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.

Betamethasone cream to treat diapers rash causing Cushing syndrome.

OBJECTIVES: Betamethasone causing iatrogenic Cushing's syndrome (CS) in infants are rarely reported. CASE PRESENTATION: In this case report, there were severe signs of CS, such as considerable weight acceleration and concurrent height deceleration, hirsutism and ecchymosis of the face, and buffalo pad, which are often found in adults. Clobetasol propionate, diflucortolone valerate, and dexamethasone nasal sprays were used in the majority of previously reported cases of corticosteroid abuse, whereas this is the first case of CS in an infant as a result of the use of betamethasone cream, also known as betnesol, which is frequently used by mothers in developing countries as a treatment for rashes. In this instance, a severe medication interaction caused by systemic betamethasone cream buildup led to the creation of CS. For the professionals, these patients are a challenge because of drug use without prescription. CONCLUSIONS: Topical corticosteroid usage puts infants at risk for CS. Because of excessive betamethasone treatment in this child with diaper dermatitis, he acquired CS. It is said to draw attention to the risks of self-medication in developing nations.

Clinical signs and symptoms of diaper dermatitis in newborns, infants, and young children: A scoping review.

RATIONALE: Diaper dermatitis (DD) is a significant problem in the care of newborns, infants, and young children and good recognition of signs and symptoms optimises timely treatment. There is also a need for a standardised set of related descriptors to enable communication between health care providers about diagnosis and treatment. OBJECTIVE: The study aimed to review the literature for descriptive words to define the clinical signs, symptoms, and characteristics, including anatomical locations and assessment scales or tools, in the newborn, infants and young children population who have been diagnosed with DD. METHODS: A systematic review process utilising PRISMA guidelines [1] was conducted using advanced search techniques to analyse the terms from the database thesauri and keywords. Data bases including Ovid MEDLINE® and Epub Ahead of Print, in-Process & Other Non-Indexed Citations, Daily and Versions® were searched from 1946 to March 18, 2021. Cochrane Handbook Searching for and selecting studies were used as a guide and as best practice to conduct the search. RESULTS: Of the 551 publications originally identified, 55 full text publications were examined and 21 met the inclusion criteria. The wide range of descriptors used in the literature for DD supports the need for a clearer approach to report the signs and symptoms, and the severity, of DD. CONCLUSIONS: These findings point to gaps in the literature, both in recording signs and symptoms of DD and features such as wetness, infection, anatomical location, severity and pain in newborns, infants, and young children. There is a need to develop a robust methodological tool to bridge the gap and link a common terminology on signs and symptoms to support diagnosis of the severity of DD.

The Importance of Skincare for Neonates and Infants: An Algorithm.

BACKGROUND: The skin of neonates and infants undergoes a maturation process from birth and is susceptible to barrier disruption. The current algorithm follows a US-based consensus paper on skincare approaches using gentle cleansers and moisturizers in neonatal and healthy infant skin. This summary provides clinical information for pediatric dermatologists, dermatologists, and pediatric healthcare providers treating neonates and infants. METHODS: The project used a modified Delphi process comprising virtual discussions followed by an online follow-up replacing the use of a questionnaire. During the virtual meeting, the systematic literature review results and a draft algorithm addressing over-the-counter skincare for neonates and infants with healthy skin were discussed and adopted using evidence coupled with the expert opinion and experience of the panel. RESULTS: The algorithm addresses three clinical signs: xerosis, erythema, and erosion/bulla. A growing body of evidence recognizes the benefits of ongoing daily use of non-alkaline cleansers and ceramides containing moisturizers to reduce inflammation and maintain a healthy skin barrier function. Diaper rash is common in infants presenting as erythema or, in more severe cases, skin erosion. Skin protection with a barrier cream and frequent diaper changes using disposable diapers resolves most cases; however, if the rash continuous despite appropriate care, rule out a candida infection. CONCLUSION: The current algorithm focuses on neonatal and infant healthy skin that can benefit from skincare. When applied from birth onwards, gentle cleansers and moisturizers containing barrier lipids help maintain the protective skin barrier. J Drugs Dermatol. 2021;20(11):1195-1205. doi:10.36849/JDD.6219.

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

BACKGROUND/OBJECTIVE: Newborn infant skin is functional but immature, and diapering products can play a significant role in infant diapered skin health. Previous work demonstrated a regimen consisting of a diaper with an emollient and apertures on the inner liner (topsheet) with an acidic, pH-buffered wipe (Regimen A) lowered newborn skin pH and reduced the enzymatic activity on skin post-stool cleaning versus a regimen without these features (Regimen B). This study extends these findings to determine the impact of Regimen A on diaper area erythema severity over a 2-week use period. METHODS: This IRB-approved, blinded, randomized, crossover study enrolled newborn infants >7 days and ≤8 weeks. Participants exclusively used two unique diaper and wipe combinations, Regimen A and Regimen B (non-emollient, non-aperture containing topsheet and wipe with limited buffering capacity), each for 14 days and preceded by a 3-day washout regimen. RESULTS: Diapered skin pH was reduced during Regimen A use to values similar to that of a non-diapered control site (chest), while use of Regimen B was associated with a more alkaline skin pH. Regimen A resulted in significantly fewer severe erythema episodes. At the site of highest erythema, the perianal space, the average erythema score was significantly lower and more newborns were free of erythema while using Regimen A vs. Regimen B (P < .05). CONCLUSIONS: These findings demonstrate that diapering products can have a significant impact on newborn skin. They reinforce the need to support the physiological normalization of skin pH and protection from skin irritation and damage.

A novel treatment of diaper dermatitis in children and adults.

BACKGROUND: Diaper dermatitis (DD) is an acute inflammatory reaction, regardless of the cause, of the diaper-covered area. Topical skin barrier repair cosmetic products are the mainstay treatment to cure and/or prevent DD. AIMS: To assess the efficacy/tolerability of a zinc gluconate-taurine/zinc oxide and panthenol/ glycerin/ Butyrospermum parkii butter barrier cream using clinical evaluation. METHODS: In this prospective, open-label trial, 20 patients (10 infants/10 adults), with mild/moderate DD enrolled at the Dermatology University Clinic of Catania (Italy) were instructed to apply the cream twice daily for 30 days. Degree of erythema was performed clinically by a 5-point severity scale (from 0 = no erythema to 4 = severe erythema), at baseline, at 15 and 30 days. An Investigator Global Assessment (IGA) using a 6-point scale (from -1 = worsening to 4 = complete response/clear) along with product tolerability was also performed at 15 and 30 days. Statistical analysis was performed using SAS version 9. RESULTS: At 15 days, a reduction of clinical erythema assessment (CEA) from baseline was observed (mean from 3.2 ± 0.8 to 2.5 ± 0.3; p < 0.06), that although nonsignificant, showed a significant progressive improvement at 30 days (mean from 3.2 ± 0.8 to 1.1 ± 0.9; p < 0.0001) without any age differences. CONCLUSIONS: Our preliminary results indicate that the tested barrier cream may represent a promising approach in DD rash. It may be used in mild-to-moderate forms in monotherapy without significant side effects or, where required, in association with pharmacological agents. Its long-term use is likely safe.

Iatrogenic Cushing Syndrome And Hypertension In An Infant Girl Due To Use Of Nappy Rash Cream Containing A Potent Topical Steroid.

Eleven months old female patient presented to paediatric out patient with parents concerned about her facial swelling. Upon examination child's weight and height for age were normal on her percentiles, she had a cushingoid facies with plethoric cheeks (Figure-1,2) though generalized oedema was absent and there was centripetal obesity with some muscle wasting (Figure-3,4). Systemic examination was normal excluding blood pressure which was high for her age. Electrolytes and cortisol levels were normal. On further inquiry it was revealed that she had been using a nappy rash cream containing a potent steroid, i.e., fluticasone for 2 months and this was identified as a cause for her cushingoid features.

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

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.

Topical triamcinolone induced Cushing syndrome: A case report.

We present a case of iatrogenic Cushing syndrome and adrenal insufficiency in a newborn secondary to an overuse of triamcinolone cream 0.1% prescrived for the treatment of diaper dermatitis.This case highlignts the risks of systemic absorption when prescribing topical medications in the diaper area of an infant, and the importance of caution and proper follow up when prescribing even mid potency steroids to pediatric patients. .

Shifts in the skin microbiome associated with diaper dermatitis and emollient treatment amongst infants and toddlers in China.

BACKGROUND: The microbiological basis of diaper dermatitis has not been clearly elucidated; however, a better understanding of microbial colonization may be vital for developing appropriate therapies. METHODS: Using 16S-rRNA gene sequencing technology, we characterized and compared the bacterial communities obtained from the buttock skin sites of children with diaper dermatitis and from healthy controls. Bacterial diversity in the buttock lesion area and subsequent recovery after emollient treatment have been discussed herein. RESULTS: In buttock skin of children with or without diaper dermatitis, Staphylococcus and Anaerococcus were predominant in the total skin microbiome. Compared with the healthy group, the overall skin bacterial richness and diversity were higher in children with diaper dermatitis, with the abundance of Proteobacteria being significantly higher. In the diaper dermatitis group, the richness of Enterococcus, Erwinia and Pseudomonas was significantly higher, and the levels of Clostridium and Actinomyces were significantly lower than those in healthy children. Richness of Staphylococcus aureus was significantly higher in the diaper dermatitis group, whereas that of Staphylococcus epidermidis and Bifidobacterium longum was lower. Staphylococcus epidermidis and Staphylococcus haemolyticus, the dominant species found in buttock skin, were observed to recover earlier after the disease had improved through emollient treatment. CONCLUSION: Staphylococcus epidermidis, as skin probiotic bacterium, and B longum, Clostridium butyricum and Lactobacillus ruminis, which are intestinal probiotic bacteria, are significantly decreased in diaper dermatitis lesions. These changes in the buttock skin microflora indicate an imbalance in the microflora and suggest that the intestinal microflora may be undergoing dynamic changes. The results of this study suggest that probiotic bacterial supplementation may be useful in the treatment and prevention of diaper dermatitis.

Dermatosis perineal y glútea en un paciente paliativo con rápida respuesta a tratamiento oral / Perineal and gluteal dermatosis in a palliative patient with rapid response to oral treatment

Los pacientes con enfermedades terminales presentan frecuentes y diversos problemas de la piel debido a sus enfermedades de base y complicaciones de su situación: encamamiento, inmovilidad, malnutrición, incontinencia, etc. Estas lesiones ocasionan importante sufrimiento por el dolor, prurito, incomodidad, alteración de la imagen corporal y falta de intimidad. Por lo tanto, su abordaje eficaz por los médicos de cuidados paliativos es prioritario. En algún caso es posible conseguir un tratamiento causal efectivo en el corto periodo de tiempo disponible como demuestra el paciente descrito

Patients with terminal disease frecuently present various skin problems due to their underlying disease and complications of their clinical situation: bed-ridden, immobility, malnutrition, incontinence, etc. These lesions commonly produce significant suffering because of pain, itching, discomfort, body image distortion and lack of intimacy. Thus, an effective management of these by palliative care is prioritary. Occasionally, a specific treatment efficacious in the short time avalilable is possible as the present case shows

Dermatitis perianal y test de diagnóstico rápido / Perianal dermatitis and rapid diagnostic test

No disponible

Premature Pubarche due to Exogenous Testosterone Gel or Intense Diaper Rash Prevention Cream Use: A Case Series.

BACKGROUND/AIMS: Premature pubarche is associated with conditions such as virilizing congenital adrenal hyperplasia, androgen-secreting tumors, and exogenous exposure to androgen products. We describe the clinical and hormonal features of a series of children who were referred to endocrine evaluation due to premature pubarche. METHODS: This is a retrospective case series study of 14 children with premature pubarche and/or virilization. Five were unintentionally exposed to testosterone gel (parental use). Nine patients were intensely exposed to diaper rash prevention creams. Clinical and laboratory data were revised. RESULTS: Moderate to severe virilization was detected in the 5 patients (2 boys and 3 girls) who were exposed to testosterone gel. These patients had pubic hair development associated with clitoromegaly (3/3), penile enlargement (2/2), and accelerated growth (5/5). Testosterone levels were elevated in 4/5 patients associated with normal prepubertal gonadotropin levels and adrenal androgen precursors. The 9 children who were intensely exposed to diaper rash prevention creams had mild pubarche (intermediate hair) without any other clinical manifestation of pubertal development. Three of them exhibited pubic hair thinning after cream withdrawal. CONCLUSION: Unintentional topical androgen exposure or the intense use of diaper rash prevention cream should be ruled out in children with precocious pubarche and/or virilization signs to avoid misdiagnosis and expendable investigation.

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.

Dermatophytosis of the diaper area: Case report and literature review.

Dermatophytosis in infants is rare, especially dermatophytosis of the diaper area. This case report and literature review provides keys to establishing the above diagnosis and discusses the current controversies concerning the use of antifungal drugs in this age group.

A Natural Cream-to-Powder Formulation Developed for the Prevention of Diaper Dermatitis in Diaper-Wearing Infants and Children: Barrier Property and In-Use Tolerance Studies.

INTRODUCTION: Diaper dermatitis is a common condition that develops in the diaper area due to factors such as elevated moisture, increased skin surface pH, and exposure to irritants from urine and feces. These factors suggest interventions to prevent or treat diaper dermatitis such as exposing the skin to air, frequent diaper changes, and thorough cleansing of the diaper area. Barrier creams and powders also have a role in preventing and treating diaper dermatitis. We developed a cream-to-powder product with a formula based on corn starch and other natural ingredients for use in the diaper area. METHODS: Dye exclusion study: The barrier properties of the cream-to-powder product were assessed using a dye exclusion protocol. Skin color at treated and untreated forearm sites was measured at baseline and after exposure to crystal violet stain. The cream-to-powder product's ability to inhibit the water-soluble dye from reaching the skin was judged by comparing color changes at the treated and untreated sites. Tolerance-in-use study: The safety of the cream-to-powder product was assessed in a four-week tolerance-in-use study conducted in a group of 52 diaper-wearing infants and toddlers. Subjects' parents/guardians applied the cream-to-powder product at each diaper change. A pediatrician judged safety endpoints of erythema, dryness, and edema in the diaper area at baseline and at study end. Parents/guardians also completed a questionnaire at study end. These studies have complied with Good Clinical Practices (GCP/ICH). OUTCOMES: The cream-to-powder product prevented about 70% of the test dye from reaching the skin surface, demonstrating its ability to supplement the skin barrier. The tolerance-in-use study showed no statistically significant changes in any of the safety endpoints; there were no adverse events. Parents/guardians responses to the cream-to-powder product were overwhelmingly positive. Taken together, these results support that the cream-to-powder formulation is safe and effective for helping to prevent diaper dermatitis. J Drugs Dermatol. 2018;17(5):566-570.