggrin and loricrin, while concurrently exerting inhibitory effects on the protein expression and phosphorylation levels of P38, ERK, NF-κB, and IκBα within their respective signaling pathways. Consequently, it can be inferred that SIO exerts a significant anti-atopic dermatitis effect by modulating the P38, ERK, NF-κB, and IκBα signaling pathways. This study contributes to expand the research and development potential of SIO, and provides novel insights and potential therapeutic strategies for AD treatment.

Effect of different materials used in the removal of orogastric catheter adhesive on the skin in premature babies in Turkey

Purpose To compare the effectiveness of sunflower oil and silicone-based spray used to remove medical adhesives from the orogastric catheter in preventing the skin injury of premature infants in the neonatal intensive care unit.

METHODS

This randomized controlled experimental study was conducted on premature infants, born between 32 and 36 weeks, hospitalized in the Neonatal Intensive Care Unit located in the city center of the Black Sea region. There were 86 participants in the study; 43 were in the control group (silicone-based spray), and 43 were in the intervention group (sunflower oil). The "Neonatal Skin Condition Score Scale" evaluated premature infants' skin.

RESULTS

Mean skin condition score of premature infants for whom silicone-based adhesive remover spray was applied was 3.63 ± 0.78, whereas the mean skin condition score measured three hours later was 3.17 ± 0.37. Mean skin condition score of premature infants for whom sunflower oil was applied as a medical adhesive remover was 3.40 ± 0.62, whereas the mean skin condition score measured three hours later was 3.07 ± 0.25. No statistically significant difference was determined between the mean skin condition scores of premature infants in both groups evaluated immediately after removing the medical adhesive and 3 h there after (p>0.05).

CONCLUSIONS

There is no difference between the skin condition of premature infants for whom silicone-based medical adhesive remover spray is used and the skin condition of premature infants for whom sunflower oil is used to remove the orogastric tube adhesive.

PRACTICE IMPLICATIONS

Pediatric nurses should use medical supplies suitable for the skin condition of premature infants and should frequently evaluate the baby's skin condition. Since silicone-based adhesive remover sprays have a risk of toxicity by being absorbed by the skin, it is recommended to use herbal, cost-effective, non-toxic products.

CLINICAL TRIAL NUMBER

NCT06280326.

[Children with atopic eczema and their environment]

Taking an interest in the environment of a child suffering from eczema means understanding the word "environment" in the broadest possible sense: the child's lifestyle, family, social and cultural environment. By taking all these aspects into account, we can optimize the effectiveness of treatments, and avoid the multiple problems and comorbidities associated with moderate and severe eczema. It's up to caregivers to be vigilant about this, and to reposition the right gestures by spotting errors right from the start, even in the case of mild eczema. The best way to respond to this challenge, i.e. to help parents understand, is to draw on the principles of therapeutic patient education.

Bathing in Atopic Dermatitis in Pediatric Age: Why, How and When

Atopic dermatitis is a chronic inflammatory skin disease. The treatment plays an important role in influencing the patients' quality of life. The basic management consists of appropriate skin cleansing, including bathing and eventually using bathing additives. Recommendations regarding frequency and duration of bathing, water temperature and usefulness of bathing additives are widely different, often leading to confusion among patients. This review aims to give insights into the best bathing practices and the use of bathing additives in atopic dermatitis in children. Several bathing additives, including bleach baths, commercial baby cleansers, bath baby oils and bath salt, appear to be promising adjunctive therapies for atopic dermatitis due to their anti-inflammatory, anti-bacterial, anti-pruritus and skin barrier repair properties through different mechanisms of action. However, their efficacy and safety are not fully understood in some cases. The usefulness of other bath additives, such as acidic and more natural substances (green tea extracts, pine tar, sodium bicarbonate), is still under investigation. Further studies are needed to determine their optimal use to achieve clinical benefit safely.

Epicutaneous Sensitization and Food Allergy: Preventive Strategies Targeting Skin Barrier Repair-Facts and Challenges

Food allergy represents a growing public health and socio-economic problem with an increasing prevalence over the last two decades. Despite its substantial impact on the quality of life, current treatment options for food allergy are limited to strict allergen avoidance and emergency management, creating an urgent need for effective preventive strategies. Advances in the understanding of the food allergy pathogenesis allow to develop more precise approaches targeting specific pathophysiological pathways. Recently, the skin has become an important target for food allergy prevention strategies, as it has been hypothesized that allergen exposure through the impaired skin barrier might induce an immune response resulting in subsequent development of food allergy. This review aims to discuss current evidence supporting this complex interplay between the skin barrier dysfunction and food allergy by highlighting the crucial role of epicutaneous sensitization in the causality pathway leading to food allergen sensitization and progression to clinical food allergy. We also summarize recently studied prophylactic and therapeutic interventions targeting the skin barrier repair as an emerging food allergy prevention strategy and discuss current evidence controversies and future challenges. Further studies are needed before these promising strategies can be routinely implemented as prevention advice for the general population.

Comparing the Efficacy of Breast Milk and Coconut Oil on Nipple Fissure and Breast Pain Intensity in Primiparous Mothers: A Single-Blind Clinical Trial

Background: Nipple fissure is a prevalent problem for breastfeeding mothers. Virgin coconut oil (VCO) is an herbal medicine that can heal microbial infections and wounds. Objective: This study aims to evaluate the efficacy of VCO and breast milk on nipple fissures in primiparous mothers. Design, Setting, Participants, and Intervention: A single-blind clinical trial was conducted with 106 breastfeeding primiparous mothers suffering from nipple fissures in health centers of Zarand, Kerman, from August 2020 to November 2020. The participants were selected randomly and allocated to two 60-member groups using block randomization. Mothers in the first group were asked to apply 0.5 mL of coconut oil on their nipples three times a day. Mothers in the second group were trained to apply three to four drops of their milk on their nipples after every breastfeeding session. The level of nipple fissures and pain intensity were examined using Storr's scale and visual analog scale, respectively. The results were analyzed using the chi-square test, repeated measures analysis of variance, and the independent samples t-test in SPSS 22. In this study, the significance level was set at p < 0.05. Results: Within-group comparisons revealed a significant difference between baseline scores and the scores on the 7th and 14th days (p < 0.001). Between-group comparison indicated no significant difference in nipple fissure (p = 0.419) and pain intensity (p = 0.405) at baseline. Nonetheless, there was a significant difference on the 7th day (p_fissure = 0.002, p_pain <0.001) and on the 14th day (p_fissure <0.001, p_pain = 0.036). Conclusion: Given its effect on nipple fissures, VCO may be used as a complementary substance to treat nipple fissures. Trial Registration: This trial is registered with the Iranian Registry of Clinical Trials with the identifier: IRCT20190724044318N1.

Effects of Topical Oils on Neonatal Skin: A Systematic Review

OBJECTIVE

To identify studies that aimed to determine the effects of topical oils on neonatal skin.

DATA SOURCES

Authors searched PubMed, Cochrane Central Register of Controlled Trials, and Science Direct databases.

STUDY SELECTION

The databases were searched for studies published through February 2022 (when the search was conducted) using the keywords "skin", "neonatal", "infant", and "oil". Fourteen randomized controlled trials that met the eligibility criteria were included in the review.

DATA EXTRACTION

Researchers used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) reporting guidelines to guide this systematic review. Two authors reviewed and evaluated the articles independently.

DATA SYNTHESIS

The 14 studies included in this review were conducted with a total of 5,683 neonates, most of whom were preterm. The included studies used blended sunflower (n = 8), coconut (n = 5), almond (n = 2), olive (n = 1), mustard (n = 1), and vegetable (n = 1) oils. These studies investigated the effects of topical oils on the skin's barrier functions and skin integrity. Most studies used noninvasive measurement devices to evaluate the skin's barrier functions; they used a variety of scoring systems to evaluate skin integrity. Eleven of the studies concluded that the oils used in the skincare of neonates effectively improve the skin condition and barrier functions of the skin. However, three studies found equivocal, negative, or mixed findings.

CONCLUSION

Although current evidence indicates a potential benefit, more studies with a high level of evidence on the subject are required.

Maintaining Skin Integrity in Neonates with Sunflower Seed Oil and Liquid Vaseline: A Prospective Randomized Controlled Study

OBJECTIVE

To test the effectiveness of sunflower seed oil (SSO) and liquid Vaseline (LV) in maintaining skin integrity in term and preterm neonates in the neonatal ICU. Because the skin of the neonate is still immature, disruption of skin integrity is a commonly observed problem.

METHODS

In this randomized controlled study, 90 preterm and term neonates in the neonatal ICU of a state hospital were equally divided into three groups. The skin condition of the neonates in all three groups was assessed using the Neonatal Skin Condition Score (NSCS); assessments were made a total of nine times at 48-hour intervals. The skin of the neonates in the first group was moisturized with SSO, and the second group was moisturized with LV, once a day, a total of 16 times. Moisturizer was not applied to the skin of the third group of neonates (the control group).

RESULTS

The median gestational age was 37.0 weeks (range, 36.0-38.0 weeks). After the third evaluation, the median NSCS scores for the neonates in the SSO and LV groups were significantly lower than for those in the control group (P < .001). The control group's median NSCS scores did not change throughout the period of the study.

CONCLUSIONS

Both SSO and LV are harmless to the skin of neonates and can be used to maintain their skin integrity. More advanced studies are needed to evaluate the effects of topical oils on maintaining skin integrity.

Oxidative Stability and Protective Effect of the Mixture between Helianthus annuus L. and Oenothera biennis L. Oils on 3D Tissue Models of Skin Irritation and Phototoxicity

The present study was aimed to evaluate the oxidative stability as well as to assess the protective effect of the mixture of Helianthus annuus L. (HAO) and Oenothera biennis L. (OBO) oils on 3D tissue models of skin irritation and phototoxicity. The following methods were used: GS analysis (fatty acids composition), thiobarbituric acid-reactive substances assay (TBA) (lipid oxidation degree of tested samples), 3D EpiDerm models (skin irritation and phototoxicity). For HAO the detected saturated fatty acids (SFA) were palmitic acid (7.179%), stearic acid (3.586%), eicosanoic (0.138%) and docosanoic acid (0.548%) The monounsaturated acids (MUFA) were palmitoleic acid (0.158%) and oleic acid (28.249%) and the polyunsaturated acids (PUFA) were linoleic acid (59.941%) and linolenic acid (0.208%). For OBO the detected SFA were myristic acid (0.325%), pentadecylic acid (0.281%), palmitic (7.2%), stearic (2.88%), and arachidic acid (0.275%). Regarding MUFA, even a lower proportion (8.196%) was observed, predominantly being oleic acid, cis form (7.175%), oleic (n10) (0.558%) and 11-eicosenoic (0.210%) acids. The higher content was found for PUFA (82.247%), the most significant proportions being linoleic acid (72.093%), arachidonic acid (9.812%) and linolenic (0.233%). Obtained data indicate a good oxidative stability and biocompatibility of the mixture on the 3D EpiDerm models with no irritant and no phototoxic effects. Oenothera biennis L. oil may be an excellent natural choice in order to delay or prevent oxidative damage of Helianthus annuus L. oil.

Construction of heteroaryl-bridged NIR AIEgens for specific imaging of lipid droplets and its application in photodynamic therapy

As a kind of subcellular organelle, lipid droplets (LDs) play a critical role in the body's normal metabolism. LDs have gained increasing attention as a fluorescent photodynamic target site. Near-infrared (NIR) organic light-emitting luminescent materials, with aggregation-induced emission (AIE)-active feature, preeminent LD-imaging ability, and effective reactive oxygen species (ROS) production property, have been widely used for photodynamic therapy (PDT) in diagnostic therapeutics, but its application remains challenging. In the present work, three novel NIR organic compounds with AIE-active feature, namely, TPET-Is, TPET-Fu, and TPEF-Is, were developed and synthesized. These heteroaryl-bridged molecules possess a donor-donor-π-acceptor structure and strong intramolecular charge transfer character. These AIEgens are capable of high-fidelity LD imaging in living cells (Pearson's coefficient values: 0.94, 0.96, 0.97) due to their biocompatibility, good photostability, and strong lipophilicity (LogP values: 9.39, 7.89, 8.03), respectively. Moreover, they can be also applied in bright imaging the LDs of oil-rich plant tissues, such as those of sunflower seeds. The respective AIEgens TPET-Fu of these compounds can also produce ROS in the condition of white light to effectively kill live Hela cells. The present study thus provides a potential strategy through heteroaryl-bridged molecular engineering for LD-targeted imaging and PDT application.

Optimizing topical management of atopic dermatitis

OBJECTIVE

Provide a review of atopic dermatitis management, focusing on optimizing topical therapy, creating a stepwise approach for treatment plans, and providing guidance on when to start systemic therapy.

DATA SOURCES

PubMed search of articles in the English language regarding atopic dermatitis in all ages.

STUDY SELECTION

Articles on the subject matter were selected and reviewed.

RESULTS

Topical corticosteroids are the first-line treatment for managing atopic dermatitis. Topical nonsteroidal agents, calcineurin inhibitors, crisaborole, and recently, ruxolitinib, which cause no cutaneous atrophy, are options for reducing the use of topical corticosteroids, including on sensitive sites. Emerging topical agents are in clinical trials. Proactive management, with continued application 2 to 3 times weekly of a midpotency topical corticosteroid or tacrolimus, may maintain control for clear (or almost clear) localized sites of dermatitis that rapidly recur when topical anti-inflammatory medication is stopped. If topical therapy alone cannot control disease and quality of life is impacted, reevaluation to confirm the diagnosis, manage comorbid conditions, address compliance and patient-specific concerns, and optimize topical therapy must be undertaken before deciding to advance to systemic medication. Dupilumab, an interleukin-4 receptor inhibitor, has become first-line systemic therapy given its efficacy and safety, allowing long-term treatment without laboratory monitoring. Other biologics and Janus kinase inhibitors are emerging as alternatives that could eliminate the need for immunosuppressants with their higher risks.

CONCLUSION

Several options are now available for topical treatment. A stepwise approach is needed to consider alternative therapies and diagnoses before advancing to systemic treatment, but the safety of newer immunomodulators will lower the threshold for more aggressive intervention.

Art of prevention: Practical tips for improving adherence to treatments for older patients in dermatology

Given demographic changes and increases in longevity, physicians will see increasing numbers of patients over the age of 65 years. As the population ages, adapting and optimizing patient care to better serve the needs of older patients should be a priority. The goal of this review is to shed light on potential barriers affecting treatment adherence and to improve clinical care for older adults with dermatologic conditions. We provide practical strategies to help overcome these barriers and provide suggestions to address the impact of functional limitations on topical medication adherence. Some less apparent risks of treatment, such as fall risks with topical treatments, are also discussed, along with issues such as cost of treatments and prescribing considerations for patients who reside in facilities.

Anti-aging properties of phytoconstituents and phyto-nanoemulsions and their application in managing aging-related diseases

Aging is spontaneous and inevitable process in all living beings. It is a complex natural phenomenon that manifests as a gradual decline of physiological functions and homeostasis. Aging inevitably leads to age-associated injuries, diseases, and eventually death. The research on aging-associated diseases aimed at delaying, preventing or even reversing the aging process are of great significance for healthy aging and also for scientific progress. Numerous plant-derived compounds have anti-aging effects, but their therapeutic potential is limited due to their short shelf-life and low bioavailability. As the novel delivery system, nanoemulsion can effectively improve this defect. Nanoemulsions enhance the delivery of drugs to the target site, maintain the plasma concentration for a longer period, and minimize adverse reaction and side effects. This review describes the importance of nanoemulsions for the delivery of phyto-derived compounds and highlights the importance of nanoemulsions in the treatment of aging-related diseases. It also covers the methods of preparation, fate and safety of nanoemulsions, which will provide valuable information for the development of new strategies in treatment of aging-related diseases.

Complementary and alternative medicine treatments for common skin diseases: A systematic review and meta-analysis

Background

Complementary and alternative medicine (CAM) treatments are growing in popularity as alternative treatments for common skin conditions.

Objectives

To perform a systematic review and meta-analysis to determine the tolerability and treatment response to CAM treatments in acne, atopic dermatitis (AD), and psoriasis.

Methods

PubMed/Medline and Embase databases were searched to identify eligible studies measuring the effects of CAM in acne, AD, and psoriasis. Effect size with 95% confidence interval (CI) was estimated using the random-effect model.

Results

The search yielded 417 articles; 40 studies met the inclusion criteria. The quantitative results of CAM treatment showed a standard mean difference (SMD) of 3.78 (95% CI [−0.01, 7.57]) and 0.58 (95% CI [−6.99, 8.15]) in the acne total lesion count, a SMD of −0.70 (95% CI [−1.19, −0.21]) in the eczema area and severity index score and a SMD of 0.94 (95% CI [−0.83, 2.71]) in the scoring of atopic dermatitis score for AD, and a SMD of 3.04 (95% CI [−0.35, 6.43]) and 5.16 (95% CI [−0.52, 10.85]) in the Psoriasis Area Severity Index score for psoriasis.

Limitations

Differences between the study designs, sample sizes, outcome measures, and treatment durations limit the generalizability of data.

Conclusions

Based on our quantitative findings we conclude that there is insufficient evidence to support the efficacy and the recommendation of CAM for acne, AD, and psoriasis.

Olive Oil with Ozone-Modified Properties and Its Application

Olive oil application in the cosmetic industry may be extended by its ozonation, bringing about new oil properties and increased stability. Olive oil treated with 0.04 mole O₃ or 0.10 mole O₃ per 100 g oil was subjected to chemical parameters evaluation and composition scrutinizing by gas chromatography–mass spectrometry (GC-MS) and headspace solid-phase microextraction (HS-SPME) GC-MS analysis. The biological activity of refined and ozonated oil included their antimicrobial properties by the agar diffusion method and cytotoxicity by the MTT assay towards two normal (LLC-PK1, HaCaT) and two cancerous (Caco-2, HeLa) cell lines. The oils served as the basis in cosmetic emulsions. The chosen organoleptic features, preservative efficacy in a challenge test, and persistency during six months of these formulations were assessed. However, the ozonation of the olive oil resulted in a decrease in unsaturated acids; several additional compounds were detected in the ozonated oil, which positively affect the physicochemical, sensory, and functional properties of cosmetic emulsions. Emulsions based on the ozonated olive oil retain their properties longer compared to emulsions based on the refined olive oil. Ozonated oil treated with 0.10 mole O₃/100 g oil allowed increasing the shelf life of the non-preserved formulation up to six months. A weak inhibitory effect against Candida albicans and Aspergillus brasiliensis was also demonstrated for this emulsion in the challenge test. Moreover, an interesting aroma, slightly enhanced antimicrobial activity against Escherichia coli, Staphylococcus aureus, C. albicans, A. brasiliensis, and a lack of cytotoxicity at concentrations 625 µg mL⁻¹ make the ozonated olive oil a promising raw material for the cosmetics and pharmaceutical industries.

Health effects of coconut oil: Summary of evidence from systematic reviews and meta-analysis of interventional studies

BACKGROUND AND AIMS

Systemic review (SR) and meta-analysis (MA) of interventional studies are considered as the highest level of evidence for clinical decision making. Therefore, we systematically summarized all high-quality evidence on the usage of coconut oil for health-related benefits from SRs and MA.

METHODS

PubMed®, Web of science®, SciVerse Scopus®, and EMBASE® databases were systematically searched to select SRs and SRs with MA of interventional studies reporting health-related clinical outcomes of coconut oil. Similar studies were grouped based on their respective clinical areas. A methodological quality appraisal was conducted for all included SRs and SRs with MA using the Critical Appraisal Checklist for Systematic Reviews.

RESULTS

A total of seven papers were selected for inclusion in this review, consisting of three MA and one SR on cardio-metabolic health, one SR on oral health, and one SR and one MA each on skin health. Coconut oil significantly increases serum total cholesterol, low-density- and high-density- lipoprotein cholesterol levels compared to poly- and mono-unsaturated oils. Limited studies showed that topical use of coconut oil helps in the prevention and treatment of atopic dermatitis and oil pulling for the prevention of dental caries. All four studies on cardiometabolic health and the SR on oral health had a high score in the quality assessment, SR with MA on skin health fulfilled high-quality scoring whereas the SR on the same topic had a low-quality scoring.

CONCLUSIONS

In summary, consistent and strong evidence shows that coconut oil has an adverse effect on the lipids parameters associated with cardio-metabolic health, with limited studies to conclude the effects of atopic dermatitis and oil pulling.

Coconut allergy: Characteristics of reactions and diagnostic predictors in a pediatric tertiary care center

BACKGROUND

Little is known on the clinical manifestations of coconut allergy. Our knowledge to date is mainly based on case reports.

OBJECTIVE

To characterize the allergic reactions to coconut and suggest diagnostic cutoffs for specific immunoglobulin E (sIgE) and skin prick testing (SPT) to predict clinically reactive coconut allergy.

METHODS

Methods include retrospective chart review at an urban tertiary care center of patients with positive testing result for coconut. Probability curves were computed by logistic regression for SPT and coconut sIgE.

RESULTS

Of 275 records reviewed, 69 patients reported coconut reactions and 206 were sensitized only or nonallergic. The reactions occurred with breastfeeding (n = 2), contact (n = 10), or oral ingestion (n = 57). Approximately 50% of oral ingestion reactions were associated with mild/moderate anaphylaxis. Clinical reactivity vs sensitization was more common in topical coconut users (2-fold) (P = .02). Although not statistically significant, there was a trend toward more coconut allergy vs sensitization in Asian and African American patients. The probability of allergy with positive SPT result was approximately 50% and with sIgE was approximately 60%. At an SPT of 9 mm wheal or sIgE of 58 kU of allergen/L, there is a 95% probability of reaction. Cosensitization with tree nuts, legumes, and seeds was common. Macadamia nut had the strongest correlation with coconut (r = 0.81, P < .001, n = 101).

CONCLUSION

Although the rate of reactivity to coconut in sensitized individuals is low, half of the reactions from consumption met the criteria for anaphylaxis. Clinicians should be aware of the spectrum of reactions and diagnostic use of sIgE and SPT.

Home remedies in different pediatric dermatoses: An observational study

Traditional medicinal systems are widely practiced in the Indian subcontinent for a wide variety of diseases. We aimed to identify the various home remedies used by people to treat numerous pediatric dermatoses. It was an observational study carried out over 18 months in which 150 children attending our clinics were recruited. A detailed history regarding the various indigenous preparations used was taken from caregivers and noted in a proforma. A total of 150 children (M:F-89:61) aged between 4 months to 18 years were included. Atopic dermatitis and eczema (n = 28) were the most common dermatoses whereas the most common home remedies used for these either solo or in combination were coconut oil (13), olive oil (11), mustard oil (7), aloevera gel (6), ghee (6), curd (4), and honey (2). Acne was the second most common dermatoses (n = 22), products used for acne were Fuller's earth, aloevera gel, turmeric, gram flour, mustard oil, lime and sandalwood paste. Other dermatoses treated by indigenous products included impetigo and other bacterial infections, seborrheic dermatitis, dermatophytoses, verruca, molluscum, hypopigmentary disorders, etc. In Indian setup, home remedies are commonly used by the caregivers before visiting a dermatologist to treat various pediatric dermatoses.

Approach to the Assessment and Management of Pediatric Patients With Atopic Dermatitis: A Consensus Document. Section III: Treatment Options for Pediatric Atopic Dermatitis

Because atopic dermatitis (AD) is a chronic, relapsing disease, treatment requires the use of both active therapy to control flares and preventative maintenance therapy to promote integrity of the skin barrier. In this third of four sections, important clinical considerations for the treatment of pediatric AD are reviewed. Emerging therapies in development for pediatric AD are introduced.

Approach to the Assessment and Management of Pediatric Patients with Atopic Dermatitis: A Consensus Document. Section II: Comorbid Disease in Pediatric Atopic Dermatitis

Pediatric atopic dermatitis (AD) is one of the most common skin conditions encountered by health-care providers caring for infants, children, and adolescents. Pediatric patients with AD may present with other allergic and nonallergic comorbidities that require appropriate treatment and referral. They may also experience a trajectory of allergic diseases known as the atopic march, which depends on a complex interaction between genetic and environmental factors and likely involves early epidermal barrier dysfunction. Here we provide a review and clinical recommendations on the assessment and referral of comorbidities in pediatric AD.

Clinical Pearls on Sleep Management in Atopic Dermatitis

Multiple etiologies contribute to sleep disturbance in atopic dermatitis (AD) patients, including learned scratching behavior and increased monoamines, cutaneous blood flow, inflammatory cell activities, and cytokines, as well as decreased melatonin, anti-inflammatory cytokines, and skin barrier function. Insomnia impairs cognitive development in children with AD, leading to behavioral problems and learning disabilities. Insomnia in adults with AD impedes work productivity. In this article, we discuss pearls on improving insomnia through both nonpharmacologic modalities, such as environmental adjustments and massage therapy, and pharmaceutical approaches including melatonin, antihistamines, tricyclic antidepressants, mirtazapine, and benzodiazepine and nonbenzodiazepine sedatives. Future investigations should further delineate the mechanistic link between insomnia and AD exacerbation and identify strategies to combat sleep-related disease burden.

Infant skin care: updates and recommendations

PURPOSE OF REVIEW

Neonatal skin acclimates rapidly to dry, aerobic conditions at birth and skin function gradually matures throughout infancy. Gentle skin care practices support the ongoing development and function of newborn skin. This article reviews research updates and current skin care recommendations for full-term infants, premature infants, and infants born with severe cutaneous manifestations of genetic skin disorders.

RECENT FINDINGS

Although safe early bathing of full-term infants with environmental controls is possible, delaying the first newborn bath for 12-24 h of life offers benefits of increased parental bonding and breastfeeding success. Swaddled bathing every 4 days is an effective bathing strategy for premature neonates. Among infants with a family history of atopic dermatitis, regular application of bland skin moisturizers reduces their risk of developing the disease. For newborns with erosive or blistering genetic skin conditions, use of specialized wound dressings and emollients promotes wound healing and helps limit skin damage. Environmental control with humidified incubators helps prevent life-threatening hypernatremic dehydration among babies born with collodion membranes; however, affected infants can tolerate breaks outside of the humidifier to promote parent-infant bonding.

SUMMARY

This article reviews infant skin care recommendations relevant to pediatric practice. Research to further optimize newborn skin care is ongoing, particularly, for the special populations of premature neonates and infants born with severe skin disease.