Documentation of Impaired Epidermal Barrier in Mild and Moderate Diaper Dermatitis In Vivo Using Noninvasive Methods

Abstract

The presence of irritants from feces and urine with the concurrent mechanical friction and occlusion creates an environment in the diapered area that renders the skin prone to diaper dermatitis. Besides being a source of discomfort to the infant, these skin irritations pose a risk of secondary infections. In this study, we used noninvasive in vivo techniques to define measurable parameters that correlate with diaper dermatitis pathophysiology. In 35 infants (16 with mild or moderate and 19 without diaper dermatitis) we compared skin of diapered areas afflicted with diaper dermatitis to lesion-free diapered sites and to skin outside the diapered area (thigh). Our findings show significantly elevated cutaneous erythema, pH, and hydration, with significantly compromised water barrier function in involved areas compared to nonlesional sites both within and outside the diapered area. Furthermore, skin pH in nonlesional diapered skin for the diaper dermatitis cohort was significantly higher compared to the nondiapered sites. These observations are consistent with the current understanding of pathological skin changes in diaper dermatitis. In this study, we demonstrate that noninvasive methods can document relevant parameters to diaper dermatitis in vivo.

Update on Infant Skin with Special Focus on Dryness and the Impact of Moisturizers

“…This relatively high pH most likely infl uences skin barrier function, as a number of process in the skin that are crucial for maturation or maintenance of the epidermal barrier are pH sensitive, such as bacterial proliferation on the skin [ 75,76 ] , processing of intercellular lipids [ 36,77 ] , and desquamation [ 35 ] . The diapered area with pH values even higher than other regions is in particular prone to skin irritation (diaper rash) that is accompanied by a broken barrier [ 16 ] .…”

“…This condition affl icts the buttocks, perianal region, inner thighs, and abdomen and presents with redness and scaling of the skin and in severe cases with papules and edema [ 91 ] . Diapering creates an environment with distinct characteristics that comprise skin occlusion and friction [ 92 ] , fecal enzyme activity [ 93 ] , excessive hydration, and increased pH [ 16,94 ] . All these factors weaken the barrier function and contribute to the risk of developing diaper dermatitis.…”

“…Infant skin is more hydrated than that of adults [ 10,13 ] ; nevertheless, atopic dermatitis, an infl ammatory skin condition marked by extreme skin dryness, is a common affl iction at young age [ 14 ] . The "acid mantle" of the skin is not yet developed in newborns [ 13 ] , and the high skin pH and hydration levels in part contribute to frequent damage to diapered skin [ 15,16 ] . Furthermore, sebaceous glands and eccrine sweat glands are not functioning maturely yet [ 17,18 ] .…”

Problems of Prevention and Treatment of Diaper Dermatitis in Children within the Current Concepts of the Disease Pathogenesis

“…Амбарчян, Р.В. Епишев ВВЕДЕНИЕ С целью описания воспалительной реакции кожи в области промежности, включая ягодицы, перианаль-ную область, гениталии, а также внутреннюю поверх-ность бедер и талию, пользуются неспецифическим термином «пеленочный дерматит» [1,2]. Пеленочным дерматитом -одним из самых распространенных пато-логических состояний кожи у новорожденных и младен-цев -страдает от 7 до 50% детей.…”

Windeldermatitis

“…Ein weiteres, in der Pathogenese der WD zu beobachtendes Charakteristikum ist die verstärkte 7 Hyperhydratation des Stratum corneum infolge der okklusiven Bedingungen der Windel, die mit erhöhter Permeabilität für Infektionserreger und externe Irritanzien verbunden ist [29]. Darüber hinaus sind die mechanischen Einflüsse (Reiben, Scheuern) einer Windel aufgrund des hohen Reibungskoeffizienten bei feuchter Haut wesentlich höher im Vergleich zur trockenen Haut [4].…”