I remember my first pregnancy and the anxiety that came with it. Everything had to be perfect before the arrival of my bundle of joy. The hospital bag had everything I needed for the baby's arrival, including a whole range of skincare products. It's funny how a tiny human being who had only known the amniotic fluid as its living sole environment, in my mind, 'needed' so many skincare products!
Unfortunately, in the two weeks of celebrating my child’s birth, I felt like shoving all those products into the bin. My newborn’s delicate skin could not tolerate all the soaps, lotions, and other products I was using on it. Her skin developed a rash and it was often dry.
That was when I understood that I could never compare an adult’s skin to a baby’s skin. Understanding the differences in the make-up of baby skin was crucial for making decisions about its care and management. As a doctor who now understands the medical conditions affecting the skin, I thought I would share the most important keynotes a mother needs to know about taking care of their child’s skin.
The first important fact one needs to comprehend is that infant skin can never be compared with adult skin. The skin of a child is more delicate and vulnerable in its structural composition compared to mature skin, hence the need to care for it differently. Baby skin is not mature at birth but continues to develop during its first year of existence outside the mother’s womb. The outermost layer of skin known as the Stratum Corneum (SC) is thinner and more permeable in infants compared to adults. This layer is often referred to as the skin barrier since it serves a crucial role in protecting the inner environment from colonization by harmful bacteria, irritants, and allergens.
The skin also loses water quickly as well as absorbs substances at a faster rate than adult skin. With this in mind, it should be very clear that any harsh chemicals that come in contact with your baby’s skin are quickly absorbed into the system. Moisture escapes from its body much faster than it is absorbed.
A neonate’s skin also comprises of thinner collagen fibres, fewer lipids, less natural moisturizing factors, and less melanin compared to adults which increases its vulnerability to sun exposure and applied substances. A break in the stratum corneum will increase a baby’s susceptibility to the external harmful environment hence may increase the chances of developing conditions such as eczema and other skin infection in their early childhood.
A talk on baby skin would not be complete without mention of one of the commonest skin disorders affecting children; Eczema or Atopic dermatitis which is inflammation of the skin. It is a very common childhood illness characterized by dry, itchy, and scaling skin. It often starts in the first 6 months of life and tends to be long-term although, it can sometimes improve or completely clear as a child gets older. It is believed to result as an interplay of genes passed down from parents and the immune system; resulting in an impaired/compromised skin barrier function, which leads to increased water loss and permits entry of various environmental allergens. Environmental factors such as soap, dust mites, detergents play a major role in weakening the skin barrier.
Atopic eczema tends to precede and be associated with other common allergic conditions such as hay fever, asthma and allergic conjunctivitis. Untreated, the condition can cause serious discomfort to the child and new parents.
Atopic eczema can affect any part of the body. The affected areas tend to change as a child grows;
in children less than 6 months, the face and scalp are commonly affected,
between 6-12months, the elbows and knees are commonly affected and
in toddlers, it frequently involves the elbow and knee creases, wrists, and the skin around the mouth.
Affected skin in darker populations appears darker or greyish and red on lighter skin shades. The risk of infection of the affected skin for example by bacteria is also increased.
The course of Atopic Eczema is characterized by flares, whose cause is sometimes unknown or related to the weather, change in soaps, dry skin, heat, sweating, infections, allergens such as pollen and dander as well as certain foods.
Treatment is aimed at improving the barrier function and controlling the itchiness. Management involves being aware of your child’s triggers and avoiding them and avoiding long warm baths that strip the skin of essentials oils. Aqueous creams tend to worsen eczema outbreaks by further drying out the skin. The key to staying on top of Atopic Eczema is the use of barrier creams to lock in the moisture; thick emollient creams/emulsifying ointments are favoured for this function. Anti-itch medication is prescribed for the itch while various treatment modalities often in the form of creams are prescribed to reduce inflammation on affected areas by a trained specialist. Management for severe eczema definitely needs to be done by a trained specialist.
It is therefore very clear that an infant requires a gentler approach to skincare.
This article was co-written by Dr. Vallarie Mashavave - Aesthetic Dermatologist and Dr. Rulani Makondo- Dermatology Registrar at the University of Witwatersrand.
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