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Dermatology and Therapy
Published in: Dermatology and Therapy 3/2017

Open Access 01-09-2017 | Review

Skin Health Connected to the Use of Absorbent Hygiene Products: A Review

Authors: Johanna Karlsson Bender, Jan Faergemann, Maria Sköld

Published in: Dermatology and Therapy | Issue 3/2017

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Abstract

Over the past 50 years, absorbent hygiene products such as baby diapers and incontinence products have become essential features of modern day life. Through innovation and enhanced technology, their design, composition and performance have been dramatically upgraded from their early forms, and they have transformed the lives of millions of people, improving their quality of life. Skin health related to the use of absorbent hygiene products has accordingly also greatly improved. Still, the wearing of absorbent hygiene products will affect the skin, and for some users the changes in microclimate, mechanical interactions and the exposure to urine and faeces may result in irritant contact dermatitis, i.e. diaper dermatitis (DD) or incontinence-associated dermatitis (IAD). Babies with developing skin and the elderly with deteriorating skin functions who are the most frequent users of absorbent hygiene products are more vulnerable to the causal factors. Although irritant reactions are the most common, allergic contact dermatitis should be considered if a DD/IAD fails to improve by recommended actions. There is also a connection between IAD and pressure ulcer development of which it is important to be aware. A holistic approach of using high-quality absorbent hygiene products in combination with appropriate skin care will help maintaining good skin health.
Literature
1.
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(2):102–8.CrossRefPubMed
2.
Wilson PA, Dallas MJ. Diaper performance: maintenance of healthy skin. Pediatr Dermatol. 1990;7(3):179–84.CrossRefPubMed
3.
Oranje AP, de Waard-van der Spek FB. Comparison of cloth and superabsorbent paper diapers for preventing diaper dermatitis. Eur J Pediat Dermatol. 1991;1:225–32.
4.
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(6):378–81.CrossRefPubMed
5.
Grove GL, Lemmen JT, Garafalo M, Akin FJ. Assessment of skin hydration caused by diapers and incontinence articles. Curr Probl Dermatol. 1998;26:183–95.CrossRefPubMed
6.
Schafer P, Bewick-Sonntag C, Capri MG, Berardesca E. Physiological changes in skin barrier function in relation to occlusion level, exposure time and climatic conditions. Skin Pharmacol Appl Skin Physiol. 2002;15(1):7–19.CrossRefPubMed
7.
8.
Elias PM, Friend DS. The permeability barrier in mammalian epidermis. J Cell Biol. 1975;65(1):180–91.CrossRefPubMed
9.
van Smeden J, Janssens M, Gooris GS, Bouwstra JA. The important role of stratum corneum lipids for the cutaneous barrier function. Biochem Biophys Acta. 2014;1841(3):295–313.PubMed
10.
Elias PM. Epidermal lipids, barrier function, and desquamation. J Invest Dermatol. 1983;80(1 Suppl):44s–9s.CrossRef
11.
Swartzendruber DC, Wertz PW, Madison KC, Downing DT. Evidence that the corneocyte has a chemically bound lipid envelope. J Invest Dermatol. 1987;88(6):709–13.CrossRefPubMed
12.
Michaels AS, Chandrasekaran SK, Shaw JE. Drug permeation through human skin: theory and in vitro experimental measurement. AIChE. 1975;21(5):985–96.CrossRef
13.
Forslind B. The structure of the human skin barrier. In: Kanewa L, Elsner P, Wahlberg JE, Maibach HI, editors. Handbook of occupational dermatology. Berlin: Springer; 2000. p. 56–63.CrossRef
14.
Bouwstra JA, Gooris GS, van der Spek JA, Bras W. Structural investigations of human stratum corneum by small-angle X-ray scattering. J Invest Dermatol. 1991;97(6):1005–12.CrossRefPubMed
15.
Norlen L, Al-Amoudi A, Dubochet J. A cryotransmission electron microscopy study of skin barrier formation. J Invest Dermatol. 2003;120(4):555–60.CrossRefPubMed
16.
Iwai I, Han H, den Hollander L, Svensson S, Ofverstedt LG, Anwar J, et al. The human skin barrier is organized as stacked bilayers of fully extended ceramides with cholesterol molecules associated with the ceramide sphingoid moiety. J Invest Dermatol. 2012;132(9):2215–25.CrossRefPubMed
17.
Houben E, De Paepe K, Rogiers V. A keratinocyte’s course of life. Skin Pharmacol Physiol. 2007;20(3):122–32.CrossRefPubMed
18.
Rippke FVS, Schwanitz HJ. The acidic milieu of the horny layer. New findings ont he physiology of skin pH. Am J Clin Dermatol. 2002;3(4):261–72.CrossRefPubMed
19.
20.
21.
Schreml S, Zeller V, Meier RJ, Kortinng HC, Behm B, Landthaler M, et al. Impact of age and body site on adult female skin surface pH. Dermatology. 2012;224:66–71.CrossRefPubMed
22.
23.
24.
Prasad HRY, Srivastava P, Verma KK. Diaper dermatitis—an overview. Indian J Pediatr. 2003;70:635–7.CrossRefPubMed
25.
Scheinfeld N. Diaper dermatitis. A review and brief survey of eruptions of the diaper area. Am J Clin Dermatol. 2005;6(5):273–81.CrossRefPubMed
26.
Stamatas GN, Tierney NK. Diaper dermatitis: etiology, manifestations, prevention, and management. Pediatr Dermatol. 2014;31(1):1–7.CrossRefPubMed
27.
Gray M, Beeckman D, Bliss DZ, Fader M, Logan S, Junkin J, et al. Incontinence-associated dermatitis: a comprehensive review and update. J Wound Ostomy Continence Nurs. 2012;39(1):61–74.CrossRefPubMed
28.
Gray M. Optimal management of incontinence-associated dermatitis in the elderly. Am J Clin Dermatol. 2010;11(3):201–10.CrossRefPubMed
29.
Beeckman D, Woodward S, Gray M. Incontinence-associated dermatitis: step by step prevention and treatment. Br J Community Nurs. 2011;16(8):382–9.CrossRefPubMed
30.
Gray M. Incontinence-related skin damage: essential knowledge. Ostomy Wound Manag. 2007;53(12):28–32.
31.
Adalat S, Wall D, Goodyear H. Diaper dermatitis-frequency and contributory factors in hospital attending children. Pediatr Dermatol. 2007;24(5):438–88.CrossRef
32.
Liu N, Wang X, Odio M. Frequency and severity of diaper dermatitis with use of traditional chinese cloth diapers: observations in 3- to 9-month-old children. Pediatr Dermatol. 2011;28(4):380–6.CrossRefPubMed
33.
Blume-Peytavi U, Hauser M, Lunneman L, Stamatas GN, Kottner J, Garcia Bartels N. Prevention of diaper dermatitis in infants—a literature review. Pediatr Dermatol. 2014;31(4):413–29.CrossRefPubMed
34.
Runeman B, Rybo G, Forsgren-Brusk U, Larkö O, Larsson P, Faergemann J. The vulvar skin microenvironment: influence of different panty liners on temperature, pH and microflora. Acta Derm Venereol. 2004;84(4):277–84.PubMed
35.
Stamatas GN, Zerweck C, Grove G, Martin KM. Documentation of impaired epidermal barrier in mild and moderate diaper dermatitis in vivo using noninvasive methods. Pediatr Dermatol. 2011;28(2):99–107.CrossRefPubMed
36.
37.
38.
Gerhardt L-C, Strässle V, Lenz A, Spencer ND, Derler S. Influence of epidermal hydration on the friction of human skin against textiles. J R Soc Interface. 2008;5:1317–28.CrossRefPubMedPubMedCentral
39.
Wilson M. Microbial Inhabitants of humans: their ecology and role in health and disease. Cambridge: Cambridge University Press, 2005.
40.
41.
Roul S, Ducombs G, Leaute-Labreze C, Taieb A. ‘Lucky luke’ contact dermatitis due to rubber components of diapers. Contact Dermatitis. 1998;38:363–4.CrossRefPubMed
42.
Onken AT, Baumstark J, Belloni B, Ring J, Schnopp C. Atypical diaper dermatitis: contact allergy to mercapto compounds. Pediatr Dermatol. 2011;28(6):739–41.CrossRefPubMed
43.
Belhadjali H, Giordano-Labadie F, Rance F, Bazex J. ‘Lucky Luke’ contact dermatits from diapers: a new allergen? Contact Dermatitis. 2001;44:248.CrossRefPubMed
44.
Giroux L, Pratt MD. Contact dermatitis to incontinency pads in a (meth)acrylate allergic patient. American Journal of Contact Dermatitis. 2002;13(3):143–5.PubMed
45.
JiaDe Y, Treat J, Chaney K, Brod B. Potential allergens in disposable diaper wipes, topical diaper preparations, and disposable diapers: under-recognized etiology of pediatric perineal dermatitis. Dermatitis. 2016;27(3):110–8.CrossRef
46.
Scheynius A. Immunological aspects. In: Lepoittevin JP, Basketter DA, Goossens A, Karlberg AT, editors. Allergic contact dermatitis The molecular basis. Berlin: Springer; 1998. p. 4–18.CrossRef
47.
Andersen KE, White IR, Goossens A. Allergens from the European Baseline series. In: Johansen JD, Frosch PJ, Lepoittevin J-P, editors. Contact Dermatitis. 5th ed. Berlin: Springer; 2011. p. 545–90.CrossRef
48.
Alberta L, Sweeney SM, Wiss K. Diaper dye dermatitis. Pediatrics. 2005;116(3):450–2.CrossRef
49.
Kutting B, Brehler R, Traupe H. Allergic contact dermatitis in children: strategies of prevention and risk management. Eur J Dermatol. 2004;14(2):80–5.PubMed
50.
Bruckner AL, Weston WL, Morelli JG. Does sensitization to contact allergens begin in infancy? Pediatrics. 2000;105(1):e3.CrossRefPubMed
51.
Militello G, Jacob SE, Crawford GH. Allergic contact dermatitis in children. Curr Opin Pediatr. 2006;18(4):385–90.CrossRefPubMed
52.
53.
Fischer AA. Allergic contact dermatitis in early infancy. Cutis. 1994;54:300–2.
54.
Ayala F, Balato N, Lembo G, Patruno C, Tosti A, Schena D, et al. A multicentre study of contact sensitization in children. Gruppo Italiano Ricerca Dermatiti da Contatto e Ambientali (GIRDCA). Contact Dermatitis. 1992;26(5):307–10.CrossRefPubMed
55.
Lembo S, Lembo C, Patruno C, Cuomo P, Ayala F, Balato N, et al. Contact sensitization of children referred to the Dermatology Department of the University Federico II of Naples, Italy: a two-decade years history. Giornale italiano di dermatologia e venereologia: organo ufficiale, Societa italiana di Dermatologia e Sifilografia. 2017.
56.
Vukmanovic-Stejic M, Rustin MHA, Nikolich-Zugich J, Akbar AN. Immune responses in the skin in old age. Curr Opin Immunol. 2011;23:525–31.CrossRefPubMed
57.
Friedmann PS, Pickard C. Contact hypersemsitivity: quantitative aspects, susceptibility and risk factors. In: Martin SF, editor. T Lymphocytes as Tools in Diagnostics and Immunotoxicology. Basel: Springer; 2014. p. 51–71.CrossRef
58.
Warshaw EM, Raju SI, Fowler JF, Maibach HI, Belsito DV, ZK A, et al. Positive patch test reactions in older individuals: retrspective analysis from the North American Contact Dermatitis Group, 1994-2008. J Am Acad Dermatol. 2012;66(2):229–40.CrossRefPubMed
59.
Smith WJ, Jacob SE. The role of allergic contact dermatitis in diaper dermatitis. Pediatr Dermatol. 2009;26(3):369–70.CrossRefPubMed
60.
Siegfried EC. Neonatal skin care and toxicology. In: Eichenfield LF, Frieden IJ, Esterly NB, editors. Textbook of neonatal dermatology. Philadelphia: Saunders; 2001. p. 62–72.
61.
Stamatas GN, Nikolovski J, Luedtke MA, Kollias N, Wiegand BC. Infant skin microstructure assessed in vivo differs from adult skin in organization and at the cellular level. Pediatr Dermatol. 2010;27(2):125–31.CrossRefPubMed
62.
Bertaux E, Derler S, Rossi RM. Xianyi Zeng, Koehl L, Ventenat V. Textile, Physiological, and Sensorial Parameters in Sock Comfort. Text Res J. 2010;80(17):1803–10.CrossRef
63.
West DP, Worobec S, Solomon LM. Pharmacology and toxicology of infant skin. J Invest Dermatol. 1981;76(3):147–50.CrossRefPubMed
64.
65.
Harpin VA, Rutter N. Barrier properties of the newborn infant’s skin. J Pediatrics. 1983;102(3):419–25.CrossRef
66.
Kalia YN, Nonato LB, Lund CH, Guy RH. Development of skin barrier function in premature infants. J Invest Dermatol. 1998;111(2):320–6.CrossRefPubMed
67.
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(1):45–51.CrossRefPubMed
68.
Berg RW, Milligan MC, Sarbaugh FC. Association of skin wetness and pH with diaper dermatitis. Pediatr Dermatol. 1994;11(1):18–20.CrossRefPubMed
69.
Seidenari S, Giusti G. Objective assessment of the skin of children affected by atopic dermatitis: a study of pH, capacitance and TEWL in eczematous and clinically uninvolved skin. Acta Derm Venereol. 1995;75(6):429–33.PubMed
70.
Wilhelm KP, Maibach HI. Factors predisposing to cutaneous irritation. Dermatol Clin. 1990;8(1):17–22.PubMed
71.
Behne MJ, Barry NP, Hanson KM, Aronchik I, Clegg RW, Gratton E, et al. Neonatal development of the stratum corneum pH gradient: localization and mechanisms leading to emergence of optimal barrier function. J Invest Dermatol. 2003;120(6):998–1006.CrossRefPubMed
72.
Rutter N. Clinical consequences of an immature barrier. Seminars in neonatology. 2000;5(4):281–7.CrossRefPubMed
73.
Nikolovski J, Stamatas GN, Kollias N, Wiegand BC. Barrier function and water-holding and transport properties of infant stratum corneum are different from adult and continue to develop through the first year of life. J Invest Dermatol. 2008;128(7):1728–36.CrossRefPubMed
74.
Mack MC, Chu MR, Tierney NK, Ruvolo E, Stamatas GN, Kollias N, et al. Water-holding and transport properties of skin stratum corneum of infants and toddlers are different from those of adults: studies in three geographical regions and four ethnic groups. Pediatr Dermatol. 2016;33(3):275–82.CrossRefPubMedPubMedCentral
75.
Kashibuchi N, Hirai Y, O’Goshi K, Tagami H. Three-dimensional analyses of individual corneocytes with atomic force microscope: morphological changes related to age, location and to the pathologic skin conditions. Skin Res Technol. 2002;8(4):203–11.CrossRefPubMed
76.
Michel S, Schmidt R, Shroot B, Reichert U. Morphological and biochemical characterization of the cornified envelopes from human epidermal keratinocytes of different origin. J Invest Dermatol. 1988;91(1):11–5.CrossRefPubMed
77.
Fluhr JW, Lachmann N, Baudouin C, Msika P, Darlenski R, De Belilovsky C, et al. Development and Organization of Human Stratum Corneum After Birth. Electron Microscopy Isotropy Score and Immunocytochemical Corneocyte Labelling as Epidermal Maturation’s Markers in Infancy. Br J Dermatol. 2014;171(5):978–86.CrossRefPubMed
78.
Yaar M, Gilchrest BA. Skin aging: postulated mechanisms and consequent changes in structure and function. Clin Geriatr Med. 2001;17(4):617–30.CrossRefPubMed
79.
Zouboulis CC, Makrantonaki E. Clinical aspects and molecular diagnostics of skin aging. Clin Dermatol. 2011;29:3–14.CrossRefPubMed
80.
81.
Doughty D, Junkin J, Kurz P, Selekov J, Gray M, Fader M, et al. Incontinece-associated dermatitis. Consensus statements, evidence-based guidelines for prevention and treatment, and current challenges. J Wound Ostomy Continence Nurs. 2012;39(3):303–15.CrossRefPubMed
82.
Farage M, Maibach HI. The vulvar epithelium differs from the skin: implications for cutaneous testing to address topical vulvar exposures. Contact Dermatitis. 2004;51(4):201–9.CrossRefPubMed
83.
Elsner P. Anatomical and physiological basis of topical therapy of the mucosa. Curr Probl Dermatol. 2011;40:1–8.CrossRefPubMed
84.
Farage MA, Maibach HI. Morphology and physiological changes of genital skin and mucosa. Curr Probl Dermatol. 2011;40:9–19.CrossRefPubMed
85.
Farage MA, Miller KW, Berardesca E, Maibach HI. Incontinence in the aged: contact dermatitis and other cutaneous consequences. Contact Dermatitis. 2007;57(4):211–7.CrossRefPubMed
86.
Telofski LS, Morello AP III, Mack Correa MC, Stamatas GN. The infant skin barrier: can we preserve, protect, and enhance the barrier? Dermatology Res Practice. 2012. doi:10.​1155/​2012/​198789.
87.
Rönner AC, Berland CR, Runeman B, Kaijser B. The hygienic effectiveness of 2 different skin cleansing procedures. J Wound Ostomy Continence Nurs. 2010;37(3):260–4.CrossRefPubMed
88.
Lavender T, Furber C, Campbell M, Victor S, Roberts I, Bedwell C, et al. Effect on skin hydration of using baby wipes to clean the napkin area of newborn babies: assessor-blinded randomised controlled equivalence trial. BMC Pediatr. 2012. doi:10.​1186/​471-2431-12-59.PubMedPubMedCentral
89.
Kottner J, Lichterfeld A, Blume-Peytavi U. Maintaining skin integrity in the aged: a systematic review. Br J Dermatol. 2013;169:528–42.CrossRefPubMed
90.
Ness MJ, Davies DMR, Carey WA. Neonatal skin care: a concise review. Int J Dermatol. 2013;52:14–22.CrossRefPubMed
91.
Blume-Peytavi U, Lavender T, Jenerowicz D, Ryumin I, Stalder J-F, Torrelo A, et al. Recommendations from a Europena roundtable meeting on best practice healthy infant skin care. Pediatr Dermatol. 2016;33(3):311–21.CrossRefPubMedPubMedCentral
Metadata
Title
Skin Health Connected to the Use of Absorbent Hygiene Products: A Review
Authors
Johanna Karlsson Bender
Jan Faergemann
Maria Sköld
Publication date
01-09-2017
Publisher
Springer Healthcare
Published in
Dermatology and Therapy / Issue 3/2017
Print ISSN: 2193-8210
Electronic ISSN: 2190-9172
DOI
https://doi.org/10.1007/s13555-017-0189-y

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