Impact of sunflower seed oil versus mustard seed oil on skin barrier function in newborns: a community-based, cluster-randomized trial

Aimee Summers, Marty O Visscher, Subarna K Khatry, Jeevan B Sherchand, Steven C LeClerq, Joanne Katz, James M Tielsch, Luke C Mullany, Aimee Summers, Marty O Visscher, Subarna K Khatry, Jeevan B Sherchand, Steven C LeClerq, Joanne Katz, James M Tielsch, Luke C Mullany

Abstract

Background: Natural vegetable oils are widely used for newborn massage in many low resource settings. Animal models indicated that sunflower seed oil (SSO) can accelerate skin barrier recovery following damage, while other oils, including mustard oil (MO), may cause further skin barrier damage. The objective was to compare the effects of two SSO and MO used for routine massage on skin integrity in premature and full-term neonates.

Methods: This community-based cluster randomized controlled trial included 995 neonates assigned to full body massage with sunflower seed oil (SSO, intervention) or mustard seed oil (MO, standard practice) from July 2012-May 2014 in Sarlahi, Nepal. Skin integrity measures were evaluated over 28 days, including skin condition (erythema, rash, dryness), skin surface pH, stratum corneum (SC) cohesion/protein concentration, and transepidermal water loss (TEWL). Overall means and rates of change in these skin measures were compared between oil groups using bivariate random-effects models.

Results: 500 and 495 live born neonates received repeated massage with MO and SSO, respectively. Skin pH decreased more quickly for SSO than MO in the first week of life, with a difference in mean daily reductions of 0.02 (95% CI: 0.002-0.040). Erythema, rash and dryness increased (worsened) over days 1-14 then decreased by day 28, with no significant oil group differences. TEWL increased over time, with no significant oil group differences. Gestational age did not modify the effect; the slightly faster decrease in skin pH among SSO infants was similar in magnitude between term and preterm infants.

Conclusions: Oil type may contribute to differences in skin integrity when neonates are massaged regularly. The more rapid acid mantle development observed for SSO may be protective for neonates in lower resource settings.

Trial registration: ClinicalTrials.gov (NCT01177111); registered August 6th, 2010.

Keywords: Emollient therapy; Massage; Mustard oil; Neonate; Skin; Skin barrier; Skin condition; Stratum corneum; Sunflower oil; TEWL; pH.

Conflict of interest statement

The authors declare that they have no competing interest.

Figures

Fig. 1
Fig. 1
Participant Flowsheet. For SSO and MO, 11 (2.2%) and 10 (2.0%) infants died and 67 (13.5%) and 74 (14.8%) moved out of the study area prior to age 28 days, respectively
Fig. 2
Fig. 2
Lowess curves of change in chest skin condition throughout the neonatal period by oil group, Sarlahi, Nepal
Fig. 3
Fig. 3
Lowess curves of the changes in TEWL, Skin pH, and SC protein concentration throughout the neonatal period, Sarlahi, Nepal

References

    1. Darmstadt GL, Dinulos JG. Neonatal skin care. Pediatr Clin N Am. 2000;47(4):757–782. doi: 10.1016/S0031-3955(05)70239-X.
    1. Visscher MO, Adam R, Brink S, Odio M. Newborn infant skin: physiology, development, and care. Clin Dermatol. 2015;33(3):271–280. doi: 10.1016/j.clindermatol.2014.12.003.
    1. Evans NJ, Rutter N. Development of the epidermis in the newborn. Biol Neonate. 1986;49(2):74–80. doi: 10.1159/000242513.
    1. Cartlidge P. The epidermal barrier. Semin Neonatol. 2000;5(4):273–280. doi: 10.1053/siny.2000.0013.
    1. Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: when? Where? Why? Lancet. 2005;365(9462):891–900. doi: 10.1016/S0140-6736(05)71048-5.
    1. Belizan JM, McClure EM, Goudar SS, Pasha O, Esamai F, Patel A, Chomba E, Garces A, Wright LL, Koso-Thomas M, et al. Neonatal death in low- to middle-income countries: a global network study. Am J Perinatol. 2012;29(8):649–656. doi: 10.1055/s-0032-1314885.
    1. Darmstadt GL, Mao-Qiang M, Chi E, Saha SK, Ziboh VA, Black RE, Santosham M, Elias PM. Impact of topical oils on the skin barrier: possible implications for neonatal health in developing countries. Acta Paediatr. 2002;91(5):546–554. doi: 10.1111/j.1651-2227.2002.tb03275.x.
    1. Darmstadt GL, Saha SK, Ahmed AS, Ahmed S, Chowdhury MA, Law PA, Rosenberg RE, Black RE, Santosham M. Effect of skin barrier therapy on neonatal mortality rates in preterm infants in Bangladesh: a randomized, controlled, clinical trial. Pediatrics. 2008;121(3):522–529. doi: 10.1542/peds.2007-0213.
    1. Darmstadt GL, Saha SK, Ahmed AS, Chowdhury MA, Law PA, Ahmed S, Alam MA, Black RE, Santosham M. Effect of topical treatment with skin barrier-enhancing emollients on nosocomial infections in preterm infants in Bangladesh: a randomised controlled trial. Lancet. 2005;365(9464):1039–1045. doi: 10.1016/S0140-6736(05)74228-8.
    1. Ministry of Health N, ERA N, ICF . Kathmandu, Nepal: Ministry of Health , Nepal. 2017. Nepal Demographic and Health Survey 2016.
    1. Mullany LC, Darmstadt GL, Khatry SK, Tielsch JM. Traditional massage of newborns in Nepal: implications for trials of improved practice. J Trop Pediatr. 2005;51(2):82–86. doi: 10.1093/tropej/fmh083.
    1. Eichenfield LF, Hardaway CA. Neonatal dermatology. Curr Opin Pediatr. 1999;11(5):471–474. doi: 10.1097/00008480-199910000-00017.
    1. Darmstadt GL. The skin and nutritional disorders in the newborn. Eur J Pediatr Dermatol. 1998;4:221–228.
    1. Summers A, Visscher MO, Khatry SK, Sherchand JB, LeClerq SC, Katz J, Tielsch JM, Mullany LC. Indicators of skin barrier integrity among newborns massaged with mustard oil in rural Nepal. J Perinatol. 2018;38(1):64–70. doi: 10.1038/jp.2017.158.
    1. Lukacovic M, Dunlap RE, Visscher MO, Watson DD. Forearm wash test to evaluate the clinical mildness of cleansing products. J Soc Cosmet Chem. 1988;39:355–366.
    1. Odio MR, O'Connor RJ, Sarbaugh F, Baldwin S. Continuous topical administration of a petrolatum formulation by a novel disposable diaper. 2. Effect on skin condition. Dermatology. 2000;200:238–243. doi: 10.1159/000018366.
    1. De Paepe K, Houben E, Adam R, Wiesemann F, Rogiers V. Validation of the VapoMeter, a closed unventilated chamber system to assess transepidermal water loss vs. the open chamber Tewameter. Skin Res Technol. 2005;11(1):61–69. doi: 10.1111/j.1600-0846.2005.00101.x.
    1. Voegeli R, Rawlings AV, Doppler S, Heiland J, Schreier T. Profiling of serine protease activities in human stratum corneum and detection of a stratum corneum tryptase-like enzyme. Int J Cosmet Sci. 2007;29(3):191–200. doi: 10.1111/j.1467-2494.2007.00386.x.
    1. Rothfusz LP. Fort Worth, TX:National Oceanic and Atmospheric Administration: National Weather Service, Office of Meteorology. 1990. The Heat Index “Equation” (or, More Than You Ever Wanted to Know About Heat Index)
    1. Steadman RG. The assessment of sultriness. Part I: a temperature-humidity index based on human physiology and clothing science. J Appl Meteorol. 1979;18(7):861–873. doi: 10.1175/1520-0450(1979)018<0861:TAOSPI>;2.
    1. Katz J, Wu LA, Mullany LC, Coles CL, Lee AC, Kozuki N, Tielsch JM. Prevalence of small-for-gestational-age and its mortality risk varies by choice of birth-weight-for-gestation reference population. PLoS One. 2014;9(3):e92074. doi: 10.1371/journal.pone.0092074.
    1. Darmstadt GL, Badrawi N, Law PA, Ahmed S, Bashir M, Iskander I, Al Said D, El Kholy A, Husein MH, Alam A, et al. Topically applied sunflower seed oil prevents invasive bacterial infections in preterm infants in Egypt: a randomized, controlled clinical trial. Pediatr Infect Dis J. 2004;23(8):719–725. doi: 10.1097/01.inf.0000133047.50836.6f.
    1. 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):378–381. doi: 10.1111/1523-1747.ep12556778.
    1. Fluhr JW, Kao J, Jain M, Ahn SK, Feingold KR, Elias PM. Generation of free fatty acids from phospholipids regulates stratum corneum acidification and integrity. J Invest Dermatol. 2001;117(1):44–51. doi: 10.1046/j.0022-202x.2001.01399.x.
    1. Puhvel SM, Reisner RM, Amirian DA. Quantification of bacteria in isolated pilosebaceous follicles in normal skin. J Invest Dermatol. 1975;65(6):525–531. doi: 10.1111/1523-1747.ep12610239.
    1. 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(4):261–272. doi: 10.2165/00128071-200203040-00004.
    1. 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. doi: 10.1159/000094670.
    1. Elias PM. The how, why and clinical importance of stratum corneum acidification. Exp Dermatol. 2017;26(11):999–1003. doi: 10.1111/exd.13329.
    1. Fluhr JW, Man MQ, Hachem JP, Crumrine D, Mauro TM, Elias PM, Feingold KR. Topical peroxisome proliferator activated receptor activators accelerate postnatal stratum corneum acidification. J Invest Dermatol. 2009;129(2):365–374. doi: 10.1038/jid.2008.218.
    1. Hachem JP, Roelandt T, Schurer N, Pu X, Fluhr J, Giddelo C, Man MQ, Crumrine D, Roseeuw D, Feingold KR, et al. Acute acidification of stratum corneum membrane domains using polyhydroxyl acids improves lipid processing and inhibits degradation of corneodesmosomes. J Invest Dermatol. 2010;130(2):500–510. doi: 10.1038/jid.2009.249.
    1. Garcia Bartels N, Mleczko A, Schink T, Proquitte H, Wauer RR, Blume-Peytavi U. Influence of bathing or washing on skin barrier function in newborns during the first four weeks of life. Skin Pharmacol Physiol. 2009;22(5):248–257. doi: 10.1159/000235552.
    1. Garcia Bartels N, Scheufele R, Prosch F, Schink T, Proquitte H, Wauer RR, Blume-Peytavi U. Effect of standardized skin care regimens on neonatal skin barrier function in different body areas. Pediatr Dermatol. 2010;27(1):1–8. doi: 10.1111/j.1525-1470.2009.01068.x.
    1. Minami-Hori M, Honma M, Fujii M, Nomura W, Kanno K, Hayashi T, Nakamura E, Nagaya K, Miyauchi Y, Fujimura T, et al. Developmental alterations of physical properties and components of neonatal-infantile stratum corneum of upper thighs and diaper-covered buttocks during the 1st year of life. J Dermatol Sci. 2014;73(1):67–73. doi: 10.1016/j.jdermsci.2013.08.015.
    1. Visscher M, Odio M, Taylor T, White T, Sargent S, Sluder L, Smith L, Flower T, Mason B, Rider M, et al. Skin care in the NICU patient: effects of wipes versus cloth and water on stratum corneum integrity. Neonatology. 2009;96(4):226–234. doi: 10.1159/000215593.
    1. Kanti V, Grande C, Stroux A, Buhrer C, Blume-Peytavi U, Garcia Bartels N. Influence of sunflower seed oil on the skin barrier function of preterm infants: a randomized controlled trial. Dermatology. 2014;229(3):230–239. doi: 10.1159/000363380.
    1. Kanti Varvara, Günther Malise, Stroux Andrea, Sawatzky Sabine, Henrich Wolfgang, Abou-Dakn Michael, Blume-Peytavi Ulrike, Garcia Bartels Natalie. Influence of sunflower seed oil or baby lotion on the skin barrier function of newborns: A pilot study. Journal of Cosmetic Dermatology. 2017;16(4):500–507. doi: 10.1111/jocd.12302.
    1. Darmstadt GL, Ahmed S, Ahmed AS, Saha SK. Mechanism for prevention of infection in preterm neonates by topical emollients: a randomized, controlled clinical trial. Pediatr Infect Dis J. 2014;33(11):1124–1127. doi: 10.1097/INF.0000000000000423.
    1. 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(1):84–92. doi: 10.1016/0012-1606(86)90230-7.
    1. du Plessis J, Stefaniak A, Eloff F, John S, Agner T, Chou TC, Nixon R, Steiner M, Franken A, Kudla I, et al. International guidelines for the in vivo assessment of skin properties in non-clinical settings: part 2. Transepidermal water loss and skin hydration. Skin Res Technol. 2013;19(3):265–278. doi: 10.1111/srt.12037.
    1. Pinnagoda J, Tupker RA, Agner T, Serup J. Guidelines for transepidermal water loss (TEWL) measurement. A report from the standardization Group of the European Society of contact dermatitis. Contact Dermatitis. 1990;22(3):164–178. doi: 10.1111/j.1600-0536.1990.tb01553.x.
    1. Rosenberg RE, Ahmed AS, Ahmed S, Saha SK, Chowdhury MA, Black RE, Santosham M, Darmstadt GL. Determining gestational age in a low-resource setting: validity of last menstrual period. J Health Popul Nutr. 2009;27(3):332–338.
    1. Horimukai K, Morita K, Narita M, Kondo M, Kitazawa H, Nozaki M, Shigematsu Y, Yoshida K, Niizeki H, Motomura K, et al. Application of moisturizer to neonates prevents development of atopic dermatitis. J Allergy Clin Immunol. 2014;134(4):824–830. doi: 10.1016/j.jaci.2014.07.060.
    1. Simpson EL, Chalmers JR, Hanifin JM, Thomas KS, Cork MJ, McLean WH, Brown SJ, Chen Z, Chen Y, Williams HC. Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention. J Allergy Clin Immunol. 2014;134(4):818–823. doi: 10.1016/j.jaci.2014.08.005.
    1. Glatz M, Jo JH, Kennedy EA, Polley EC, Segre JA, Simpson EL, Kong HH. Emollient use alters skin barrier and microbes in infants at risk for developing atopic dermatitis. PLoS One. 2018;13(2):e0192443. doi: 10.1371/journal.pone.0192443.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe