Newborn and Infant Nursing Reviews
Volume 9, Issue 1 , Pages 31-47 , March 2009

Update on the Use of Topical Agents in Neonates

  • Marty O. Visscher, PhD

      Affiliations

    • Corresponding Author InformationAddress correspondence to Marty O. Visscher, PhD, The Skin Sciences Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229.

References 

  1. Hoath SB, Visscher M, Heaton C, Neale H. Skin science and the future of dermatology. J Cutan Med Surg. 1998;3:2–8
  2. Mazurek T, Mikiel-Kostyra K, Mazur J, Wieczorek P, Radwanska B, Pachuta-Wegier L. Influence of immediate newborn care on infant adaptation to the environment. Med Wieku Rozwoj. 1999;3:215–224
  3. Ferber SG, Makhoul IR. The effect of skin-to-skin contact (kangaroo care) shortly after birth on the neurobehavioral responses of the term newborn: a randomized, controlled trial. Pediatrics. 2004;113:858–865
  4. Als H, Duffy FH, McAnulty GB, et al. Early experience alters brain function and structure. Pediatrics. 2004;113:846–857
  5. Kleberg A, Westrup B, Stjernqvist K. Developmental outcome, child behaviour and mother-child interaction at 3 years of age following Newborn Individualized Developmental Care and Intervention Program (NIDCAP) intervention. Early Hum Dev. 2000;60:123–135
  6. Alasmi MM, Pickens WL, Hoath SB. Effect of tactile stimulation on serum lactate in the newborn rat. Pediatr Res. 1997;41:857–861
  7. Gillespie PG, Walker RG. Molecular basis of mechanosensory transduction. Nature. 2001;413:194–202
  8. Denda M, Tsuchiya T. Barrier recovery rate varies time-dependently in human skin. Br J Dermatol. 2000;142:881–884
  9. Choi EH, Brown BE, Crumrine D, et al. Mechanisms by which psychologic stress alters cutaneous permeability barrier homeostasis and stratum corneum integrity. J Invest Dermatol. 2005;124:587–595
  10. Aberg KM, Radek KA, Choi EH, et al. Psychological stress downregulates epidermal antimicrobial peptide expression and increases severity of cutaneous infections in mice. J Clin Invest. 2007;117:3339–3349
  11. Cunico RL, Maibach HI, Khan H, Bloom E. Skin barrier properties in the newborn. Transepidermal water loss and carbon dioxide emission rates. Biol Neonate. 1977;32:177–182
  12. Yosipovitch G, Maayan-Metzger A, Merlob P, Sirota L. Skin barrier properties in different body areas in neonates. Pediatrics. 2000;106(1 Pt 1):105–108
  13. Visscher M, Maganti S, Munson KA, Bare DE, Hoath SB. Early adaptation of human skin following birth: a biophysical assessment. Skin Res Technol. 1999;5:213–220
  14. Visscher MO, Narendran V, Pickens WL, et al. Vernix caseosa in neonatal adaptation. J Perinatol. 2005;25:440–446
  15. Visscher MO, Chatterjee R, Munson KA, Pickens WL, Hoath SB. Changes in diapered and nondiapered infant skin over the first month of life. Pediatr Dermatol. 2000;17:45–51
  16. Watanabe M, Tagami H, Horii I, Takahashi M, Kligman AM. Functional analyses of the superficial stratum corneum in atopic xerosis. Arch Dermatol. 1991;127:1689–1692
  17. Visscher M. Infant skin research. In: Second Annual Joint Meeting of the International Society of Bioengineering and the Skin and the International Society for Skin Imaging. (Philadelphia, Pa). 2005;
  18. Hoeger PH, Enzmann CC. Skin physiology of the neonate and young infant: a prospective study of functional skin parameters during early infancy. Pediatr Dermatol. 2002;19:256–262
  19. Walker VP, Akinbi HT, Meinzen-Derr J, Narendran V, Visscher M, Hoath SB. Host defense proteins on the surface of neonatal skin: implications for innate immunity. J Pediatr. 2008;152:777–781
  20. Pickens WL, Warner RR, Boissy YL, Boissy RE, Hoath SB. Characterization of vernix caseosa: water content, morphology, and elemental analysis. J Invest Dermatol. 2000;115:875–881
  21. Hardman MJ, Sisi P, Banbury DN, Byrne C. Patterned acquisition of skin barrier function during development. Development. 1998;125:1541–1552
  22. Akinbi HT, Narendran V, Pass AK, Markart P, Hoath SB. Host defense proteins in vernix caseosa and amniotic fluid. Am J Obstet Gynecol. 2004;191:2090–2096
  23. Marchini G, Lindow S, Brismar H, et al. The newborn infant is protected by an innate antimicrobial barrier: peptide antibiotics are present in the skin and vernix caseosa. Br J Dermatol. 2002;147:1127–1134
  24. Yoshio H, Tollin M, Gudmundsson GH, et al. Antimicrobial polypeptides of human vernix caseosa and amniotic fluid: implications for newborn innate defense. Pediatr Res. 2003;53:211–216
  25. Tollin M, Bergsson G, Kai-Larsen Y, et al. Vernix caseosa as a multi-component defence system based on polypeptides, lipids and their interactions. Cell Mol Life Sci. 2005;62:2390–2399
  26. Bautista MI, Wickett RR, Visscher MO, Pickens WL, Hoath SB. Characterization of vernix caseosa as a natural biofilm: comparison to standard oil-based ointments. Pediatr Dermatol. 2000;17:253–260
  27. Barai N. Effect of vernix caseosa on epidermal barrier maturation and repair: implications in wound healing. In: Ph.D. Thesis, College of Pharmacy. Cincinnati: University of Cincinnati; 2005;p. 128
  28. Oudshoorn MH, Rissmann R, van der Coelen D, Hennink WE, Ponec M, Bouwstra JA. Development of a murine model to evaluate the effect of vernix caseosa on skin barrier recovery. Exp Dermatol. 2008;
  29. Tansirikongkol A, Wickett RR, Visscher MO, Hoath SB. Effect of vernix caseosa on the penetration of chymotryptic enzyme: potential role in epidermal barrier development. Pediatr Res. 2007;62:49–53
  30. Sedin G, Hammarlund K, Stromberg B. Transepidermal water loss in full-term and pre-term infants. Acta Paediatr Scand Suppl. 1983;305:27–31
  31. Cartlidge P. The epidermal barrier. Semin Neonatol. 2000;5:273–280
  32. Evans NJ, Rutter N. Development of the epidermis in the newborn. Biol Neonate. 1986;49:74–80
  33. Agren J, Sjors G, Sedin G. Transepidermal water loss in infants born at 24 and 25 weeks of gestation. Acta Paediatr. 1998;87:1185–1190
  34. Okah FA, Wickett RR, Pickens WL, Hoath SB. Surface electrical capacitance as a noninvasive bedside measure of epidermal barrier maturation in the newborn infant. Pediatrics. 1995;96(4 Pt 1):688–692
  35. Denda M, Sato J, Tsuchiya T, Elias PM, Feingold KR. Low humidity stimulates epidermal DNA synthesis and amplifies the hyperproliferative response to barrier disruption: implication for seasonal exacerbations of inflammatory dermatoses. J Invest Dermatol. 1998;111:873–878
  36. Rawlings AV, Scott IR, Harding CR, Bowser PA. Stratum corneum moisturization at the molecular level. J Invest Dermatol. 1994;103:731–741
  37. Scott IR, Harding CR. Filaggrin breakdown to water binding compounds during development of the rat stratum corneum is controlled by the water activity of the environment. Dev Biol. 1986;115:84–92
  38. Blank IH. Factors which influence the water content of the stratum corneum. J Invest Dermatol. 1952;18:433–440
  39. Gloor M, Bettinger J, Gehring W. Modification of stratum corneum quality by glycerin-containing external ointments. Hautarzt. 1998;49:6–9
  40. Halkier-Sorensen L, Petersen BH, Trestrup-Pedersen K. Epidemiology of occupational skin diseases in Denmark: notification, recognition and compensation. In:  van der Balk PGM,  Maigach HI editor. The irritant contact dermatitis syndrome. Boca Raton (Fla): CRC Press; 1995;p. 23–52
  41. Hurkmans JF, Bodde HE, Van Driel LM, Van Doorne H, Junginger HE. Skin irritation caused by transdermal drug delivery systems during long-term (5 days) application. Br J Dermatol. 1985;112:461–467
  42. Kligman AM. Hydration injury to human skin. In:  van der Valk PGM,  Maibach HI editor. The irritant contact dermatitis syndrome. Boca Raton: CRC Press; 1996;p. 187–194
  43. Medeiros M. Aquagenic urticaria. J Investig Allergol Clin Immunol. 1996;6:63–64
  44. Rustemeyer T, Frosch PJ. Occupational skin diseases in dental laboratory technicians. (I). Clinical picture and causative factors. Contact Dermatitis. 1996;34:125–133
  45. Willis I. The effects of prolonged water exposure on human skin. J Invest Dermatol. 1973;60:166–171
  46. Warner RR, Boissy YL, Lilly NA, et al. Water disrupts stratum corneum lipid lamellae: damage is similar to surfactants. J Invest Dermatol. 1999;113:960–966
  47. Warner RR, Stone KJ, Boissy YL. Hydration disrupts human stratum corneum ultrastructure. J Invest Dermatol. 2003;120:275–284
  48. Zimmerer RE, Lawson KD, Calvert CJ. The effects of wearing diapers on skin. Pediatr Dermatol. 1986;3:95–101
  49. Zhai H, Maibach HI. Occlusion vs. skin barrier function. Skin Res Technol. 2002;8:1–6
  50. Hoath SB, Pickens WL, Visscher MO. The biology of vernix caseosa. Int J Cosmet Sci. 2006;28:319–333
  51. Singh G, Archana G. Unraveling the mystery of vernix caseosa. Indian J Dermatol. 2008;53:54–60
  52. Gaylord MS, Wright K, Lorch K, Lorch V, Walker E. Improved fluid management utilizing humidified incubators in extremely low birth weight infants. J Perinatol. 2001;21:438–443
  53. Harpin VA, Rutter N. Humidification of incubators. Arch Dis Child. 1985;60:219–224
  54. Agren J, Sjors G, Sedin G. Ambient humidity influences the rate of skin barrier maturation in extremely preterm infants. J Pediatr. 2006;148:613–617
  55. Bhandari V, Brodsky N, Porat R. Improved outcome of extremely low birth weight infants with Tegaderm application to skin. J Perinatol. 2005;25:276–281
  56. Vernon HJ, Lane AT, Wischerath LJ, Davis JM, Menegus MA. Semipermeable dressing and transepidermal water loss in premature infants. Pediatrics. 1990;86:357–362
  57. Mancini AJ, Sookdeo-Drost S, Madison KC, Smoller BR, Lane AT. Semipermeable dressings improve epidermal barrier function in premature infants. Pediatr Res. 1994;36:306–314
  58. Bustamante SA, Steslow J. Use of a transparent adhesive dressing in very low birth weight infants. J Perinatol. 1989;9:165–169
  59. Lane AT, Drost SS. Effects of repeated application of emollient cream to premature neonates' skin. Pediatrics. 1993;92:415–419
  60. Nopper AJ, Horii KA, Sookdeo-Drost S, Wang TH, Mancini AJ, Lane AT. Topical ointment therapy benefits premature infants. J Pediatr. 1996;128(5 Pt 1):660–669
  61. Lund C, Kuller J, Lane A, Lott JW, Raines DA. Neonatal skin care: the scientific basis for practice. J Obstet Gynecol Neonatal Nurs. 1999;28:241–254
  62. Lund CH, Kuller J, Lane AT, Lott JW, Raines DA, Thomas KK. Neonatal skin care: evaluation of the AWHONN/NANN research-based practice project on knowledge and skin care practices. Association of Women's Health, Obstetric and Neonatal Nurses/National Association of Neonatal Nurses. J Obstet Gynecol Neonatal Nurs. 2001;30:30–40
  63. Lund CH, Osborne JW, Kuller J, Lane AT, Lott JW, Raines DA. Neonatal skin care: clinical outcomes of the AWHONN/NANN evidence-based clinical practice guideline. Association of Women's Health, Obstetric and Neonatal Nurses and the National Association of Neonatal Nurses. J Obstet Gynecol Neonatal Nurs. 2001;30:41–51
  64. Edwards WH, Conner JM, Soll RF. The effect of prophylactic ointment therapy on nosocomial sepsis rates and skin integrity in infants with birth weights of 501 to 1000 g. Pediatrics. 2004;113:1195–1203
  65. Gunt H. Water handling properties of vernix caseosa. In: MS Thesis, College of Pharmacy. Cincinnati: University of Cincinnati; 2002;p. 1–167
  66. Aly R, Shirley C, Cunico B, Maibach HI. Effect of prolonged occlusion on the microbial flora, pH, carbon dioxide and transepidermal water loss on human skin. J Invest Dermatol. 1978;71:378–381
  67. Campbell JR, Zaccaria E, Baker CJ. Systemic candidiasis in extremely low birth weight infants receiving topical petrolatum ointment for skin care: a case-control study. Pediatrics. 2000;105:1041–1045
  68. Conner JM, Soll RF, Edwards WH. Topical ointment for preventing infection in preterm infants. Cochrane Database Syst Rev. 2004;CD001150
  69. Darmstadt GL, Saha SK. Traditional practice of oil massage of neonates in Bangladesh. J Health Popul Nutr. 2002;20:184–188
  70. Darmstadt GL, Mao-Qiang M, Chi E, et al. Impact of topical oils on the skin barrier: possible implications for neonatal health in developing countries. Acta Paediatr. 2002;91:546–554
  71. Darmstadt GL, Saha SK, Ahmed AS, et al. Effect of topical treatment with skin barrier-enhancing emollients on nosocomial infections in preterm infants in Bangladesh: a randomised controlled trial. Lancet. 2005;365:1039–1045
  72. Darmstadt GL, Saha SK, Ahmed AS, et al. Effect of skin barrier therapy on neonatal mortality rates in preterm infants in Bangladesh: a randomized, controlled, clinical trial. Pediatrics. 2008;121:522–529
  73. Kiechl-Kohlendorfer U, Berger C, Inzinger R. The effect of daily treatment with an olive oil/lanolin emollient on skin integrity in preterm infants: a randomized controlled trial. Pediatr Dermatol. 2008;25:174–178
  74. Man MM, Feingold KR, Thornfeldt CR, Elias PM. Optimization of physiological lipid mixtures for barrier repair. J Invest Dermatol. 1996;106:1096–1101
  75. Mao-Qiang M, Brown BE, Wu-Pong S, Feingold KR, Elias PM. Exogenous nonphysiologic vs physiologic lipids. Divergent mechanisms for correction of permeability barrier dysfunction. Arch Dermatol. 1995;131:809–816
  76. Schurer N, Schliep V, Williams ML. Differential utilization of linoleic and arachidonic acid by cultured human keratinocytes. Skin Pharmacol. 1995;8:30–40
  77. Food and Drug Administration. In: Skin protectant drug products for over-the-counter human use; Final monograph. Washington: Health and Human Services, U.S. Goverment; 2003;p. 33362–33380
  78. Berg RW. Etiologic factors in diaper dermatitis: a model for development of improved diapers. Pediatrician. 1987;14(Suppl 1):27–33
  79. Berg RW. Etiology and pathophysiology of diaper dermatitis. Adv Dermatol. 1988;3:75–98
  80. Berg RW, Buckingham KW, Stewart RL. Etiologic factors in diaper dermatitis: the role of urine. Pediatr Dermatol. 1986;3:102–106
  81. Berg RW, Milligan MC, Sarbaugh FC. Association of skin wetness and pH with diaper dermatitis. Pediatr Dermatol. 1994;11:18–20
  82. Davis JA, Leyden JJ, Grove GL, Raynor WJ. Comparison of disposable diapers with fluff absorbent and fluff plus absorbent polymers: effects on skin hydration, skin pH, and diaper dermatitis. Pediatr Dermatol. 1989;6:102–108
  83. Honig PJ, Gribetz B, Leyden JJ, McGinley KJ, Burke LA. Amoxicillin and diaper dermatitis. J Am Acad Dermatol. 1988;19(2 Pt 1):275–279
  84. Visscher SBH. Diaper dermatitis. In:  Chew A,  Maibach H editor. Irritant Dermatitis. Berlin: Springer; 2006;p. 37–51
  85. Visscher MO, Chatterjee R, Munson KA, Bare DE, Hoath SB. Development of diaper rash in the newborn. Pediatr Dermatol. 2000;17:52–57
  86. Willis CM, Stephens CJ, Wilkinson JD. Epidermal damage induced by irritants in man: a light and electron microscopic study. J Invest Dermatol. 1989;93:695–699
  87. Willis CM, Stephens CJ, Wilkinson JD. Differential effects of structurally unrelated chemical irritants on the density of proliferating keratinocytes in 48 h patch test reactions. J Invest Dermatol. 1992;99:449–453
  88. Barany E, Lindberg M, Loden M. Biophysical characterization of skin damage and recovery after exposure to different surfactants. Contact Dermatitis. 1999;40:98–103
  89. Gibbs S, Vietsch H, Meier U, Ponec M. Effect of skin barrier competence on SLS and water-induced IL-1alpha expression. Exp Dermatol. 2002;11:217–223
  90. Gloor M, Senger B, Langenauer M, Fluhr JW. On the course of the irritant reaction after irritation with sodium lauryl sulphate. Skin Res Technol. 2004;10:144–148
  91. Jensen JM, Schutze S, Neumann C, Proksch E. Impaired cutaneous permeability barrier function, skin hydration, and sphingomyelinase activity in keratin 10 deficient mice. J Invest Dermatol. 2000;115:708–713
  92. Sato J, Denda M, Chang S, Elias PM, Feingold KR. Abrupt decreases in environmental humidity induce abnormalities in permeability barrier homeostasis. J Invest Dermatol. 2002;119:900–904
  93. Visscher M. Environmental interactions. In:  Hoath SB,  Maibach HI editor. Neonatal skin structure and function. 2nd ed.. New York: Marcel Dekker, Inc.; 2003;p. 325–366
  94. Caplan RM. The irritant role of feces in the genesis of perianal itch. Gastroenterology. 1966;50:19–23
  95. Ruseler-van Embden JG, van Lieshout LM, Smits SA, van Kessel I, Laman JD. Potato tuber proteins efficiently inhibit human faecal proteolytic activity: implications for treatment of peri-anal dermatitis. Eur J Clin Invest. 2004;34:303–311
  96. Andersen PH, Bucher AP, Saeed I, Lee PC, Davis JA, Maibach HI. Faecal enzymes: in vivo human skin irritation. Contact Dermatitis. 1994;30:152–158
  97. Nield LS, Kamat D. Prevention, diagnosis, and management of diaper dermatitis. Clin Pediatr (Phila). 2007;46:480–486
  98. Neonatal drug withdrawal. American Academy of Pediatrics Committee on Drugs. Pediatrics. 1998;101:1079–1088
  99. Lainwala S, Brown ER, Weinschenk NP, Blackwell MT, Hagadorn JI. A retrospective study of length of hospital stay in infants treated for neonatal abstinence syndrome with methadone versus oral morphine preparations. Adv Neonatal Care. 2005;5:265–272
  100. Manzoni P, Gomirato G. Effectiveness of topical acetate tocopherol for the prevention and treatment of skin lesions in newborns: a 5 years experience in a 3rd level Italian Neonatal Intensive Care Unit. Minerva Pediatr. 2005;57:305–311
  101. Candidiasis. In:  Pickering LK editors. Red Book: 2003 Report on the Committee on Infectious Disease. Elk Grove Village: American Academy of Pediatrics; 2003;p. 229–231
  102. Ward DB, Fleischer AB, Feldman SR, Krowchuk DP. Characterization of diaper dermatitis in the United States. Arch Pediatr Adolesc Med. 2000;154:943–946
  103. Concannon P, Gisoldi E, Phillips S, Grossman R. Diaper dermatitis: a therapeutic dilemma. Results of a double-blind placebo controlled trial of miconazole nitrate 0.25%. Pediatr Dermatol. 2001;18:149–155
  104. Eichenfield LF, Bogen ML. Absorption and efficacy of miconazole nitrate 0.25% ointment in infants with diaper dermatitis. J Drugs Dermatol. 2007;6:522–526
  105. Schunck M, Neumann C, Proksch E. Artificial barrier repair in wounds by semi-occlusive foils reduced wound contraction and enhanced cell migration and reepithelization in mouse skin. J Invest Dermatol. 2005;125:1063–1071
  106. Visscher M, Hoath SB, Conroy E, Wickett RR. Effect of semipermeable membranes on skin barrier repair following tape stripping. Arch Dermatol Res. 2001;293:491–499
  107. Zhai H, Maibach HI. Barrier creams. In:  Chew A,  Maibach HI editor. Irritant Dermatitis. Berlin: Springer-Verlag; 2006;p. 435–438
  108. Hoggarth A, Waring M, Alexander J, Greenwood A, Callaghan T. A controlled, three-part trial to investigate the barrier function and skin hydration properties of six skin protectants. Ostomy Wound Manage. 2005;51:30–42
  109. Atherton D. Maintaining healthy skin in infancy using prevention of irritant napkin dermatitis as a model. Community Pract. 2005;78:255–257
  110. Honig PJ. Diaper dermatitis. Factors to consider in diagnosis and treatment. Postgrad Med, 74, 79-84, 88. (1983).
  111. Zehrer CL, Newman DK, Grove GL, Lutz JB. Assessment of diaper-clogging potential of petrolatum moisture barriers. Ostomy Wound Manage. 2005;51:54–58
  112. Moller P, Lohmann M, Brynitz S. Cholestyramine ointment in the treatment of perianal skin irritation following ileoanal anastomosis. Dis Colon Rectum. 1987;30:106–107
  113. Senon G, Hergott C, Micard S, Rieutord A, Aujard Y, Brion F. Treatment of severe perianal cutaneous lesions in hospitalized neonates: Orabase ointment interest. J Gynecol Obstet Biol Reprod (Paris). 2005;34(1 Suppl):S84–S88
  114. White CM, Gailey RA, Lippe S. Cholestyramine ointment to treat buttocks rash and anal excoriation in an infant. Ann Pharmacother. 1996;30:954–956
  115. Hayashi AH, Lau HY, Gillis DA. Topical sucralfate: effective therapy for the management of resistant peristomal and perineal excoriation. J Pediatr Surg. 1991;26:1279–1281
  116. Lyon CC, Stapleton M, Smith AJ, Griffiths CE, Beck MH. Topical sucralfate in the management of peristomal skin disease: an open study. Clin Exp Dermatol. 2000;25:584–588
  117. Visscher M. Use of a water-based skin barrier film to treat skin breakdown. In: National Association of Neonatal Nurses Annual Educational Conference. (Fort Lauderdale, FL). 2008;
  118. Loden M, Buraczewska I, Edlund F. The irritation potential and reservoir effect of mild soaps. Contact Dermatitis. 2003;49:91–96
  119. Atherton DJ. The aetiology and management of irritant diaper dermatitis. J Eur Acad Dermatol Venereol. 2001;15(Suppl 1):1–4
  120. Ehretsmann C, Schaefer P, Adam R. Cutaneous tolerance of baby wipes by infants with atopic dermatitis, and comparison of the mildness of baby wipe and water in infant skin. J Eur Acad Dermatol Venereol. 2001;15(Suppl 1):16–21
  121. Odio M, Streicher-Scott J, Hansen RC. Disposable baby wipes: efficacy and skin mildness. Dermatol Nurs, 13, 107-112, 117-108, 121 (2001).
  122. Visscher M, Taylor T, White T, Sargent S, Sluder L, Smith L, et al. Wipes versus current standard for diaper skin care. In: National Association of Neonatal Nurses Annual Meeting. (San Diego, CA). 2007;
  123. Visscher M, Taylor T, White T, Sargent S, Sluder L, Smith L, et al. Wipes versus current standard for diaper skin care. In: European Society for Pediatric Dermatology. (Athens, Greece). 2008;
  124. Elias PM. The skin barrier as an innate immune element. Semin Immunopathol. 2007;29:3–14
  125. Rippke F, Schreiner V, Schwanitz HJ. The acidic milieu of the horny layer: new findings on the physiology and pathophysiology of skin pH. Am J Clin Dermatol. 2002;3:261–272
  126. Schmid-Wendtner MH, Korting HC. The pH of the skin surface and its impact on the barrier function. Skin Pharmacol Physiol. 2006;19:296–302
  127. Mauro T, Holleran WM, Grayson S, et al. Barrier recovery is impeded at neutral pH, independent of ionic effects: implications for extracellular lipid processing. Arch Dermatol Res. 1998;290:215–222
  128. Adam R. Skin care of the diaper area. Pediatr Dermatol. 2008;25:427–433
  129. Wilson JR, Mills JG, Prather ID, Dimitrijevich SD. A toxicity index of skin and wound cleansers used on in vitro fibroblasts and keratinocytes. Adv Skin Wound Care. 2005;18:373–378
  130. Weston WL, Lane AT, Weston JA. Diaper dermatitis: current concepts. Pediatrics. 1980;66:532–536
  131. Siegel E, Wason S. Boric acid toxicity. Pediatr Clin North Am. 1986;33:363–367
  132. Scheinfeld N. Diaper dermatitis: a review and brief survey of eruptions of the diaper area. Am J Clin Dermatol. 2005;6:273–281

PII: S1527-3369(08)00172-4

doi: 10.1053/j.nainr.2008.12.010

Newborn and Infant Nursing Reviews
Volume 9, Issue 1 , Pages 31-47 , March 2009

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