Use of an emollient-containing diaper and pH-buffered wipe regimen restores skin pH and reduces residual enzymatic activity

Abstract

Background/objectives: Diaper dermatitis is one of the most frequent skin conditions affecting infants and is associated with elevated skin pH, exposure to urine and feces, and increased fecal protease and lipase activity, resulting in stratum corneum barrier damage and increased risk of infection. The study aim was to determine the impact of two diaper and wipe regimens on newborn infant skin pH and residual enzyme activity after stool cleaning.

Methods: Two diaper and wipe regimens were compared in a randomized, single-blinded crossover study. Regimen A paired an emollient-containing diaper with an acidic, pH-buffered wipe. Regimen B was a non-emollient diaper and wipe with limited buffering capacity. A 3-day washout period preceded each 3-day regimen use period. Skin pH at the perianal/buttocks interface (PBI), genital region, and undiapered chest control were measured at baseline and day 3. Skin swabs were collected for residual enzyme activity after a stool cleaning event.

Results: Diapered skin pH at the PBI was similar to undiapered skin after 3 days of use for Regimen A, while PBI pH for Regimen B was elevated versus control. PBI pH was lower for Regimen A versus Regimen B. After a stool cleaning, PBI skin pH for Regimen A was lower immediately and had lower residual enzyme activity versus Regimen B (P < .05), and the pH-lowering effect was sustained up to 60 minutes.

Conclusions: These results suggest that the use of an emollient-containing diaper with a pH-buffered wipe creates conditions favorable to optimum diapered skin health.

Keywords: diaper dermatitis; neonatal; skin barrier.

Conflict of interest statement

Jennifer Gustin, Lisa Bohman, Julie Ogle, Tanuja Chaudhary, Lijuan Li, Gina Fadayel, Maria C. Mitchell, and Andrew Carr are employees of The Procter and Gamble Company.

© 2020 The Procter & Gamble Company. Pediatric Dermatology published by Wiley Periodicals, Inc.

Figures

FIGURE 1

Skin pH at an undiapered skin site (Chest; yellow bar) and the perianal/buttock interface after 3 days of use of either Regimen A (green bar) or Regimen B (blue bar). Statistical significance is indicated by the connected bars. NS, not significant

FIGURE 2

Perianal/buttock interface skin pH after 3 days of use and 0‐60 minutes post–stool cleaning (Regimen A, green bars; Regimen B, blue bars). There were no differences between product regimens for stool pH (Regimen A: 5.7 ± 0.11; Regimen B: 5.6 ± 0.11) or number of wipes used post–stool cleaning (Regimen A: 2.49 ± 0.20; Regimen B: 2.66 ± 0.20). * P < .05 vs. Regimen B

FIGURE 3

Babies on Regimen A (green bar) had 40% less enzyme activity remaining on skin post–stool cleaning vs. Regimen B (blue bar). There were no differences between product regimens for stool enzyme activity (Regimen A: 1819 ± 167; Regimen B: 2041 ± 187 ng/mg stool) or number of wipes used post–stool cleaning (Regimen A: 2.52 ± 0.25; Regimen B: 2.57 ± 0.25). * P < .05 vs. Regimen B