Reply to: Barrier function of neonatal skin

Abstract

We thank Drs Williams and Feingold for their comments concerning our study about the disruption of neonatal skin after adhesive removal.1Lund CH Nonato LB Kuller JM Franck LS Cullander C Durand DJ. Disruption of barrier function in neonatal skin associated with adhesive removal.J Pediatr. 1997; 131: 367-372Abstract Full Text PDF PubMed Scopus (69) Google Scholar They make a good point about the difference between tape-stripping research in adults versus our method of adhesive application and removal after 24 hours' adherence. However, we disagree with some of the points raised about occlusion effects of the adhesives used and wish to point out the other measurement techniques used to validate our conclusion that skin disruption did in fact occur. (1) It is difficult to categorize the adhesives as occlusive or nonocclusive. The plastic tape is impregnated with holes and may be defined as semipermeable. The pectin barrier is constructed of a matrix of hydrocolloids, and we do not know its occlusive properties. The hydrogel adhesive is manufactured with a solid backing and therefore was not entirely nonocclusive. (2) Measurements of transepidermal water loss were obtained 30 minutes after adhesive removal because this interval has been shown to provide sufficient time for the linear concentration gradient across the stratum corneum to be reestablished after occlusion.2Roskos K Guy R. Assessment of skin barrier function using TEWL.Pharm Res. 1989; 6: 949-953Crossref PubMed Scopus (86) Google Scholar (3) We included two other measurements to confirm the disruption of epidermis because of adhesive removal. Colorimeter measurements were used to quantify erythema seen with skin irritation, and values were significantly elevated where pectin barrier and plastic tape were removed. Because erythema is not observed with occlusion or "inhibition of maturation," we believe that this finding supports our interpretation of the damaging effects of these adhesives. In addition, we included visual-inspection rating scales used in previous research on adhesive removal in adults.3Weber B Speer M Swartz D Rupp S O'Linn W Stone K. Irritation and stripping effects of adhesive tapes on skin layers of coronary artery bypass graft patients.Heart Lung. 1987; 16: 567-572PubMed Google Scholar We observed damage, characterized by erythema and visible removal of skin layers, with scores significantly higher forz he plastic tape and pectin barrier sites. Therefore we maintain that the adhesives—plastic tape and pectin barrier—are damaging to neonatal skin after a single application and removal, and that the methods selected for our study confirm this finding.