Dr. Rajsmita Bhattacharjee, MD, is an alumnus of prestigious colleges like KEM, Mumbai. She is a specialist in Dermatology, Venereology and Leprosy. She is also a Life Member of Indian Association of Dermatology, Venereology and Leprosy. She is a well published academician and has over 28 publications in National and International journals. Her area of special interests include Paediatric Dermatology, Bullous Disease, SLE, Leprosy and Infectious Tropical Diseases. She currently lives in Chandigarh with her Mom, husband and a one year old daughter. They are all music buffs and a family of foodies.
1. How is newborn skin different from that of an adult’s?
A normal, full‐term infant has an almost fully developed, functional skin, which matures further as the baby grows. Unlike adults, water loss through the outer layer of the skin is high in the first few days of life for all babies, both term and pre-term. Though this improves with time, a lot of care has to be taken in the initial period of a newborn’s life in order to minimize this water loss, through maintaining the right ambient conditions.
2. What are a few important things one must do in terms of baby skin care routine?
As I said, the skin of a full term newborn is almost fully developed at birth. However, substances/products applied on the skin can easily penetrate its outer layer and get absorbed, often due to the presence of occlusive conditions, like nappies and diapers, as well as high ambient temperatures and humidity. The latter, especially, should be borne in mind, in addition to paying attention to the kind of products that are used on the baby’s skin. Babies should not be wrapped in too many clothing layers, except if it’s too cold. This can make them uncomfortable and sweat a lot more, often resulting in prickly heat, causing unnecessary worry to parents. Scientifically, there is very little evidence yet on which doctors could base their recommendations for routine newborn skin care products, in terms of cleansing and/or moisturizing. Frequent washing and cleansing of babies’ skin should be avoided, as it tends to cause unnecessary dryness. Babies do not usually need to be bathed with soap on a daily basis. However, if using soap, it should be imperative that a mild soap with an optimum ph balance of 5.5 is chosen. I personally love the sebamed baby soap. Oilatum bar is another commonly recommended soap, especially in atopic babies who tend to have dry skin and eczema. A baby’s skin should always be patted dry with a soft cotton cloth. Excessive rubbing or friction should always be avoided. A bland emollient without any added fragrance/additives is the only moisturizer that a baby’s skin needs. An emollient containing white soft paraffin and liquid paraffin, or simply coconut oil works just fine, though even the routine use of topical petrolatum‐based emollients in preterm babies should be done with due care and caution. Some easily available and commonly prescribed moisturizers for babies and children that area bland and paraffin based include Moisturex soft cream/lotion, Oilatum cream/lotion, Olesoftcream/lotion. Creams are usually preferred for small areas like the face, while lotions have the advantage of easy spreadability, and can be easily applied over the whole body. Babies do not need shea butter, cocoa butter and the likes!
3. What are few things new parents must absolutely avoid?
Absolutely nothing should be applied to a baby’s skin without careful consideration of the potential side effects and harm of absorption through the skin, particularly in pre-term or pre-mature babies, whose skin function is still not fully developed. Over the counter (OTC) creams, especially those containing steroids, antibiotics, antiseptics, alcohol, among others, should be strictly avoided, unless prescribed by a skin doctor for a particular skin condition. Studies have shown that something as seemingly innocuous as olive oil (very commonly used for baby massage) can damage the skin barrier, hence so best avoided in babies as well. A number of other substances should never be used innewborns, especially not in preterm babies; examples include boric acid, salicylic acid, etc. Common antiseptics such as chlorhexidine and iodine(such as that present in betadine) should also be used with caution; there is always a risk of ‘chemical burns’with these products, especially those containing alcohol. Utmost care should also be taken with various agents used in laundry and storage like mothballs, which can inadvertently cause skin damage. There has been a lot of controversy regarding the use of talcum powder in babies and adults alike. In my opinion, talcum powder is unnecessary. If the baby is sweating too much, or developing sweat or friction dermatitis on the creases and folds, it is pertinent to keep those areas dry and aerated, in addition to wearing cotton clothes.
4. We see a lot of eczema in babies these days. Any special advice to parents whose babies have eczema?
Eczema, or atopic dermatitis, is one of the commonest skin problems faced by babies. First things first, it is extremely common and nothing to panic about. So, it is important that parents understand there is no permanent cure or magic solution to this. It is just way the baby’s skin tends to behave and has an inherent tendency to dryness. The most important component of caring for a baby with atopic dermatitis or eczema is frequent and copious moisturization with a bland moisturizer like a paraffin based one or just coconut oil (I have listed some commonly recommended brand names above). This works the best when the skin is supple and moist, like immediately after bath, once the skin is patted dry. Since the skin of such babies is highly sensitive, it is imperative to not apply anything on it unless prescribed by your skin doctor, and keep a hawk’s eye over potential allergic reactions to topical medications as well. The condition invariably tends to flare in winters; hence it is important for parents to expect this and be prepared. Always always make sure the baby is made to wear pure cotton clothes underneath the heavy woollens. High neck or turtle neck sweaters irritate the skin of the neck, and are better avoided. Finally, children usually tend to outgrow the condition with age, or at least get much better.
5. What are the best ways to treat common and small rashes, boils, cuts, etc on babies and toddlers?
It is best to avoid applying anything on a baby’s skin without consulting a skin doctor. Over the counter creams, especially ones containing steroid, can be extremely dangerous. But I would say keeping a mupirocin ointment like T Bact or a fusidic acid cream handy would be good for simple cuts. Zinc oxide containing diaper rash creams like Desitin or Sebamed, or even simply coconut oil can be used before every diaper change, to avoid diaper rash, especially if disposable diapers are being used. An established diaper rash should be treated by a skin doctor as often steroid containing creams need to be applied on such areas.
6. Is it safe to use regular detergent for washing baby clothes? Should we select any particular brand that is baby friendly?
Not really. There is no bearing of the kind of detergent you use in washing baby clothes on their skin. We just need to make sure the detergent is completely rinsed off the clothes and there is no residue left in them. Any standard brand of detergent like Surf Excel is good to use.