What we know today about applying oils to newborn skin

The use of olive or sunflower oil on newborn babies’ skin damages the skin barrier, researchers from the University of Manchester recently reported.1 This latest study adds to the conflicting information around caring for newborn skin and how to manage conditions like atopic dermatitis.

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Study author and midwife Alison Cooke, Ph.D., M.Res., R.M., B.Midwif.(Hons), of The University of Manchester, UK, and colleagues tested the effects of the two oils on 115 newborn infants. They divided the babies into three groups: olive oil, sunflower oil and no oil.

“When compared to no oil, both topical olive oil and topical sunflower oil, used twice daily for 28 days, impeded the development of the skin barrier function from birth,” Dr. Cooke tells Dermatology Times. “Although this was a pilot randomized controlled trial, in order to avoid any potential harm, the study findings suggest that these oils should not be recommended to new parents to use on their baby’s skin until further research is conducted to support his practice,” she adds.

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This finding appears to conflict with the little research there is on sunflower oil. While there is no UK national guidance on neonatal skincare, according to Dr. Cooke, there is evidence from studies carried out in South Asia that sunflower oil has an anti-microbial effect, which could benefit premature babies in developing countries.

NEXT: Exzema links

Eczema links

There as been a dramatic increase in eczema over the last few decades, which has been linked with changes to skincare practices for babies, according to Dr. Cooke.

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“There have been suggestions from various professional circles that the substantial increase in prevalence of atopic eczema cannot be attributed to genetic predisposition alone, and is more likely due to environmental factors, which include the increased availability and use of topical oils,” Dr. Cooke says. “The two oils tested in our study had a negative effect on the skin barrier function. As a damaged skin barrier is a characteristic of atopic eczema, we hypothesize whether there is a link between the use of topical oils from birth and the development of atopic eczema. We suggest that this should be investigated in further research.”

Dermatologists say the link between such topical oils for newborns and eczema is far from proven.

The data linking an increased incidence of atopic dermatitis is much stronger for parameters included in the hygiene hypothesis than types of emollients used in infancy, according to Elaine C. Siegfried, M.D., professor of pediatrics and dermatology, Saint Louis University, Cardinal Glennon Children's Hospital, in St. Louis, Mo. The hygiene hypothesis suggests the decreasing incidence of early exposure to microbial pathogens in Western countries and, more recently, in developing countries is at the root of the increasing incidence of autoimmune and allergic diseases. ²

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Yasmine Kirkorian, M.D.It’s true, there has been a dramatic increase in pediatric eczema (atopic dermatitis, AD) worldwide, according to Yasmine Kirkorian, M.D., assistant professor of dermatology and pediatrics, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, D.C. ³

“This increase cannot be explained by genetics, alone; therefore, researchers have searched for environmental triggers,” she explains. “Evidence is mounting that skin barrier disruption occurs prior to the onset of clinical signs of AD. Therefore it is reasonable to imagine that skincare regimens that disrupt the newborn skin barrier might trigger AD,” Dr. Kirkorian says.

“Although this is a plausible theory, there is no evidence that newborn or childhood skincare is linked to the rise in AD. On the other hand, there is exciting data from a small randomized-controlled trial that applying emollients to neonates may prevent AD in children at high risk for development of this condition,”⁴  Dr. Kirkorian says. “There is a larger [randomized controlled trial] currently recruiting in the UK, which we hope will provide more definitive answers on the role of emollients in the primary prevention of eczema in high risk children.”⁵

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Organic oils impact the microbiome, particularly the yeast microbiome, like Malassezia, which is the most common yeast on the skin, Dr. Siegfried says.

“And when you have overgrowth of Malassezia, it can be associated with adverse outcomes. … olive oil is particularly nourishing for Malassezia. And overgrowth of Malassezia has been associated with skin inflammation in a variety of conditions: tinea versicolor neonatal acne, seborrheic dermatitis and even atopic dermatitis. But that has been less well studied,” she explains.

NEXT: Guideline gap

Guideline gap

There is no data to provide guidelines on good ingredients for newborn skin, according to Dr. Kirkorian.

“Since we don’t have definitive data, I would recommend bland emollients, such as petrolatum ointment and cleansers that are fragrance- and dye-free,” she says.

There are more studies on what might be bad ingredients for newborn skin, according to Dr. Kirkorian.

“…there are multiple studies in mice,⁶ adults⁷ and now infants¹ that suggest that the use of some topical oils may actually disrupt the skin barrier. Specifically, olive oil, mustard oil and soybean oil have been demonstrated to disrupt the lipid barrier and increase epidermal inflammation and should probably be avoided,” Dr. Kirkorian says.

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There is data supporting the use of sunflower seed oil or safflower oil as an emollient in neonates, in particular in the prevention of nosocomial infections in preterm children in developing countries, according to Dr. Kirkorian. ⁸

“However, the Oil in Baby SkincaRE [ObSeRvE] Study demonstrated increased skin barrier disruption with both [sunflower seed oil] and olive oil,” 1 she says. “Other popular oils, such as tea tree oil, can cause allergic contact dermatitis. Since definitive evidence is currently lacking, it might be sensible to avoid the use of all oils on newborn skin at this time or to use sunflower seed oil, which has better evidence of safety and efficacy compared to other oils.”

NEXT: Preventive care

Preventive care

There is no definitive data that demonstrates that any product prevents eczema.

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“In fact, Cochrane and non-Cochrane reviews did not demonstrate conclusive evidence for any strategy for primary prevention of eczema, although limited data supported exclusive breastfeeding until six months and the use of prebiotics in high-risk patients,”⁹ Dr. Kirkorian says. “The good news is that research is underway to develop new agents to upregulate filaggrin as a means of primary prevention of eczema so we may have products to recommend to our patients in the future.” ¹⁰

Educating parents

Well-meaning parents are gravitating toward baby products that are “natural,” which they equate with “safe,” according to Dr. Kirkorian, which makes a dermatologist’s advice more important than ever.

“A Google search of ‘the best oils for baby massage’ demonstrates more than 14 million results indicating that patients are actively seeking out and using these products,” Dr. Kirkorian says.

Many of the products being marketed are complex and could be contributing to contact dermatitis. This includes seemingly natural baby products. After all, poison ivy is natural, according to Dr. Siegfried.

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“Dermatologists can provide information that supports parents while educating about the risks of barrier disruption with the use of certain oils. Parents can be encouraged to carry out infant massage or other practices using a bland emollient such as petrolatum ointment that does not contain any preservatives such as parabens,” Dr. Kirkorian says. “Parents might also be motivated to use emollients daily if informed about the potential benefit in the primary prevention of atopic dermatitis.”

Dr. Siegfried says that she stresses simplicity to parents when making recommendations about newborn skincare practices. For example, she recommends applying topical mineral oil to the baby’s skin after his or her bath.

“More recently, I’ve been recommending coconut oil, because there is some data on the safety and efficacy of coconut oil on atopic dermatitis and also on neonates,” Dr. Siegfried says.  ^{11, 12, 13}

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As frontline providers for pediatric patients with eczema, dermatologists are keenly aware of the disease’s impact on the patients’ and families’ quality of life.

“It is exciting that a relatively simple approach of daily emollient use might have a disproportionate benefit for our patients, if reduction of the incidence of atopic dermatitis is confirmed with this treatment,” Dr. Kirkorian says. “We can give patients hope and help to ‘do no harm’ by gently providing information and steering them away from ‘natural’ treatments that might have harmful effects on newborn skin.”

References:

1.     Cooke A, Cork MJ, Victor S, Campbell M, Danby S, Chittock J, Lavender T. Olive Oil, Sunflower Oil or no Oil for Baby Dry Skin or Massage: A Pilot, Assessor-blinded, Randomized Controlled Trial (the Oil in Baby SkincaRE [OBSeRvE] Study). Acta Derm Venereol. 2015 Nov 9.http://www.ncbi.nlm.nih.gov/pubmed/26551528

2.     Okada H, Kuhn C, Feillet H, Bach J-F. The “hygiene hypothesis” for autoimmune and allergic diseases: an update. Clinical and Experimental Immunology. 2010;160(1):1-9. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2841828/

3.     Williams H, Stewart A, von Mutius E, Cookson W, Anderson HR; International Study of Asthma and Allergies in Childhood (ISAAC) Phase One and Three Study Groups. Is eczema really on the increase worldwide? J Allergy Clin Immunol. 2008 Apr;121(4):947-54.e15.

4.     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 Oct;134(4):818-23.

5.     The Barier Enhancement for Eczema Prevention (BEEP) Study http://www.nottingham.ac.uk/research/groups/cebd/projects/1eczema/beep-maintrial.aspx

6.     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):546-54.

7.     Danby SG, AlEnezi T, Sultan A, Lavender T, Chittock J, Brown K, Cork MJ.  Effect of olive and sunflower seed oil on the adult skin barrier: implication for neonatal skin care. Pediatr Dermatol. 2013 Jan-Feb;30(1):42-50.

8.     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 Mar;121(3):522-9.