Topical Use of Human Milk in the Neonatal Intensive Care Unit: An Integrative Review.

BACKGROUND: Research has shown that the bioactive components in human milk could demonstrate efficacy when applied topically. One common neonatal skin issue is diaper dermatitis (DD). DD treatment and prevention guidelines often lack the inclusion of topical human milk as a viable option. PURPOSE: To analyze the safety and efficacy of topical human milk application as a means to support future research of human milk as a topical treatment for DD. DATA SOURCES: Google Scholar, CINAHL, PubMed, and Cochrane. STUDY SELECTION: The search was limited to articles published between 2011 and 2023 in the English language. Disqualifying characteristics included nonhuman subjects, literature reviews, inability to obtain articles, and non-peer-reviewed articles. DATA EXTRACTION: For Google Scholar, the search terms "human milk OR breast milk" and "topical" were used. For CINAHL, PubMed, and Cochrane, the search terms "human milk OR chest milk OR breast milk OR donor milk" and "topical" were used. Quantitative significance was defined by a P value of less than .05. RESULTS: The search yielded 20 articles. The results of the review demonstrate that topical human milk application is a safe and effective topical treatment to skin integrity/inflammatory issues such as DD. It also identified that caregivers will likely show positive regard to the treatment, promoting its acceptance. IMPLICATIONS FOR PRACTICE AND RESEARCH: The results provide evidence to support methodologic development for human milk application for the prevention and treatment of DD. Further studies can use the results to develop protocols that investigate the effects of human milk application.

Comparison the effects of topical application of olive and calendula ointments on Children's diaper dermatitis: A triple-blind randomized clinical trial.

This study compares the effective of of topical application of olive and calendula ointments on childrens' diaper dermatitis (DD). This triple-blind clinical trial was conducted on 73 healthy children under the age of 2 years with non-severe and not infected DD, referred to a pediatric healthcare center in Tabriz, Iran. The children were assigned to 1.5% olive ointment (n = 37) and 1.5% calendula ointment (n = 39) using a random block method with the ratio of 2:2. The severity of DD in both groups was measured and compared on a six-point scale on days 0 (before the intervention) and 3, 5, and 7 after interventions. The findings releaved there was not significant stastistical difference between the olive oil and calendula groups in terms of severity of DD in the third, fifth and seventh days. No adverse effect was reported from either of the medications in this study. The external validity and consequently the ability to generalize the findings may be diminished as this study was conducted at a single site. Owing to olive ointment and calendula ointment providing the same results in the healing of DD, olive ointment can be used as an alternative case to DD.

Preventive effects of topical washing with miconazole nitrate-containing soap to diaper candidiasis in hospitalized elderly patients: A prospective, double-blind, placebo-controlled study.

The objective of the present randomized, double-blind trial was to evaluate the efficacy and safety of daily washing with miconazole nitrate-containing soap for candidiasis at diaper-covered sites in elderly subjects under long-term inpatient care. To confirm the onset and disappearance of candidiasis, we microscopically evaluated the existence of the pseudohyphae and/or blastoconidia of Candida spp. We enrolled 75 elderly patients who wore diapers all day in the hospital or nursing home. Patients were randomly assigned to receive treatment with either miconazole soap or miconazole-free placebo soap, and 28 patients in the miconazole group and 27 patients in the placebo group were followed for 4 weeks. Although washing with miconazole soap did not affect the frequency of pseudohyphae/blastoconidia-positive patients, it significantly inhibited the positive conversion of pseudohyphae/blastoconidia compared with the placebo group. As a result, the frequency of patients positive for pseudohyphae/blastoconidia was significantly lower in the miconazole group than in the control group at 4 weeks (17.9% vs 44.4%). Clinically apparent diaper candidiasis did not develop in either group. Washing with miconazole soap was a significant independent factor for reducing the cases positive for pseudohyphae/blastoconidia, while diarrhea and heart failure were significant factors associated with an increase in the positive rate at the end-point. Severe adverse effects were not found in any patients. Thus, washing with miconazole soap is well-tolerated and can inhibit the positive conversion of Candida in patients wearing diapers. Therefore, maintenance of genital hygiene using this soap may prophylactically decrease the overall prevalence of patients with diaper candidiasis.

Multiple Scrotal Ulcers in an Infant Due to a Traditional Child Care Practice: Salting.

Application of salt to the newborn's skin is a common traditional child care custom in Turkey. We present an infant with multiple ulcerating scrotal lesions due to prolonged salt exposure in the diaper area. Scrotal ulcers associated with salting have not been described previously.

Comparing the effects of Bentonite & Calendula on the improvement of infantile diaper dermatitis: A randomized controlled trial.

BACKGROUND & OBJECTIVES: Infantile diaper dermatitis is a common, acute inflammatory reaction of the skin around diaper among infants. This study was undertaken to compare the effect of topical application of Bentonite and Calendula creams on the improvement of infantile diaper dermatitis. METHODS: This double blind randomized controlled trial was undertaken on 100 patients of infantile diaper dermatitis. The 100 participants were randomly assigned into two groups of 50 each, and were prescribed the coded medicine. The mothers were trained to apply the cream and level of improvement was judged by observing the affected area on the first visit and then after three days of receiving treatment. RESULTS: The mean age of infants was 6.45±5.53 months in Calendula group and 7.35±6.28 months in Bentonite group. Overall, 88 per cent of lesions in the Bentonite group started improving in the first six hours while this rate was 54 per cent in Calendula group (P<0.001). The risk ratio for the improvement in the first six hours was 2.99 folds in the Bentonite group. Also, lesions in 86 per cent infants in the Bentonite group and 52 per cent in the Calendula group were completely improved in the first three days after treatment (P<0.001). INTERPRETATION & CONCLUSIONS: Our results showed that in comparison with Calendula, Bentonite had faster healing effect and was more effective on the improvement of infantile diaper dermatitis (IRCT ID: IRCT 2012112811593N1).

Diaper dermatitis care of newborns human breast milk or barrier cream.

AIMS AND OBJECTIVES: To establish the effectiveness of human breast milk and barrier cream (40% zinc oxide with cod liver oil formulation) applied for the skincare of newborns in the neonatal intensive care unit on the healing process of diaper dermatitis. BACKGROUND: Diaper dermatitis is the most common dermatological condition in newborns who are cared for in the neonatal intensive care unit. Recently, there are several kinds of complementary skincare methods suggested for newborns, such as sunflower oil, human breast milk, etc. Also, some chemical formulations are still being used in many neonatal intensive care units. DESIGN: Randomised controlled, prospective, experimental. METHODS: This study was carried out with a population including term and preterm newborns who developed diaper rash while being treated in the neonatal intensive care unit of a university hospital in Istanbul between February-October 2010. On completion of the research, a total of 63 newborns from human breast milk (n = 30) and barrier cream (n = 33) groups were contacted. RESULTS: Genders, mean gestation weeks, feeding method, antibiotic use, diaper area cleansing methods, diaper brands and prelesion scores of newborns in both groups were found to be comparable (p > 0·05). There was no statistically significant difference (p = 0.294) between the groups in terms of mean number of clinical improvement days, but postlesion score of the barrier cream group was statistically significantly lower (p = 0·002) than the human breast milk group. CONCLUSION: Barrier cream delivers more effective results than treatment with human breast milk, particularly in the treatment of newborns with moderate to severe dermatitis in the result of the study. RELEVANCE TO CLINICAL PRACTICE: This study will shed light on nursing care of skin for newborns who are treated in neonatal intensive care unit.

A prospective two-year assessment of miconazole resistance in Candida spp. With repeated treatment with 0.25% miconazole nitrate ointment in neonates and infants with moderate to severe diaper dermatitis complicated by cutaneous candidiasis.

A petrolatum and zinc oxide-based ointment containing 0.25% miconazole nitrate is reported to be effective and well tolerated in the treatment of diaper dermatitis complicated by cutaneous candidiasis (DDCC). This prospective, multicenter, open-label, long-term, phase IV study investigated the potential resistance of Candida spp. to repeated topical use of 0.25% miconazole nitrate in infants age 15 months and younger with moderate to severe DDCC. For initial and recurring episodes of DDCC over the 2-year study period, subjects were treated with a 7-day course of 0.25% miconazole nitrate ointment (active components: miconazole nitrate 0.25%, zinc oxide 15%, and white petrolatum 81.35%) with a 7-day follow-up. Clinical and mycologic evaluations were conducted before treatment (day 0) and 7 days after treatment (day 14). Potential resistance to miconazole was defined using an arbitrary breakpoint of minimum inhibitory concentration of 2 µg/mL. There was no evidence of resistance to miconazole in Candida spp. after single or repeated treatment courses of 0.25% miconazole nitrate ointment. For the initial episode of DDCC, 83 of 168 subjects (49.4%) achieved a clinical cure, 77 (45.8%) achieved a mycologic cure, and 49 (29.2%) achieved an overall cure (clinical and mycologic). The overall cure rate for recurrent episodes of DDCC was similar to or numerically greater than rates observed for the initial episode. Treatment of DDCC with 0.25% miconazole nitrate ointment was effective and generally well tolerated. No evidence of the development of resistance to miconazole in Candida spp. was observed.

Efficacy of petrolatum jelly for the prevention of diaper rash: a randomized clinical trial.

PURPOSE: To assess the efficacy of petrolatum jelly for the prevention of diaper rash and to evaluate the relationship between the occurrence of diaper rash and certain treatments and type of nutrition. DESIGN AND METHODS: A randomized clinical trial was carried out with two parallel groups (n = 213) at the neonatal care unit of Donostia University Hospital in San Sebastián, Guipuzcoa Province, Spain. RESULTS: There was a lower incidence of diaper rash in the experimental group with petrolatum jelly (17.1%) than the control group (22.2%), but the difference was not statistically significant (p =.39). The use of antibiotics and oral 50% glucose as well as an increased number of stools are associated with a higher incidence of diaper rash, while breastfeeding and phototherapy are protective factors. PRACTICE IMPLICATIONS: Prevention is strengthened by a better understanding of the risk factors.

Guaiazulene: a new treatment option for recalcitrant diaper dermatitis in NICU patients.

AIM: Based on a maternal observation, we aimed to evaluate the treatment effectiveness of guaiazulene (GA) containing local pomade in the high-risk neonates with recalcitrant diaper dermatitis (RDD). METHODS: We included 30 NICU patients of RDD, with level II-III aged between 22 and 67 days. Study group patients (n = 20) were treated with GA containing local pomade (0.05 g/100 g). Control group consisted of patients who had extended antifungal treatment. A visual scale was used to assess the response to treatment at the end of a week. Scoring was done at the beginning of the treatment, on the first, third and seventh days. RESULTS: Statistically significant differences in visual scores were determined between the two groups at the initial and following days of the treatment. In study group, improvements at the first and third days of the treatment were better than those of control group. Additionally, complete recovery rate in study group was better than that in controls. CONCLUSION: Having beneficial but no adverse effects, GA containing local pomade provided rapid recovery in risky neonates with RDD, who required rapid improvement.

A randomized comparative trial on the therapeutic efficacy of topical aloe vera and Calendula officinalis on diaper dermatitis in children.

INTRODUCTION: Diaper dermatitis (DD) is a common inflammatory disorder among children and infants. The objective of the present randomized and double-blind trial was to compare the therapeutic efficacies of aloe vera cream and Calendula officinalis ointment on the frequency and severity of DD in children. METHODS: Sixty-six infants with DD (aged < 3 years) were randomized to receive either aloe cream (n = 32) or Calendula ointment (n = 34). Infants were treated with these drugs 3 times a day for 10 days. The severity of dermatitis was graded at baseline as well as at the end of trial using a 5-point scale. The adverse effects of study medications were assessed during the trial. RESULTS: Although improvement in the severity of DD was observed in both treatment groups (P < 0.001), patients receiving Calendula ointment had significantly fewer rash sites compared to aloe group (P = 0.001). No adverse effect was reported from either of the medications. DISCUSSION: The evidence from this study suggests that topical aloe and in particular Calendula could serve as safe and effective treatment for the treatment of diaper dermatitis in infants.

Dermatitis del pañal, prevención y tratamiento. Papel del Aloe vera / Preventing and treating nappy rash: the role of Aloe vera

La dermatitis del pañal (DP) es un cuadro clínico frecuente en la infancia, quepuede ser más o menos grave. La causa más frecuente es la irritativa, seguidade la candidiasis. En alguna ocasión puede ser una manifestación más de unaenfermedad cutánea o sistémica. El mejor tratamiento de la DP es la prevención,mediante cambios frecuentes del pañal, limpieza de la zona con agua yjabón suave después de las deposiciones, y aplicación de alguna crema barrera.El Aloe vera es una sustancia natural que tiene unas propiedades antiinflamatorias,antipruriginosas, cicatrizantes y, en determinadas concentraciones,se ha demostrado que tiene efecto bactericida, fungicida y viricida.Pensamos que puede ser útil junto con el óxido de cinc como adyuvante añadidoa un preparado tópico preventivo o terapéutico de la DP (AU)

Nappy rash is a common symptom in infancy which can be more or lessserious. The most frequent cause is irritation, followed by candidiasis. Onoccasions it may be a symptom of a cutaneous or systemic disorder. Themain treatment for nappy rash is prevention by means of frequent nappychanging, cleaning of the area with mild soap and water after depositionsand application of a barrier cream. Aloe vera is a natural substance whichpossesses anti-inflammatory, antipruriginous and healing properties, andat some concentrations it has been proven to have bactericidal, fungicidaland virucidal effects. The authors believe that it may be useful together withzinc oxide as an adjuvant added to a preventive or therapeutic skin preparationfor nappy rash (AU)

Role of menthol in treatment of candidial napkin dermatitis.

BACKGROUND: The antibacterial, antifungal and probable anti-inflammatory effects of menthol were evaluated in the treatment of napkin dermatitis (ND). METHODS: A pilot clinical trial was conducted in Iran at the Tehran University of Medical Sciences. Eligible neonates with a diagnosis of candidial ND who did not require critical care or systematic antifungal and anti-inflammatory drugs were included in the study. Overall, 84 patients were randomly allocated into two groups: menthol group (n=42) receiving standard therapy (topical clotrimazole) plus menthol drops applied topically and control group (n=42) receiving standard therapy plus a placebo. Thirty-five neonates in each group finished the course of study and were analyzed for skin rash using Munz and Concannon rash scoring methods before therapy and on the 1st, 3rd, 5th and 7th day after the treatments. RESULTS: Demographic data and the baseline total skin rash score were not significantly different between the menthol and control groups. The total course of therapy for complete healing was found to be shorter in the menthol group (4.3±1.6 vs. 6.9±1.8 days, P=0.0001) and erythema and pustules had a significant (P=0.0001) relief in this group. During the study no severe adverse effects of the drug were observed. CONCLUSION: Topical application of menthol may be effective in treatment of candidial ND.

Psoriasis en la infancia / Psoriasis in childhood

La psoriasis es una enfermedad crónica inflamatoria de la piel que afecta a un 2-3% de la población general. Aproximadamente, en uno de cada tres pacientes comienza en la edad infantil, y supone el 4% de todas las enfermedades de la piel del niño. La cara y las zonas de los pliegues se ven afectadas con frecuencia, y además son áreas especialmente sensibles a los efectos adversos de los corticoides tópicos. Los inhibidores de la calcineurina tópicos suponen una opción eficaz y segura en el tratamiento de la psoriasis invertida en niños(AU)

Psoriasis is a chronic inflammatory skin disorder that affects 2% to 3% of the population. Approximately one-third of the patients note its onset during childhood, and it accounts for 4%of the cutaneous disorders in children. The face and intertriginous areas are often involved, and they are particularly sensitive to the adverse effects of steroid use. Topical calcineurin inhibitors are an effective and safe option for the treatment of inverse psoriasis in children(AU)

Skin interaction with absorbent hygiene products.

Skin problems due to the use of absorbent hygiene products, such as diapers, incontinence pads, and feminine sanitary articles, are mostly due to climate or chafing discomfort. If these conditions are allowed to prevail, these may develop into an irritant contact dermatitis and eventually superficial skin infections. Skin humidity and aging skin are among the most significant predisposing and aggravating factors for dermatitis development. Improved product design features are believed to explain the decline in observed diaper dermatitis among infants. Where adult incontinence-related skin problems are concerned, it is very important to apply a holistic perspective to understand the influences due to the individual's incontinence level and skin condition, as well as the hygiene and skin care measures provided. Individuals with frail, sensitive skin or with skin diseases may preferably have to use high-quality products, equipped with superabsorbent polymers and water vapor-permeable back sheets, to minimize the risk of skin complications.

Hamamelis in children with skin disorders and skin injuries: results of an observational study.

Published clinical experience with hamamelis ointment in children is limited. This observational study included children (age 27 days to 11 years) with minor skin injuries, diaper dermatitis, or localized inflammation of skin. The children received either hamamelis ointment or dexpanthenol ointment in groups at a 3-to-1 ratio. Baseline and post-treatment assessments compared the total scores of predefined signs and symptoms for each condition. Physicians and parents were asked for a global assessment of efficacy and tolerability of the respective treatments at the end of therapy. A total of 309 children were treated (hamamelis n = 231; dexpanthenol n = 78). The treatment groups were comparable regarding demographic data and baseline total scores of signs and symptoms. In all three diagnosis groups, the efficacy of hamamelis and dexpanthenol was shown by a statistically significant and clinically relevant decrease of total scores from baseline to endpoint (p < 0.0001 for each group, Wilcoxon signed-rank test). Overall, the results for the hamamelis and the dexpanthenol groups were similar. Descriptive advantages for the hamamelis group were observed for a number of parameters and diagnosis groups. Both treatments were well tolerated. Ratings of the tolerability of hamamelis were "excellent" or "good" in 99.1% (physicians) and 98.2% (parents) of cases, respectively. The corresponding ratings for dexpanthenol were 97.4 and 92.3%. In conclusion, hamamelis ointment is an effective and safe treatment for certain skin disorders in children up to the age of 11 years. The observed effects are similar to dexpanthenol.