Impact of Emollient Therapy on Barrier Function in Healthy Infants

Infant skin is thinner and less mature than adult skin, making it more susceptible to water loss, irritation, allergens, and pathogens. The epidermal barrier, the largest organ of the newborn infant, is developmentally compromised and easily injured at birth, particularly in preterm infants. This increases the risk of accelerated water and heat loss, growth faltering, systemic infection, and mortality¹.

Emollient therapy supports barrier integrity, hydration, and protection by supplying essential lipids and retaining moisture. Regular use strengthens the developing barrier, reduces vulnerability to environmental stressors, and promotes long-term skin health.

Mechanisms of Action

Some emollient formulations not only enhance skin barrier function but also support antimicrobial defense by upregulating proteins such as cathelicidin LL37. Barrier integrity and innate immune defense are closely linked and co-regulated². Emollients reinforce barrier function through:

• Occlusion: Forming a protective lipid layer that reduces water loss
• Humectant Effect: Attracting and retaining moisture in the stratum corneum
• Lipid Supplementation: Supplying essential lipids including ceramides, cholesterol, and fatty acids
• pH Regulation: Maintaining the slightly acidic environment of the skin surface

Clinical Evidence and Benefits

• Basic emollients improve hydration, replenish stratum corneum lipids, and support barrier function
• Modern formulations combine occlusive agents (e.g., petrolatum, paraffin) with humectants (e.g., glycerol, urea) to retain moisture
• Physiologic lipids (ceramides, cholesterol, free fatty acids) restore the intercellular matrix
• Additional components may reduce itch and promote epidermal differentiation
• Regular use reduces transepidermal water loss, improves hydration, and maintains physiologic pH
• Early and consistent application may lower xerosis, irritant dermatitis, and potentially reduce atopic dermatitis risk in high-risk infants³

Emollient Selection and Application

• Choose fragrance-free, preservative-minimal, pH-balanced formulations with physiologic lipids
• Apply gently on slightly damp skin once or twice daily, adjusting for climate and skin condition

Safety and Precautions

Studies indicate that emollients commonly used in infants are generally safe and well tolerated⁴. Clinicians and caregivers can be reassured about their use when proper precautions are followed:

• Avoid application near nasal areas
• Use caution with highly occlusive products in warm conditions
• Discontinue use if irritation occurs and monitor safety around bathing

Appropriate emollient therapy provides a safe, cost-effective strategy to enhance skin barrier function in healthy infants, offering immediate hydration and protection while potentially supporting long-term skin health and resilience.

References

1. Kumar V, Kumar A, Mishra S, et al. Emollient therapy and neonatal outcomes. Am J Clin Nutr. 2022;115(4):1092–1104.
2. Elias PM, Man MQ, Darmstadt GL. Optimised emollient mixture for barrier repair. J Glob Health. 2022;12:03019.
3. Fluhr JW, Muguet V, Christen-Zaech S. Emollients for xerosis cutis. Int J Dermatol. 2025;64 Suppl 1:5–12.
4. Bhanot A, Huntley A, Ridd MJ. Adverse events from emollient use. Dermatol Ther (Heidelb). 2019;9(2):193–208.