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Skin barrier function in infancy: a systematic review
Laine Ludriksone1, Natalie Garcia Bartels, Varvara Kanti
1Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
Insights
Infant skin barrier maturation, measured by transepidermal water loss (TEWL) and skin surface pH, shows rapid pH changes in the first month but stable TEWL in the first two years. This indicates a competent permeability barrier develops early.
Area of Science:
- Neonatal Dermatology
- Pediatric Skin Physiology
- Barrier Function Development
Background:
- Neonatal and infant skin possess unique properties making them susceptible to barrier disruption.
- Understanding skin barrier maturation is crucial for infant dermatological health.
Purpose of the Study:
- To characterize skin barrier maturation in infants during the first two years of life.
- To analyze changes in transepidermal water loss (TEWL) and skin surface pH as indicators of barrier development.
Main Methods:
- Systematic review of MEDLINE and EMBASE databases (1975-2013).
- Inclusion of 36 studies with 8,483 TEWL and 6,437 pH measurements in healthy full-term infants (0-24 months).
- Analysis of data across 26 anatomical areas for TEWL and 14 for pH.
Main Results:
- Skin surface pH significantly decreases in the first postnatal week, followed by gradual site-specific acidification.
- Transepidermal water loss (TEWL) shows variability across anatomical sites but no consistent time-dependent development in the first two years.
- Specific pH and TEWL values varied significantly by anatomical location and infant age.
Conclusions:
- Infant skin pH undergoes rapid changes post-birth, indicating early maturation of the acid mantle.
- The permeability barrier, assessed by TEWL, appears competent in most areas early in life and does not show significant developmental changes during the first two years.
- Findings highlight the dynamic nature of infant skin pH and the relatively stable permeability barrier function within the first 24 months.
Abstract:
The skin of neonates and infants exhibits distinct anatomical and functional properties that might be clinically reflected by its characteristic susceptibility to skin barrier disruption. In this systematic review, we aimed to characterize skin barrier maturation as reflected by transepidermal water loss (TEWL) and skin surface pH during the first 2 years of life. We systematically searched MEDLINE and EMBASE via OVID from 1975 to 2013 to identify primary studies reporting TEWL and/or skin surface pH values in healthy full-term infants aged 0-24 months without any cutaneous diseases. After full text assessment, 36 studies reporting n = 8,483 TEWL measurements for 26 anatomical areas and n = 6,437 skin surface pH measurements for 14 anatomical areas were included. The mean age of the subjects ranged from 1.4 h to 1.2 years. The lowest pH of 4.63 was identified on the forehead at the age of 25.6 weeks, whereas the highest of 7.31 was on the volar forearm at 0.0 weeks. The lowest TEWL value of 3.1 g/m(2)/h was reported for the back at 0.6 weeks and the highest of 43.1 g/m(2)/h for the upper leg at 58.7 weeks. The skin surface pH reveals a steep decline during the first postnatal week, succeeded by a further gradual site-specific acidification process during the first month. A competent permeability barrier in most anatomical areas is indicated by TEWL, which does not exhibit a time-dependent development during the first 2 years of life.
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