REVIEW   Free access

Italian Journal of Dermatology and Venereology 2023 June;158(3):224-35

DOI: 10.23736/S2784-8671.23.07336-X

Copyright © 2023 EDIZIONI MINERVA MEDICA

language: English

Algorithm to attenuate atopic dermatitis and for promoting a healthy skin barrier using skincare in newborns and infants

Lawrence A. SCHACHNER ¹, Ulrike BLUME-PEYTAVI ², Anneke ANDRIESSEN ³ ✉, Jan IZAKOVIC ^{4, 5, 6}, Annabel MARUANI ⁷, Giuseppe MICALI ⁸, Nikolay MURASHKIN ^{9, 10, 11}, Carmen SALAVASTRU ¹², Antonio TORRELO ¹³

¹ Department of Pediatric Dermatology, Miller School of Medicine, University of Miami, Miami, FL, USA; ² Department of Dermatology and Allergology, Clinical Research Center of Hair and Skin Science, Charité-Universitatsmedizin, Berlin, Germany; ³ Radboud Academy, Radboud UMC Nijmegen, Andriessen Consultants, Malden, the Netherlands; ⁴ Department of Dermatology, Miller School of Medicine, University of Miami, Miami, FL, USA; ⁵ Department of Pediatric Dermatology, Basel University Children’s Hospital (UKBB), Basel, Switzerland; ⁶ Private Practitioner, Basel, Switzerland; ⁷ Unit of Pediatric Dermatology, Department of Dermatology, University Hospital Center of Tours, Tours, France; ⁸ Dermatology Clinic, University of Catania, Catania, Italy; ⁹ FGAU National Medical Research Center of Children’s Health of the Ministry of Health of Russia, Moscow, Russia; ¹⁰ Sechenov First Moscow State Medical University, Moscow, Russia; ¹¹ Central State Medical Academy of the Presidential Administration of the Russian Federation, Moscow, Russia; ¹² Department of Pediatric Dermatology, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; ¹³ Department of Dermatology, Niño Jesús Children University Hospital, Madrid, Spain

The human skin barrier is structurally and functionally immature at birth, with elevated skin surface pH, lower lipid content, and lower resistance to chemicals and pathogens. Infants at risk for atopic dermatitis (AD) may present with xerosis almost immediately after birth. The current algorithm on skincare for newborns and infants aims to promote a healthy skin barrier and potential mitigation of AD. The project used a modified Delphi hybrid process comprising face-to-face discussions followed by an online follow-up replacing a questionnaire. During the meeting, a panel of eight clinicians who treat newborns and infants discussed the systematic literature review results and a draft algorithm addressing non-prescription skincare for neonates and infants. Online the panel reviewed and adopted the algorithm using evidence coupled with the panel’s expert opinion and clinical experience. The algorithm provides clinical information for pediatric dermatologists, dermatologists, and pediatric healthcare providers treating neonates and infants. The advisors adopted a scale based on clinical signs for the algorithm: 1) scaling/xerosis; 2) erythema; and 3) erosion/oozing. Skincare for newborns and infants includes: aim for a cool environment and soft cotton clothing, give lukewarm baths (~5 min, 2-3 x week) with consideration of a gentle cleanser (pH 4-6) and the application of a full-body moisturizing after bath, while avoiding products with toxic and irritating ingredients. A growing body of evidence recognizes the benefits of ongoing daily use of non-alkaline cleansers and moisturizers. Gentle cleansers and moisturizers containing barrier lipids help maintain the protective skin barrier when applied from birth onwards.

KEY WORDS: Infant, newborn; Ceramides; Dermatitis, atopic; Algorithms