Time- and site-dependent differences in epidermal barrier properties were investigated over the first 28 days of life in healthy term newborn infants. Diapered and nondiapered skin sites were contrasted to the volar forearm of adults (mothers). Thirty-one term infants were evaluated in the hospital on postnatal day 1 and at home on days 4, 7, 14, 21, and 28 for a total of six visits. Measurements included baseline skin hydration, continuous capacitive reactance, peak water sorption, rate of water desorption, skin pH, skin temperature, and environmental conditions. Changes in epidermal barrier properties over the first 4 weeks of life included an increase in surface hydration, a decrease in transepidermal water movement under occlusion, a decrease in surface water desorption rate, and a decrease in surface pH. Diapered and nondiapered regions were indistinguishable at birth but exhibited differential behavior over the first 14 days, with the diapered region showing a higher pH and increased hydration. Maternal measurements remained constant throughout the period. We conclude that healthy newborn skin undergoes progressive changes in epidermal barrier properties over the first 28 days. Adult skin testing does not replicate newborn skin during the first month of life.

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Melanin in the epidermis determines the wide variation in skin color associated with ethnic skin diversity. Ethnic differences exist regarding melanosome loss in keratinocytes, but the mechanisms underlying these differences, and their contribution to the regulation of skin color, remain unclear. Here, we explored the involvement of autophagy in determining skin color by regulating melanosome degradation in keratinocytes. Keratinocytes derived from Caucasian skin exhibit higher autophagic activity than those derived from African American (AA) skin. Furthermore, along with the higher autophagy activity in Caucasian skin-derived keratinocytes compared with AA skin-derived keratinocytes, Caucasian skin-derived keratinocytes were more sensitive to melanosome treatment as shown by their enhanced autophagic activity, which may reflect the substantial mechanisms in the human epidermis owing to the limitations of the models. Melanosome accumulation in keratinocytes was accelerated by treatment with lysosomal inhibitors or with small interfering RNAs specific for autophagy-related proteins, which are essential for autophagy. Furthermore, consistent with the alterations in skin appearance, the melanin levels in human skin cultured ex vivo and in human skin substitutes in vitro were substantially diminished by activators of autophagy and enhanced by the inhibitors. Taken together, our data reveal that autophagy has a pivotal role in skin color determination by regulating melanosome degradation in keratinocytes, and thereby contributes to the ethnic diversity of skin color.

WHAT'S KNOWN ON THIS SUBJECT:Initiation of medication for ADHD is variable and persistence with therapeutic regimens is poor. Parents play a key role in managing medication use for their child with ADHD. WHAT THIS STUDY ADDS:This study identifies factors that influence parent decision-making about the initiation and continuation of medication treatment. Awareness of these factors may help physicians address the concerns of families while managing ADHD.abstract BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurobehavioral conditions of childhood and adolescence. Despite availability of effective treatment options, initiation of treatment is variable and persistence with therapeutic regimens is poor. OBJECTIVE:We sought to better understand how parents make decisions about treatment for their child or adolescent with ADHD. METHODS:We conducted a qualitative study among parents of children and adolescents; 52 parents participated in 1 of 12 focus groups. Parents answered questions about decision-making, information sharing, and sources of conflict and uncertainty. Sessions were audiotaped and transcribed verbatim. Themes were coded independently by 4 of the investigators, who then agreed on common themes. RESULTS:Parents in our study made decisions about treatment for their child with ADHD in the midst of experiencing a variety of emotions as they witnessed child functional impairments at home and at school. In addition, parents felt stress as a result of their daily efforts to manage their child's struggles. Multiple factors influenced the decision to initiate medication. Subsequently, revisiting the decision to give their child medicine for ADHD was common. Many parents contrasted time on and off medicine to help inform management decisions. Trials stopping medication were almost always parent-or child-initiated. CONCLUSIONS:Decisions about medication use for children and adolescents with ADHD are made and frequently revisited by their parents. Choices are often made under stressful conditions and influenced by a variety of factors. Striking a balance between benefits and concerns is an ongoing process that is often informed by contrasting time on and off medication. Development of strategies to support families across the continuum of decisions faced while managing ADHD is warranted.