Over a period spanning three decades, the handling of neonates has radically changed and the new guidelines highlight this growth and development. However, this area of skin care has lagged behind. One concern that remains is the issue of the toxic effects of ingredients found in water-based products like preservatives and fragrances. While it is possible that these may be toxic, this article will present evidence that the current skin care products that contain petrolatum and lanolin may be more toxic and potentially harmful. Further, using a product that is not preserved, yet occlusive, may in fact allow for microorganisms in colony forming units to multiply, thereby yielding systemic implications. The purpose of this article is to further illuminate these issues and to allow for greater understanding and discussion.

Skin is the largest organ of the body and provides protection between the body and its environment. In term babies, while there may be issues related to skin breakdown and infection, the stratum corneum is fully developed and protects the newborn. In contrast, the skin and skin barrier of a preterm neonate is not fully developed.

The skin of a premature neonate accounts for approximately thirteen (13) percent of its body weight. This compares to three (3) percent of body weight for adult skin. The body weight to skin ratio is four (4) times greater in the neonate when compared to an adult. As related specifically to skin care, these characteristics in neonate skin call into account:

• Fluid imbalances

• Percutaneous absorption of toxins

• Tissue injury

• Infection

The structure of adult skin is understood, while embryonic and neonate skin is not fully appreciated. Development of the skin within the uterus is complex and still under investigation. In utero, the skin undergoes two-dimensional growth to cover the surface area of the developing embryo and fetus. Premature neonate’s skin has not gone through full epidermal and dermal epidermal development.

In neonatal intensive care units (NICU) skin care product selection is carefully reviewed. With the risks outlined above, great care must be taken to ensure the wellbeing of the neonate within the first hours and days of life. Care of the skin is one of the most important areas of care for these at risk infants. Currently, NANN and AWHONN recommended a Aquaphor?, a petrolatum-based product as neonate skin care emollient.

In earlier work done at Stanford University, it was concluded that emollient cream moisturizer therapy of premature neonates decreases dermatitis without changing the microbiological flora. An emollient is an agent that softens or soothes skin. This definition is important because just as the standard-of-care has changed in NICUs over the past three decades, the selection of emollients has changed in the pharmaceutical industry.

High-tech silicone excipients have displaced petrolatum as companies have sought ways to improve treatment compliance traced to poor aesthetics associated with petrolatum-based formulations. Silicones are not new to the pharmaceutical industry. They are used in transdermal delivery systems, catheters and specialized medical devices, including pacemakers.

In a test to determine aesthetic benefits of silicone formulas over petrolatum-based formulas, 18 untrained volunteers were impaneled. They were asked to evaluate whether two products present any differences on individual sensory properties. The evaluation was conducted on the panelist’s forearms. Each panelist was asked to evaluate wetness, spreadability, speed of absorbance (not biologically, just feel), gloss, film residue, greasiness, silkiness and slip after perceived absorbance.

Figure I shows the silicone-containing formulation was perceived to be easier to spread and was clearly less tacky before and after absorption. A perceptible film was present on the skin for both formulations but the silicone-containing formulation was less greasy, silkier and more slippery (better lubrication) than petrolatum. The panelist’ perception of higher wetness for the silicone-containing formulation was attributed to its lower oiliness.

In a study conducted at a 48-bed NICU private hospital in Houston, Texas, to evaluate why the rate of systemic candidiasis (SC) per 1000 NICU patient-days increased from 5.1% in 1996 to17.4% in 1997 (a three-fold increase), it was determined that the increase in SC incidences was linked to the use of topical petrolatum ointment (TPO). In this well designed study, the investigators went on to hypothesize that TPO enhanced the adherence of C albicans to mucocutaneous surfaces. Also referenced in the study was a finding by Law S, et al, that unlike petrolatum, skin surface lipids inhibit adherence of candida albicans to stratum corneum.

By way of further examination, let’s more closely examine these two hypotheses. As observed in the Houston study, petrolatum enhanced adherence of C albicans to mucocutaneous surfaces. Petrolatum is known as an occlusive barrier. Occlusion is problematic because while it blocks TEWL, it also blocks cellular respiration necessary for barrier repair. Further, occlusion traps microorganisms under the petrolatum where they can breed in the moisture trapped therein. On the other hand, natural skin lipids, like omega 3-6 fatty acids, inhibit adherence of microorganisms to the stratum corneum.

Studies linking petrolatum to increased incidences of infections in preterm infants is ongoing and demonstrates mixed results. However, long term studies reflect a concern over the use of TPO protocols in NICUs. Petrolatum based ointments, like Aquaphor’s? twenty five year old formula, are the emollients of choice in NICUs. When one considers the changes in the standards of care in NICUs over the past three decades, perhaps now is the time to focus on new technologies in emollients that achieve skin care objectives without the aesthetic, epidermal challenges renders skin vulnerable to chemicals & infection, prevents normal TEWL & gland secretions, inhibits barrier repair, suppresses barrier recovery and reduces the epidermal proliferative response and microbial risk disadvantages of petrolatum.

To demonstrate the effectiveness of high products using molecular height silicones against petrolatum, Nutrashield TM was tested in a wash-off study against Aquaphor? and other leading skin barriers to determine each product’s ability to maintain skin protection after cleansing. As shown in Figure II, Nutrashield performed well against Aquaphor?, and did so while providing a breathable barrier instead of the occlusive barrier associated with Aquaphor? (a lanolin and petrolatum-based product). In clinical trials Nutrashield has proven effective in the treatment of skin breakdown in disordered and damaged skin, encountered in the wound care setting, as compared to previously available products.

Based on the above results, Medline Nutrashield outperforms products containing petrolatum levels as high as 49%, and petrolatum combined with 15% Zinc Oxide. Additionally, both Sensi-Care 2 and Sween 24 also contain Dimethicone as an active ingredient (Sween at 6% versus 1% in the Nutrashield). The extended performance of the Nutrashield is most likely due to the addition of Divinyldimethicone/ Dimethicone Copolymer, which has an internal phase viscosity that is greater than 100,000,000 cst in viscosity. As it is delivered in an emulsion form, it is capable of laying down a thin, but consistent and robust film.

An in-vitro study at an independent laboratory was conducted, to determine the effectiveness of Nutrashield and Skin Repair Cream in reducing e-TEWL. Collagen samples were cut into 4×4 inch squares. Each square was pre-coated with 0.1 g of product. The product was applied by rubbing a finger over the collagen material to simulate actual use for a 20 second period. The product was then allowed to dry for five minutes. Each square was placed over Fisher Payne Permeability Cups, containing 3g of water. The samples were placed in a 37 degree oven and checked every four (4) hours. After 24 hours the cups were removed and a final weight was recorded.

Figure III shows that both REMEDY Nutrashield and REMEDY Skin Repair Cream were effective at reducing e-TEWL without occlusion. Nutrashield provided a fourfold reduction in e-TEWL over the control, while Skin Repair Cream showed a twofold improvement. The objective of topical skin care intervention is not to stop all TEWL, just excessive TEWL.

Skin care for neonates is an emerging science. But, since the reduced risk of infant mortality is paramount, improved emollient treatments deserve thoughtful consideration. Skin care for the high-risk neonate requires knowledge of the unique aspects and physiology of their skin. During the neonatal period many newborns develop preventable, clinically apparent skin problems and many more, especially preterm neonates, experience morbidity caused by compromised skin barrier integrity. Anatomical and physiological differences in the skin of premature and term infants place them at increased risk of skin injury and breakdown. All Children’s Hospital, St. Petersburg, FL, sent out a questionnaire to 482 NICU’s to learn how nurses describe and measure skin breakdown. Of the 45% that responded, it was reported that in extremely low birth weight (ELBW) infants, 21% suffered skin breakdown during the first week of life.

The reduction of microbial contamination and the protection against skin breakdown has been discussed. Another critical factor is TEWL associated with immature barrier in neonates is the rate of TEWL. A Swedish study calculated TEWL in infants 24 and 25 weeks of gestation maintained at an ambient relative humidity (RH) of 50%. The study found that TEWL on the first day after birth (58.4 +/-14.8g m(-2) h(-1) and remained at the same level during the second day. It then decreased significantly to 48.3+/-9.5 at postnatal age of day three. The use of a semipermeable skin care product like Nutrashield will reduce excessive TEWL by as much as fourfold.

Semipermeable dressings have been tested as a method to reduce TEWL in neonates to address skin breakdown and high fluid requirements common in ELBW infants. The studies revealed that semipermeable (breathable) barriers can be used safely on premature infants.

The use of ingredients perceived as “toxic” to neonates has limited the choices within the NICUs. Much of the literature points to preservatives and fragrances as falling into the “do-not-use” category. Both are found in the REMEDY products. Consideration of the potential toxicity of ingredients found in the “recommended” products may not have been fully clarified. This is interesting when one considers that lanolin and petrolatum, forming an occlusive barrier, are recommended. Let’s take a closer look at what is being recommended:

Lanolin originates as a secretion from the sebaceous glands in sheepskin. It is removed from the wool by scouring and high-speed centrifugal separators. Lanolin has had 33 alcohols and 36 fatty acids identified as constituents including aliphatic, steroid and triterpinoid alcohols; saturated nonhydroxylated, unsaturated nonhydroxylated and hydroxhlated acid. Commercial lanolin is allowed to have up to 40 parts per million (ppm) pesticide residues. However, it is not clear who monitors for this compliance.

Animal medicines, which include sheep dips for controlling lice and other parasites on sheep, are regulated by the Environmental Protection Agency (EPA). One of the common sheep dip ingredients is organochlorine (OC). This pesticide is based on the benzene ring with one or more chloride atoms attached and includes; DDT, lindane, dieldrin and aldrin. Other sheep dip pesticides include; synthetic pyrethroids, insect growth regulators, spinosyns, ivermectins and magnesium fluorosilicate. In 1994 in Wagga, NSW, a team of shearers successfully sued woolgrowers for allegedly endangering their health by improperly using chemicals. Shearers are becoming more aware of the potential risks associated with exposure to chemicals (sheep dip), particularly organophosphate group which can cause a serious nervous disorder.

There are about 26 pesticide residues found in commercial lanolin. The combined effect of pesticides acting by a common mechanism can be greater than the individual effect of any single pesticide. Since children are subject to non-dietary sources (like lanolin) of exposure pesticides, it is important to consider total exposure to pesticides from all sources combined. Nine hundred and ninety eight (989) references to lanolin and DDT were found in a Google search, April 2005.

La Leche League International is an important advocate for breastfeeding and their commitment has assured thousands of infants receive the vital nutrients found in colostrum and mother’s milk. While the organization acknowledges that toxins from the environment, including pesticides, show up in breast milk, the benefits outweigh the risks. However, the organization does recommend against topical use of commercial lanolin because of its pesticide content.

Petrolatum is a crude oil/petroleum fraction. Petroleum is a complicated mixture of chemicals, thought to have formed from the decay of ancient marine animals millions of years ago. Most of the constituents of petroleum are hydrocarbon molecules, oxygen, nitrogen, and sulfur atoms. The hydrocarbon atoms take principally four different forms; paraffins, olefins, cycloparaffins and aromatics. These constituents give us gasoline, kerosene, diesel fuel, lubricating oils (like mineral oil), petrolatum, asphalt and tar, to name a few.

During the manufacturing process, longer unbranched paraffin molecules are able to join together to form crystalline solids. These solids are called paraffin waxes. With time, paraffin waxes settle out of the lubricating oils and are usually removed. At lower temperatures, shorter unbranched paraffin molecules also settle out of lubrication oil. The semi-solid material that forms in cold lubricating oil is petrolatum or petroleum jelly.

The processing of petroleum into petrolatum removes varying amounts of toxins. The yellowish petrolatum has more residue than that of the white petrolatum. Two of the refining methods include sulphuric acid and earth filtering. The acid treatment and filtering is an old process still used to remove the impurities of the “cake” (petrolatum + technical oils). Another purification method is hydrogenation which pressurizes hydrogen through the hydrocarbons with the help of a specific catalyst.

Once one understands the source of petrolatum and why there is a risk of toxins, one must move on to a biologically more concerning issue. Petrolatum is occlusive. In an article by Fore, it was found that the degree of skin occlusion has an effect on barrier recovery. Occlusive products suppress barrier recovery and reduce the epidermal proliferative response to an abnormal stratum corneum barrier. An occlusive product, like petrolatum, will prevent TEWL and will slow the epidermal maturation and barrier repair. Occlusion of the skin increases the infectious organisms, potentially raising the skin’s pH. Occlusion will also directly increase the pH of the skin. Occlusive products also interfere with cellular respiration and may lead to cell death.

This information presents a powerful message that one may want to rethink the use of lanolin and petrolatum on neonate skin. The use of modern emollients like silicone, combined with natural omega 3-6 fatty acids, barrier-building amino acids and natural antioxidants and vitamins may deserve another look. Water-based skin care products are required by the Food and Drug Administration (FDA) to be preserved. This keeps them free of bacteria and protects the products from contamination when microorganisms from sources (like unclean hands) contaminate the product in the container as well as during use.

The requirement of preservatives and their use is not well understood. Preservatives are not optional in accordance with Food and Drug Administration (FDA) monographs covering the manufacturing of “Safe and Effective Drugs” or cosmetics. A manufacturer is required to perform a twenty eight (28) day preservative effectiveness challenge on its products and maintain a record of such testing for FDA inspections. Further, each batch requires proof that the batch meets microbial challenge requirements. Batches are tested in the tank, prior to filling, and then again at the beginning, middle and end of the filling process. This testing is done to ensure each product shipped is free of microbial contamination.

Since the use and safety of preservatives, especially parabens is under consideration in this article, comments from three regulating bodies are brought forward for consideration.

• The FDA recognizes parabens as a class of preservatives that have been used in a wide variety of foods, drugs, and cosmetics and that they keep products safe from microbial contamination. The Food, Drug, and Cosmetic Act require that cosmetics and non-prescription drugs and their individual ingredients must be safe and that labeling must be truthful and not misleading. The FDA can take immediate action to stop the sale of any product that does not meet its high standards. This includes the use of an effective preservative system.

• The European Food Safety Authority (EFSA) has reviewed the use of parabens in food and other products. The European Union (EU) Scientific Committee for Food (SCF) evaluated parabens in 1994 and established a temporary Acceptable Daily Intake (ADI) of 0-10mg/kg bw, as the sum of methyl, ethyl and propyl parabens. Further study also demonstrated that nooestrogenic activity took place in-vivo, and that there was no effect on forestomach cells in rats. In a teratogenicity study on 300 rabbits with oral does of methyl paraben, at doses of 550 mg/kg, no evidence of toxicity was found. The panel recognized that this dose far exceeded any anticipated oral dose.

• The Cosmetic, Toiletries, Fragrance Association (CTFA) is the body in the United States and through its Scientific Review Board, reviews all new cosmetic ingredients and assigns their INCI nomenclature (the required language found on packaging for all ingredients). The CTFA first studied the safety of parabens in 1984 and concluded they were safe as used in cosmetics. On November 14, 2004, as part of the normal re-review process, the CIR Expert Panel determined that it wanted to conduct a through review of the literature since the previous report in 1984. The safety of parabens has been once again reconfirmed.

Why then can there be a product that is not preserved? It is best that all products have some protection. However, some products that do not contain water can pass the challenge because microorganisms breed in water. Testing is done without the introduction of water. Consider this: a) an unpreserved product is placed on the skin, b) the product is occlusive, like petrolatum, c) the skin and its moisture, due to TEWL, contains microorganisms that are multiplying and trapped between the occlusive barrier and the skin, d) the skin care product on the skin is not preserved and now, e) a microorganism-rich moisture is being added. What are the consequences? Is there a systemic link and what is the potential sequela?

Toxins will be introduced to the neonate’s environment. They will come from mother’s milk, linens, clothing, human contact and a myriad of other sources. Careful consideration must always be given to the source of toxins and how multiple sources of them will impact the neonate. Product preservatives and fragrance are but two of these sources. The protection against e-TEWL and reducing the risks of systemic infections are worth considering when making neonate skin care choices.

Nutrashield from Medline Industries, Inc. is a semipermeable emollient barrier cream that:

• has excellent wash-off characteristics

• may reduce the incidence of colony forming microorganisms in the neonate population associated with petrolatum

• offers excellent aesthetic benefits including spreadability.

Additional creams and lotions in the REMEDY product line provide semipermeable barriers and nourish the skin37. Further research is necessary to confirm the product’s suitability in NICUs.Article by Darlene McCord, Ph.D.

So, it really comes to rephrasing the question to – ‘What is the best skin care product for me’. Yes, this is exactly the question that you should be asking, and unfortunately there is no easy answer for this. Arriving at the best skin care product for self will need some effort on your part.

First of all, you need to understand how the skin care products work. This is simple. You can consider all skin care products to be composed of 2 types of ingredients – Active and inactive. The active ingredients are the ones that actually work on your skin. The inactive ones just help in delivering these active ingredients to your skin. Both the ingredients need to work for your skin, in order for the product to be effective (and move on to become the best skin care product for you).

Besides the ingredients, the way you apply your skin care products is equally important. In fact, this is even more important. If you do not know how to apply skin care products, you might forever be hunting for the best skin care product for yourself, when that has already passed you. Moreover, it’s also important to decide on the frequency of application (of the skin care product). The environmental factors – temperature, humidity and pollution level, also affect the selection of best skin care product. Here are a few rules that you could use to ensure that your best skin care product is really the best for you: * Cleanse your skin before applying that best skin care product. * Use a makeup remover instead of plain water and remove your makeup before going to bed. * The effectiveness of active ingredients is reduced when applied over another product e.g. over moisturiser. So apply that best skin care product first and then apply a bit of moisturizer if needed. * Apply the products on moist and warm skin. * You will have to experiment with a few products before you arrive at the one that is the best skin care product for you. * Do not exfoliate too much or too hard. * Vary your skin care routine as per the seasons (winter/summer etc), changes in environmental factors and changes in your skin type

Note that the best skin care product cannot be determined overnight. It’s only through experiment (and awareness) that you can find the ‘Best skin care product’ (for you).

Truly speaking, there is nothing which is similar to the finest skin care product. Nothing can’t be ‘as the best product related to skin care’ as the products used for skin care work distinctly for distinct people (depending on their skin type). However, the product which is best for one might worsen another person’s skin. So, it is obvious to ask that ‘Which product related to skin care is the best for my skin?’ We surveyed and isolated people into 4 distinct groups depending upon their skin types- that are oily skin, sensitive skin, dry skin and normal skin. Though, differentiating them is too wide to very clearly determine the best product for skin care. ‘product best for dry skin care’ or product best for a skin that is oily’ sound as good declarations as just’ which is the good product for skin care’. However, still ‘better’ is used and it is yet not perfect.

So, again the question can be reshaped as to – ‘Which product is the best for my skin care’. This is the query which is in front of everybody with no satisfactory answers. To get the best product for your skin will need some efforts at your end.

Firstly, you should have an idea how the products related to skin care work. It is easy. You can see that all of the products related to skin care consist of two types of constituents – Inactive and active. The active ones in fact are used on the skin. An inactive ingredient merely helps in transposing the active ingredients to the skin. In order to have the product as effective both the constituents should work for the skin (and be used such as they are regarded as the best product for your skin care).

Apart from the two ingredients, how you use skin care products on your skin is equally significant. Actually, this is more significant. If you don’t understand how to use the products for your skin care, you will continuously be searching for the best product to be applied for your skin care. Also, it must be kept in mind that how often you apply the product to your skin. In addition, the ecological factors such as pollution level, humidity and temperature too affect to choose the product that is best for your skin care. Some of the tips that will help you to make sure that skin care product are in fact good for you:

*Before using the product that you consider as the best for your skin care make sure that your skin is clean.

*Instead of normal water clean your skin using make up remover and clean it before going to sleep.

*Instead of applying moisturizer first, use your skin care product initially so as to retain the effectiveness of the active components and then use moisturizer on your skin if required.

*Use the products on warm and moist skin.

*First try some skin care products and then decide which product is the best for your skin care.

*Do not scrub your skin too much and hardly.

*Depending on the variations in the environmental conditions, change in seasons (summer/winter etc) and variations in the type of your skin; change your skin care schedule.

Keep in mind that the best product for skin care cannot be obtained in a fortnight. Only by trials and consciousness you can get the ‘the product which is best for your skin care’

There are a huge number of varieties of anti aging creams available in the market. Almost all of these claim themselves to be the best suited for your aging skin. So how will you determine which cream is actually for you and if it will give you a younger looking skin or not. Following are a few tips on what all things to be considered while choosing an anti aging cream for yourself.

Research matters.

There is no need to now buy a product and then use the product and then come to a conclusion that does that cream suit you or not. This is because there goes in a lot of research in the complete process of preparation of the anti aging cream. So you can go through their research to find how the actual scenarios of theadvanced skin care , skin care anti aging products.

Best Quality Ingredients:

As any other product, even advanced skin care, skin care anti aging products are made up of high quality ingredients and low quality ingredients. So you should look at the ingredients which are used in bring that advanced skin care, skin care anti aging products together, you should also look for natural ingredients which are very good for you and your skin.

Buy a cream that actually feels good:

With your advanced skin care, skin care anti aging products, you should feel wonderful when you apply it on your face. For this you can buy advanced skin care, skin care anti aging products which give you small samples or a money back guarantee.

Rate It’s Personal Effectiveness:

After you have done all the research and looked for the best ingredients and everything, its now time to actually use the products and look for visible results. No matter how good an advanced skin care, skin care anti aging product claims itself to be, if it doesn’t give you visible results its of no use for you.

Affordability:

During your search for the best suited advanced skin care, skin care anti aging products you will come through a huge variety of products which are available in a wide variety of price ranges. So you should keep in consideration your budget, the quality offered at a price while buying your advanced skin care, skin care anti aging products.

So it is very important to try and opt for skin care products which are free from any types of chemicals. This also helps to maintain a natural glow on your skin. So you can find the best products in advanced skin care range and anti aging skin care products.with  southwestoutlets.com. We also offer the best skin care products which can make your skin clearer, smoother, and more youthful looking can be found right here. If you want to look your best, it all starts with serious skin care with us.

Anti aging and anti wrinkle products work in a magical way – they take care of those fine lines and wrinkles, sagging skin, brown spots, dark circles under your eyes and much more.  They can transform your looks in simply days or weeks with minimum effort and expense. So you can opt for our products and start looking fabulous again.

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For the vast majority of us, genes may set the lower limits of our weight, but we set the upper limits by our food choices.

Nonetheless, we all know that most of us tend to put on weight as we age. In addition, if there is one thing we cannot prevent, it is the aging process. But we can prevent eating more and exercising less as we get older. And first of all, you have to have surgeries for food control in your life, strategies that work.

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