Use of an emollient‐containing diaper and pH‐buffered wipe regimen restores skin pH and reduces residual enzymatic activity

Abstract

Background/Objectives Diaper dermatitis is one of the most frequent skin conditions affecting infants and is associated with elevated skin pH, exposure to urine and feces, and increased fecal protease and lipase activity, resulting in stratum corneum barrier damage and increased risk of infection. The study aim was to determine the impact of two diaper and wipe regimens on newborn infant skin pH and residual enzyme activity after stool cleaning. Methods Two diaper and wipe regimens were compared in a randomized, single‐blinded crossover study. Regimen A paired an emollient‐containing diaper with an acidic, pH‐buffered wipe. Regimen B was a non‐emollient diaper and wipe with limited buffering capacity. A 3‐day washout period preceded each 3‐day regimen use period. Skin pH at the perianal/buttocks interface (PBI), genital region, and undiapered chest control were measured at baseline and day 3. Skin swabs were collected for residual enzyme activity after a stool cleaning event. Results Diapered skin pH at the PBI was similar to undiapered skin after 3 days of use for Regimen A, while PBI pH for Regimen B was elevated versus control. PBI pH was lower for Regimen A versus Regimen B. After a stool cleaning, PBI skin pH for Regimen A was lower immediately and had lower residual enzyme activity versus Regimen B ( P < .05), and the pH‐lowering effect was sustained up to 60 minutes. Conclusions These results suggest that the use of an emollient‐containing diaper with a pH‐buffered wipe creates conditions favorable to optimum diapered skin health.

Improving newborn skin health: Effects of diaper care regimens on skin pH and erythema

“…The finding extends our previous results using a similar diaper and wipe combination where skin pH was lowered and residual enzyme (proteases) activity on skin was reduced post‐stool cleaning. 11 Overall, Regimen A use was associated with a shift away from more severe erythema, with 2‐3 times as many infants on this regimen experiencing little or no erythema for the entire study compared to Regimen B. These findings are consistent with previous reports, namely that skin barrier recovery from damage (via tape stripping) was more rapid when skin sites were exposed to an acidic (pH =5.5) HEPES solution (isotonic N‐2‐hydroxyethylpiperazine‐N‐2‐ethanesulfonic acid) compared to a near‐neutral pH HEPES solution (pH = 7.4).…”

“… 18 Many fecal enzymes (eg proteases and lipases) are maximally active at neutral or slightly alkaline pH, but have reduced activity at acidic pH. The lower skin pH and reduced residual enzyme activity observed with Regimen A 11 are likely key contributors to the significant reduction in skin erythema. This underscores the necessity of maintaining a sufficiently acidic pH in the diapered area to control enzyme activity and ameliorate insults to the skin, especially in the perianal region where feces and urine/feces mixtures reside.…”

“…In newborns, we recently showed that a product regimen consisting of a specially designed disposable diaper with an apertured, petrolatum‐based emollient on the inner liner (topsheet) with an acidic, pH‐buffered wipe normalized diapered skin pH and reduced residual fecal enzyme activity on skin post‐stool cleaning in just three days of use (Regimen A) when compared to a diaper without an emollient or apertured topsheet and a wipe with limited pH buffering capacity (Regimen B). 11 In the current investigation, two product regimens with the above‐mentioned product features were compared in a randomized, blinded, complete crossover study in which diapered skin erythema was assessed after 2 weeks of use for each regimen. We hypothesized that Regimen A would help mitigate the exposure of the diapered skin to urine and fecal irritants and result in less erythema when compared with Regimen B.…”

Acidic Skin Care Promotes Cutaneous Microbiome Recovery and Skin Physiology in an Acute Stratum Corneum Stress Model

“…An acidic pH is important in leave-on and rinse-off skin care products [24]. Acidic skin pH care exerts positive effects on skin physiology and specific microbial colonization patterns, especially in atopic dermatitis [22, 25, 26].…”

Just water for cleaning baby? A cross-sectional survey of the newborn skin cleansing practices of parents in the UK

“…In reality, parents worldwide use a variety of substances to cleanse newborn skin, including salt, herbs and commercial products (Lavender, 2009, Kayom et al, 2015, Adejuyigbe et al, 2015, Khalifan et al, 2017. Indeed, research on newborn skin cleansing methods suggests that water alone may not be an effective skin cleanser, particularly for fatsoluble substances such as vomit and faeces (Lavender et al, 2009, Lavender et al, 2013, Gustin et al, 2020.…”