Ilmu KesehatanKulit dan Kelamin JOURNAL READING

FakultasKedokteran April 2019

Universitas Pattimura

PHYSIOLOGY OF NEONATAL SKIN

A. Mudrikah H Dirgahayu
2017-84-027

Pembimbing:
dr. Hanny Tanasal, Sp. KK

Dibawakan Dalam Rangka Tugas Kepaniteraan Klinik

Bagian Ilmu Kesehatan Kulit dan Kelamin
Fakultas Kedokteran
Universitas Pattimura
Ambon
2019
INTRODUCTION
The transition dramatic
from an to a dry one challenge to
aqueous, but rich in the skin of
sterile, pathogens the newborn
atmosphere infant
 Prevention Epidermal Defence
of water against
loss barrier microorganisms

• The efficacy of this barrier is proportional to its thickness and

lipid composition.
• During late gestation, the number of epidermal layers and
the thickness of the stratum corneum increase with fetal
age.
VERNIX CASEOSA
• During the last trimester of gestation, the fetus is
covered by a protective biofilm called vernix caseosa.

• It forms a mechanical ‘shield’ against maceration by

amniotic fluid and bacterial infection.

• Application of vernix to normal adult skin has been

shown to increase surface hydration
COMPOSITION
 epidermal
wax esters barrier
lipids

Lipids

• Unlike postnatal skin, sebum and keratinocytes are not shed in the
fetal period but adhere to the skin;

• accumulation of vernix  compensate for the relative lack of barrier

lipids in fetal skin.

• Shedding of vernix  maturation of the transepidermal barrier

DERMIS
Dermis supplies

sebum

sweat nutrients

Epidermis
• Dermal vessels are most important for the regulation of skin
and body temperature.

• The dermis connects the epidermal sheath with the

underlying fatty tissue  provides stability and protection
against trauma to the skin.
 Sebaceous gland activity
• Squalenes and monoester waxes  sebum
• Sebum levels during 1st month = adults   until
puberty

• Stimulation of sebaceous glands by maternal

androgens starts before birth.
 Thermoregulation
• Density of sweat glands is > in adults, thermal sweating is
reduced in the term neonate

• Sweating occurs first on the forehead  the trunk and

extremities

• The intensity of sweating --> depends on gestational age.

• Preterm babies  unable to sweat 1st day of life

• Preterm babies  able to sweat 13 days age

Cont’d…
• Emotional sweating (palmoplantar)  hunger/pain. (≥36–
37 wg)

• Functional immaturity of the sweat glands appears to be

without clinical significance in the neonatal period.

• anhidrotic ectodermal dysplasia  hyperpyrexia (-)

Cont’d..
• Neonates  risk of heat loss.

• Regional heat loss = the external temperature.

• The vasoconstrictive response to reduced temperature 

diminished in the newborn infant.

• Occlusive wrapping of very-low-birthweight infants has been

shown to prevent the dangerous postnatal evaporative heat
loss.
Percutaneous respiration
• The absorption of oxygen and excretion of carbon dioxide
through the skin <2% of total respiration  In adults and
mature neonates

• Interestingly, “kangarooing” between premature babies and

their mothers  improve gas exchange independent of
postnatal age.
Wound healing
• wounded fetal tissue is characterized by overexpression of the
homeobox gene Prx-2 and decreased expression of HOXB13
compared with adult skin.

• Prx-2  regulation of extracellular matrix reorganization, matrix

metalloproteinase 2, and hyaluronic acid production.

• Fetal skin fibroblasts  lower expression of the integrin subunits

α1 and α3 and increased expression of α2.

• Fetal skin doesn’t exhibit dermal expression of some

proteoglycans following trauma decreased inflammatory and
fibrotic responses.
thankyou