BABY SKIN CARE – WHAT TO EXPECT AND CORRECT?
A lot of parents are bewildered by the plethora of information available on skin care in babies in order to understand their newborn skin better. Dr. Divya Sharma has always been a proponent of patient empowerment and their involvement in decision making. In this blog, we will discuss the important facts about skin care in babies.
Skin barrier function resides within the stratum corneum (SC) which is the top layer of the epidermis. It also helps in regulating the temperature of your baby’s skin and acts the first line of defence. The pH of the skin is generally acidic hence prevents microbial invasion.
Q) How is the skin of baby different from that of adults?
The thickness of SC is lesser in baby skin as compared to adults. The rate of loss of moisture to surrounding skin is higher in children than in adults. Even the commensal (good bacteria) differ from adults. The pH becomes acidic like normal adult skin after 2 weeks of the birth of full-term neonate.
Q) What is the difference in the skin of preterm and full-term baby?
The thickness of SC is lesser and the skin barrier is also not fully formed in pre-term babies. They lose moisture faster compared to full-term babies. The bacteria and other microbes can grow faster as the acidic mantle is not formed.
Q) What forms the skin barrier?
The major components of skin barrier are:
a) Physicochemical barrier – The stratum corneum cells are surrounded by lipid matrix formed of cholesterol, ceramides and free fatty acids in the ratio of 3:1:1.
b) Antimicrobial barrierv– The acidic pH and antimicrobial peptides form a microbial barrier.
c) Mechanical barrier – The corneocytes or skin cells are held together by strong corneodesmosomal bonds.
d) Antioxidant barrier – Composed of a few enzymes like superoxide dismutase.
Q) What special precautions should be taken for a newborn baby' skin?
A baby’s skin should not be disturbed much by vigorous cleansing or application of soaps. The topical agents also penetrate faster and hence even antiseptic solutions should be applied with caution.
Q) What are the types of moisturisers?
There are three types of moisturisers.
a) Humectants – They attract water from outside and within the skin like a magnet e.g. Urea, hyaluronic acid, glycerine and sorbitol are powerful humectants.
b) Occlusive agents – They prevent water loss from the surface e.g. Petroleum jelly, mineral oil and lanolin.
c) Emollient – They replenish the physiological barrier of the skin by actual penetration.
Q) How do I choose the moisturizer for my baby?
Preferably one should choose hypoallergenic, parabens and fragrance-free product containing cholesterol, ceramides and free fatty acids in the ratio of 3:1:1. Ceramide containing moisturisers are really helpful in the prevention of eczema.
Q) Which oil is best for my baby and Is applying oil enough?
Coconut oil, preferably virgin coconut oil is the best in maintaining the skin barrier. Olive oil does not repair the skin barrier and may worsen eczema.
Q) Why shall I buy an expensive moisturiser containing ceramide rather than cheaper petroleum jelly?
Physiologic lipids like ceramides repair the skin barrier while petroleum jelly only fills up the cracks in the skin. The latter does not prevent eczema. At DSHS, we adopt a scientific, evidence-based approach towards your child’s skin problem and spend time analyzing the causative factors and offers the safest solutions.
Q)Which oil is best for the baby?
Extra virgin coconut oil not only prevent neonates and infants because their skin differs from mature adult skin in structure, function, and composition and is particularly susceptible to infection. During the late fetal period (20 weeks to birth), skin becomes functional and develops a protective barrier. Although full-term infants are born with a competent skin barrier, their skin is still developing through the first year of life. During the postnatal period, even the composition of commensal bacteria residing on the skin surface differs from that of adults and continues to evolve over the first year of life.
Given that skin continues to develop through the first year of life, the use of appropriate, evidence-based skin care practices is important. Maintaining skin barrier function is critical to preventing organ dehydration. The SC water content is involved in maintaining SC structural integrity and functionality. It is generally accepted that recommendations for infant skin care regimens should be evidence-based. Although several studies have evaluated nonprescription emollient strategies to improve barrier function or improve fluid and electrolyte balance in neonates, infants, or children with compromised skin, limited information is available on skin care regimens that enable maintenance or enhancement of skin barrier integrity in normal neonatal or infant skin.
Skin cleansing and emollient use are two simple strategies that can help keep skin healthy. Proper skin cleansing helps keep infant skin free of unwanted irritants, including saliva, nasal secretions, urine, faeces, faecal enzymes, dirt, and microbial pathogens. Exposure to such factors for long periods, especially in the diaper region, can lead to discomfort, irritation, infection, and skin barrier breakdown. In many cases, water alone is not sufficient to cleanse the skin during bathing. Epidemiologic studies and anecdotal reports have even suggested a possible link between household use of hard water and atopic eczema in children, though a causal relationship has not been found.
In addition to using cleansers during bathing, emollient use during or after bathing may have benefits. Emollients decrease transepidermal water loss (TEWL), improve skin conditions, and may even lead to reduced mortality in extremely premature infants. In adults, 7 weeks of emollient use is supposed to lead to the improvement in skin barrier function.