The skin houses millions of bacteria, fungi, viruses and other microbes that together comprise the skin microbiome. During the neonatal period, infant microbiomes are highly vulnerable and susceptible to multiple influences. Preserving and promoting the natural development of the baby’s skin microbiome is important to enhance a baby’s health through infancy and into childhood.1 This article examines baby’s skin physiology and the development, disruption and maintenance of the microbiome.
Baby’s skin physiology
The skin consists of three main layers – the epidermis, dermis and subcutaneous layer. The outer most layer of the epidermis is the stratum corneum which acts as a protective barrier against microorganisms, chemicals and allergens, particularly for babies2. The epidermis in babies is 20% thinner and the stratum corneum is 30% thinner3, which increases susceptibility to permeability and dryness4.
From birth, barrier function and the water handling properties of the stratum corneum are continually optimising and the properties that make infant skin unique are thought to persist through the first 12 months of life2. Furthermore, the baby’s skin is less firmly attached than mature skin and has a higher propensity to increased trans epidermal water loss and reduced stratum corneum hydration, resulting in a less effective skin barrier function4,5,6. Additionally, because the ratio between baby body surface to baby body weight is higher, topical agents are more readily absorbed and can therefore have a more pronounced effect on the baby’s skin4.
A baby’s skin is therefore more vulnerable to the environment than adult skin, and if not properly cared for, it becomes susceptible to dryness, conditions such as atopic dermatitis, nappy dermatitis, or even infections.
Development of baby skin microbiome
The skin microbiome protects us against invading pathogens, is involved in the development of our immune systems and breaks down natural products7.
Microbes and their metabolites affect development as early as in utero, with significant colonisation occurring at birth—babies born vaginally acquire bacteria that colonise the vagina and those born via caesarean section acquire those that are associated with the skin7,8,9. Over the first six weeks of life, these differences seen based on mode of delivery lessen and the infant’s skin microbiome evolves to reflect something similar to its mother’s with bacteria varying by body site10,11.
Evidence suggests that the development and maintenance of a diverse microbiome composition in infancy is crucial in promoting normal epithelial development and integrity, as well as shaping some of our immune responses. Disruption of this process can influence the development of inflammatory conditions like food allergy and eczema12. Everything that an infant touches, bathes in, breathes, eats and drinks has the potential to affect their microbiome and the establishment of immune pathways. Naturally, anything that comes into contact with the skin directly has an important impact on the developing microbiome including detergents, hygiene products, soaps, moisturisers, wipes and other personal care products, as well as the timing and frequency of bathing12.
Disruption of baby skin microbiome
Disruption of the skin microbiome, or dysbiosis, occurs when the skin microbiome is altered from the normal “healthy” microbiome. This decreased microbial diversity of the skin microbiome can be linked with various skin pathologies such as atopic dermatitis and nappy rash.
Whilst little is known about the molecules that reside on the skin surface or how skin care products exactly influence this chemistry13,14, there is long-established evidence that suggests negative changes in diversity, skin moisture and TEWL appear to be caused in response to personal care product use and routines among adults15,16,17,18,19,20.
The effect of such personal care product ingredients on the paediatric skin microbiome is largely understudied to date but we do know that this early stage of development is critical in ensuring long-term stability of the microbiome1. As such, extra care should be taken to protect baby’s skin from birth.
How to maintain baby skin microbiome
Parent education can address common concerns like nappy rash and skin breakdown among newborns and infants21. Skin emollients consisting of preservative-free 20% zinc oxide can help to protect and enhance the skin barrier by sealing in hydration22. Parents and caregivers should be encouraged to frequently change soiled nappies to avoid build up of ammonia or harmful bacteria from faecal or urine matter on the skin. Finally, healthcare professionals should support parents to read the ingredients of products they use and make informed choices about practices that may affect their infants’ skin integrity, microbiome, and ultimately, their health21.
Choosing products with as few ingredients as possible can result in less potential microbiome interference23. For example, some baby wipes considered ‘pure’ or ‘natural’ contain seven or more ingredients. The table below outlines a list of ingredients often found in other baby wipes. Whilst it is challenging to create a formulation that has minimal ingredients, WaterWipes has created a unique and pure formulation that contains only two.
WaterWipes are gentle on the skin microbiome
Containing just two ingredients, 99.9% high purity water and 0.1% Fruit Extract, WaterWipes are gentle on the skin microbiome, making it a suitable alternative to cotton wool and regular water.
WaterWipes are manufactured under clean room conditions using a unique purifying technology. The water in WaterWipes undergoes a 7-stage water purification process which results in an ultra-pure wipe which delivers a soft feel on the skin. This process makes the water purer than cooled boiled water. This purifying technology produces a unique product that effectively cleanses the skin, without the need for several additional cleansing ingredients.
The Fruit Extract contains naturally occurring polyphenols and vitamin C which act as a gentle skin conditioner and cleanser. 24
WaterWipes provide safe cleansing for the most delicate newborn skin and are so gentle they can also be used on premature babies. Additionally, WaterWipes are recommended by midwives and other healthcare professionals worldwide and have become the preferred wipe for many Neonatal Intensive Care Units throughout Ireland, the US, Australia and New Zealand.
1 Capone KA, Dowd SE, Stamatas GN, Nikolovski J. Diversity of the human skin microbiome early in life. J Invest Dermatol. 2011;131(10):2026–2032. doi:10.1038/jid.2011.168
2 Nikolovski, J., Stamatas, G., Kollias, N., Wiegand, B., 2008. Barrier function and waterholding and transport properties of infant stratum corneum are different from adult and continue to develop through the first year of life. Journal of Investigative Dermatology 128, 1728–1736. Available at: https://www.sciencedirect.com/science/article/pii/S0022202X15339439 Last accessed April 2019
3 Stamatas, G., Nikolovski, J., Luedtke, M., et al, 2010. Infant skin microstructure assessed in vivo differs from adult skin in organization and at the cellular level. Pediatric Dermatology 27, 125–131 Available at: https://www.ncbi.nlm.nih.gov/pubmed/19804498 Last accessed April 2019
4 Cooke, A, Bedwell, C, Campbell, M, et al. Skin care for healthy babies at term: A systematic review of the evidence. Midwifery 56 (2018) 29–43 Available at: https://www.midwiferyjournal.com/article/S0266-6138(17)30354-6/pdf Last accessed: Last accessed April 2019
5 Oranges, T., Dini, V., Romanelli, M., Skin Physiology of the Neonate and Infant: Clinical Implications. Advances in Wound Care 2015: 4(10): 587-595. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4593874/ Last accessed April 2019
6 Nakagawa, N., Sakai, S., Matsumoto, M., et al , 2004. Relationship between NMF (Lactate and Potassium) content and the physical properties of the stratum corneum in healthy subjects. Journal of Investigative Dermatology 122, 755–763. Available at: https://ac.els-cdn.com/S0022202X15306928/1s2.0-S0022202X15306928-main.pdf?_tid=168c5a11-b5f6-4edd-9d55-a4f93c51d0b8&acdnat=1525272628_e84d3f2757de46454b328744997e139c Last accessed April 2019
7 Byrd, A.L., Belkai, Y., Segre, J.A., 2018. The human skin microbiome. Nature Reviews Microbiology 16, 143–145
8 Perez-Muñoz, ME., Arietta, M.C., Ramer-Tait, et al, 2017. A critical assessment of the "sterile womb" and "in utero colonization" hypotheses: implications for research on the pioneer infant microbiome. Microbiome 5, 48
9 Mueller, N.T., Bakacs, E., Combellick, J., et al, 2015. The infant microbiome development: Mom matters. Trend Mol Med 21, 109–117
10 von Mutius, E., 2015. The shape of the microbiome in early life. Nat Med 23, 274–275
11 Chu, D.M., Ma, J., Prince A.L., et al, 2017. Maturation of the infant microbiome community structure and function across multiple body sites and in relation to mode of delivery. Nat Med, 23, 314–326
12 Prescott, S.L., Larcombe, D.L., Logan, A.C., et al, 2017. The skin microbiome: Impact of modern environments on skin ecology, barrier integrity, and systemic immune programming. World Allergy Organ J 22, 29
13 Dorrestein PC, Gallo RL, Knight R. Microbial Skin Inhabitants: Friends Forever. Cell. 2016 May;165(4):771-772. DOI: 10.1016/j.cell.2016.04.035.
14 Bouslimani A, Porto C, Rath CM, et al. Molecular cartography of the human skin surface in 3D. Proc Natl Acad Sci U S A. 2015;112(17):E2120–E2129. doi:10.1073/pnas.1424409112
15 Wallen Russell, Kit. (2018). The Role of Every-Day Cosmetics in Altering the Skin Microbiome: A Study Using Biodiversity. Cosmetics. 6. 2. 10.3390/cosmetics6010002.
16 Goossens A. Contact-allergic reactions to cosmetics. J Allergy (Cairo). 2011;2011:467071. doi:10.1155/2011/467071
17 Holland, K.T., Bojar, R.A. Cosmetics. Am J Clin Dermatol 3, 445–449 (2002). https://doi.org/10.2165/00128071-200203070-00001
18 Rocha, Lílian Alves et al. Changes in hands microbiota associated with skin damage because of hand hygiene procedures on the health care workers. American Journal of Infection Control, Volume 37, Issue 2, 155 – 159
19 Staudinger, T., Pipal, A. and Redl, B. (2011), Molecular analysis of the prevalent microbiota of human male and female forehead skin compared to forearm skin and the influence of make‐up. Journal of Applied Microbiology, 110: 1381-1389. doi:10.1111/j.1365-2672.2011.04991.x
20 Stingley RL, Zou W, Heinze TM, Chen H, Cerniglia CE. Metabolism of azo dyes by human skin microbiota. J Med Microbiol. 2010;59(Pt 1):108–114. doi:10.1099/jmm.0.012617-0
21 Mutic AD, Jordan S, Edwards SM, Ferranti EP, Thul TA, Yang I. The Postpartum Maternal and Newborn Microbiomes. MCN Am J Matern Child Nurs. 2017;42(6):326–331. doi:10.1097/NMC.0000000000000374. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5649366/
22 Coughlin CC, Frieden IJ, Eichenfield LF. Review Clinical approaches to skin cleansing of the diaper area: practice and challenges. Pediatr Dermatol. 2014 Nov; 31 Suppl 1():1-4. Available at https://www.ncbi.nlm.nih.gov/pubmed/25403931/
23 Bouslimani, A., da Silva, R., Kosciolek, T. et al. The impact of skin care products on skin chemistry and microbiome dynamics. BMC Biol 17, 47 (2019). https://doi.org/10.1186/s12915-019-0660-6
24 Burnett, C. 2017. Safety Assessment of Citrus Plant- and Seed-Derived Ingredients as Used in Cosmetics. Cosmetic Ingredient Review. http://www.cir-safety.org/sites/default/files/cplant122016rep.pdf, last accessed 12 March 2020