Effect of Diaper Cream and Wet Wipes on Skin Barrier Properties in Infants: A Prospective Randomized Controlled Trial

Abstract

The effect of different diaper care procedures on skin barrier function in infants has been minimally investigated and may be assessed using objective methods. In a single-center, prospective trial, 89 healthy 9-month-old infants (±8 wks) were randomly assigned to three diaper care regimens: group I used water-moistened washcloths at diaper changes (n = 30), group II additionally applied diaper cream twice daily (n = 28), and group III used wet wipes and diaper cream twice daily (n = 31). Transepidermal water loss (TEWL), skin hydration (SCH), skin pH, interleukin 1α (IL-1α) levels, and microbiologic colonization were measured in diapered skin (upper outer quadrant of the buttocks), nondiapered skin (upper leg), and if diaper dermatitis (DD) occurred, using the most affected skin area at day 1 and weeks 4 and 8. Skin condition was assessed utilizing a neonatal skin condition score and diaper rash grade. On diapered skin, SCH decreased in groups II and III, whereas TEWL values were reduced in group II only. Skin pH increased in groups II and III. In general, SCH, skin pH, and IL-1α levels were higher in healthy diapered skin than in nondiapered skin. The incidence and course of DD was comparable in all groups. Areas with DD had greater TEWL and skin pH than unaffected skin areas. Infants who received diaper cream had lower SCH and TEWL and higher pH levels in the diapered area than on nondiapered skin. No correlation with the occurrence of DD was found.

Neonatal skin care: Developments in care to maintain neonatal barrier function and prevention of diaper dermatitis

“…Increased liquid removal from the skin also removes irritants, such as the ammonia in the urine, and so reduces dermatitis and improves skin function. Two comparative studies on infant diaper dermatitis rates measured transepidermal water loss (TEWL), skin hydration, and pH and found significantly worse results in skin affected by diaper dermatitis . One study randomized 89, 9‐month‐old infants into three groups: plain wash cloths only, wash cloths with diaper cream, and wet wipes (baby wipes) with diaper cream.…”

“…One study randomized 89, 9‐month‐old infants into three groups: plain wash cloths only, wash cloths with diaper cream, and wet wipes (baby wipes) with diaper cream. Although dermatitis rates were the same across the three groups, the actual TEWL and pH were improved, in the presence of diaper dermatitis, with the diaper barrier creams . Though the age group involved in this study would not be categorized as neonates, there is an absence of comparable evidence relating to infants in the first weeks of life.…”

“…Though the age group involved in this study would not be categorized as neonates, there is an absence of comparable evidence relating to infants in the first weeks of life. Furthermore, incidence of diaper dermatitis peaks at around the age of 9‐12 months; therefore, findings in this age group may help guide our understanding of the condition more generally.…”

Assessment effect of breast milk on diaper dermatitis

“…The three most common types of diaper dermatitis are: chafing dermatitis, irritant contact dermatitis and diaper candidacies. 4 Diaper dermatitis is also known as diaper rash or nappy rash, indicating inflammation of the skin in the area covered by diapers. Diaper dermatitis commonly occurs in general pediatric practice, occurring in 16% of children with a primary or a secondary skin complaint.…”

“…Diaper dermatitis commonly occurs in general pediatric practice, occurring in 16% of children with a primary or a secondary skin complaint. 4 An estimated 7% to 35% of the infant population is affected at a given time, with the highest prevalence in infants 9 to 12 months of old. Only 7% of diaper dermatitis cases seek medical advice.…”