Journal Mobile Options
Table of Contents
Vol. 24, No. 6, 2011
Issue release date: September 2011
Skin Pharmacol Physiol 2011;24:322–329

Epidermal Barrier Treatments Based on Vernix Caseosa

Visscher M.O. · Barai N. · LaRuffa A.A. · Pickens W.L. · Narendran V. · Hoath S.B.
aSkin Sciences Institute, Division of Neonatology and Pulmonary Biology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, and bJames L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio, USA

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


Background/Aims: Premature infants lack the vernix caseosa, have an incompetent stratum corneum (SC) barrier and are predisposed to infection. Use of topical agents to improve barrier function has had mixed outcomes. The aim was to determine the effect of vernix versus common barrier creams on the rate and quality of the epidermal barrier repair following controlled wounding. Methods: Minor wounds were created with (1) laser ablation in the minipig and (2) tape stripping of mother’s volar skin as a model for premature skin. Native vernix was applied to the mother’s tape-stripped skin. Treatments were no occlusion (NO), vernix and a petrolatum-based cream (PBC) in the pig, and NO, vernix, PBC, an oil-in-water cream (OWC), a semipermeable film (SP) and full occlusion (FO) in adults. Results: Outcomes for both trials were barrier recovery and skin hydration (moisture accumulation rate, MAT), initial hydration, erythema and dryness in adults. Vernix and PBC produced greater barrier repair than NO in the pig. SP produced greater recovery than NO and FO in adults. Vernix yielded greater recovery than FO and was similar to PBC, OWC and NO. Vernix had a directionally higher MAT than OWC and directionally higher initial hydration than NO. Conclusions: The findings suggest that vernix-based topical creams would be effective for the treatment of epidermal wounds and show promise to augment SC repair and maturation in infants.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Pickens W, Warner R, Boissy R, Hoath S: Characterization of human vernix: water content morphology and elemental analysis. J Invest Dermatol 2000;115:875–881.
  2. Visscher MO, Narendran V, Pickens WL, LaRuffa AA, Meinzen-Derr J, Allen K, Hoath SB: Vernix caseosa in neonatal adaptation. J Perinatol 2005;25:440–446.
  3. Youssef W, Wickett RR, Hoath SB: Surface free energy characterization of vernix caseosa: potential role in waterproofing the newborn infant. Skin Res Technol 2001;7:10–17.
  4. Bautista M, Pickens W, Visscher M, Hoath S: Characterization of vernix caseosa as a natural biofilm: comparison to standard oil-based ointments. Pediatr Dermatol 2000;17:253–260.
  5. Visscher MO, Utturkar R, Picken WL, LaRuffa AA, Robinson M, Wickett RR, Narendran V, Hoath SB: Neonatal skin maturation – vernix caseosa and free amino acids. Pediatr Dermatol 2011;28:122–132.

    External Resources

  6. Visscher MO, Chatterjee R, Munson KA, Pickens WL, Hoath SB: Changes in diapered and nondiapered infant skin over the first month of life. Pediatr Dermatol 2000;17:45–51.
  7. Akinbi HT, Narendran V, Pass AK, Markart P, Hoath SB: Host defense proteins in vernix caseosa and amniotic fluid. Am J Obstet Gynecol 2004;191:2090–2096.
  8. Marchini G, Lindow S, Brismar H, Stabi B, Berggren V, Ulfgren AK, Lonne-Rahm S, Agerberth B, Gudmundsson GH: The newborn infant is protected by an innate antimicrobial barrier: peptide antibiotics are present in the skin and vernix caseosa. Br J Dermatol 2002;147:1127–1134.
  9. Yoshio H, Tollin M, Gudmundsson GH, Lagercrantz H, Jornvall H, Marchini G, Agerberth B: Antimicrobial polypeptides of human vernix caseosa and amniotic fluid: implications for newborn innate defense. Pediatr Res 2003;53:211–216.
  10. Tollin M, Bergsson G, Kai-Larsen Y, Lengqvist J, Sjovall J, Griffiths W, Skuladottir GV, Haraldsson A, Jornvall H, Gudmundsson GH, Agerberth B: Vernix caseosa as a multi-component defence system based on polypeptides, lipids and their interactions. Cell Mol Life Sci 2005;62:2390–2399.
  11. Tansirikongkol A, Wickett RR, Visscher MO, Hoath SB: Effect of vernix caseosa on the penetration of chymotryptic enzyme: potential role in epidermal barrier development. Pediatr Res 2007;62:49–53.

    External Resources

  12. Oudshoorn MH, Rissmann R, van der Coelen D, Hennink WE, Ponec M, Bouwstra JA: Development of a murine model to evaluate the effect of vernix caseosa on skin barrier recovery. Exp Dermatol 2009;18:178–184.

    External Resources

  13. Zhukov BN, Neverova EI, Nikitin KE, Kostiaev VE, Myshentsev PN: A comparative evaluation of the use of vernix caseosa and solcoseryl in treating patients with trophic ulcers of the lower extremities (in Russian). Vestn Khir Im I I Grek 1992;148:339–341.
  14. Hoath SB, Pickens WL, Visscher MO: The biology of vernix caseosa. Int J Cosmet Sci 2006;28:319–333.
  15. Hoath S, Narendran V: Adhesives and emollients in newborn care. Sem Neonatol 2000;5:289–296.
  16. Rutter N: The immature skin. Eur J Pediatr 1996;155(suppl 2):S18–S20.

    External Resources

  17. Darmstadt GL, Dinulos JG: Neonatal skin care. Pediatr Clin North Am 2000;47:757–782.
  18. Agren J, Sjors G, Sedin G: Transepidermal water loss in infants born at 24 and 25 weeks of gestation. Acta Paediatr 1998;87:1185–1190.
  19. Harpin VA, Rutter N: Barrier properties of the newborn infant’s skin. J Pediatr 1983;102:419–425.
  20. Kalia YN, Nonato LB, Lund CH, Guy RH: Development of skin barrier function in premature infants. J Invest Dermatol 1998;111:320–326.
  21. Nonato LB, Lund CH, Kalia YN, Guy RH: Transepidermal water loss in 24 and 25 weeks gestational age infants. Acta Paediatr 2000;89:747–748.
  22. Nikolovski J, Stamatas GN, Kollias N, Wiegand BC: Barrier function and water-holding and transport properties of infant stratum corneum are different from adult and continue to develop through the first year of life. J Invest Dermatol 2008;128:1728–1736.
  23. Edwards WH, Conner JM, Soll RF: The effect of prophylactic ointment therapy on nosocomial sepsis rates and skin integrity in infants with birth weights of 501 to 1,000 g. Pediatrics 2004;113:1195–1203.
  24. Nopper AJ, Horii KA, Sookdeo-Drost S, Wang TH, Mancini AJ, Lane AT: Topical ointment therapy benefits premature infants. J Pediatr 1996;128:660–669.
  25. Pabst RC, Starr KP, Qaiyumi S, Schwalbe RS, Gewolb IH: The effect of application of Aquaphor on skin condition, fluid requirements, and bacterial colonization in very low birth weight infants. J Perinatol 1999;19:278–283.
  26. Visscher M, Hoath SB, Conroy E, Wickett RR: Effect of semipermeable membranes on skin barrier repair following tape stripping. Arch Dermatol Res 2001;293:491–499.
  27. Bock M, Damer K, Wulfhorst B, John SM: Semipermeable glove membranes – effects on skin barrier repair following SLS irritation. Contact Dermatitis 2009;61:276–280.

    External Resources

  28. Mancini AJ, Sookdeo-Drost S, Madison KC, Smoller BR, Lane AT: Semipermeable dressings improve epidermal barrier function in premature infants. Pediatr Res 1994;36:306–314.
  29. Vernon HJ, Lane AT, Wischerath LJ, Davis JM, Menegus MA: Semipermeable dressing and transepidermal water loss in premature infants. Pediatrics 1990;86:357–362.
  30. Gunt H: Water Handling Properties of Vernix Caseosa: Pharmacy. Cincinnati, University of Cincinnati, 2002.
  31. Tansirikongkol A, Visscher MO, Wickett RR: Water-handling properties of vernix caseosa and a synthetic analogue. J Cosmet Sci 2007;58:651–662.
  32. Visscher M, Narendran V, Joseph W, Gunt H, Hoath S: Development of topical eqidermal barriers for preterm infant skin: comparison of Aquaphor and vernix caseosa. Pediatr Acad Soc Annu Meet, Baltimore, 2002.
  33. Schunck M, Neumann C, Proksch E: Artificial barrier repair in wounds by semi-occlusive foils reduced wound contraction and enhanced cell migration and reepithelization in mouse skin. J Invest Dermatol 2005;125:1063–1071.
  34. Kitzmiller WJ, Stanton RA, Wickett RR, Tolia G, Boissy RE, Visscher MO: Noninvasive skin measurements after CO2 and erbium laser resurfacing. Aesthet Surg J 2003;23:20–27.

    External Resources

  35. Sterilization of health care products. Requirements for validation and routine control – radiation sterilization. Arlington, Association for the Advancement of Medical Instrumentation, 1995.
  36. Jemac GB, Serup J: Epidermal hydration and skin mechanics: the relationship between electrical capacitance and the mechanical properties of human skin in vivo. Acta Derm Venereol (Stockh) 1990;70:245–247.

    External Resources

  37. Treffel P, Gabard B: Stratum corneum dynamic function measurements after moisturizer or irritant application. Arch Dermatol Res 1995;287:474–479.
  38. Sedin G, Hammarlund K, Stromberg B: Transepidermal water loss in full-term and pre-term infants. Acta Paediatr Scand Suppl 1983;305:27–31.
  39. Visscher M, Robinson M, Wickett R: Stratum corneum free amino acids following barrier perturbation and repair. Int J Cosmet Sci 2011;33:80–89.
  40. Visscher M, Robinson M, Wickett R: Stratum corneum free amino acids following barrier perturbation and repair. Int J Cosmet Sci 2011;33:80–89.
  41. Breternitz M, Flach M, Prassler J, Elsner P, Fluhr JW: Acute barrier disruption by adhesive tapes is influenced by pressure, time and anatomical location: integrity and cohesion assessed by sequential tape stripping. A randomized, controlled study. Br J Dermatol 2007;156:231–240.
  42. Harding CR, Watkinson A, Rawlings AV, Scott IR: Dry skin, moisturization and corneodesmolysis. Int J Cosmet Sci 2000;22:21–52.
  43. Agren J, Sjors G, Sedin G: Transepidermal water loss in infants born at 24 and 25 weeks of gestation. Acta Paediatr 1998;87:1185–1190.
  44. Agren J, Sjors G, Sedin G: Ambient humidity influences the rate of skin barrier maturation in extremely preterm infants. J Pediatr 2006;148:613–617.
  45. Narendran V, Visscher MO, Abril I, Hendrix SW, Hoath SB: Biomarkers of epidermal innate immunity in premature and full-term infants. Pediatr Res 2010;67:382–386.
  46. Visscher MO, Said D, Wickett R: Stratum corneum cytokines, structural proteins, and transepidermal water loss: effect of hand hygiene. Skin Res Technol 2010;16:229–236.

    External Resources

  47. Okah FA, Wickett RR, Pickens WL, Hoath SB: Surface electrical capacitance as a noninvasive bedside measure of epidermal barrier maturation in the newborn infant. Pediatrics 1995;96:688–692.
  48. Denda M, Sato J, Masuda Y, Tsuchiya T, Koyama J, Kuramoto M, Elias PM, Feingold KR: Exposure to a dry environment enhances epidermal permeability barrier function. J Invest Dermatol 1998;111:858–863.
  49. Lane AT, Drost SS: Effects of repeated application of emollient cream to premature neonates’ skin. Pediatrics 1993;92:415–419.
  50. Conner JM, Soll RF, Edwards WH: Topical ointment for preventing infection in preterm infants. Cochrane Database Syst Rev 2004;1:CD001150.
  51. Rissmann R, Groenink HW, Weerheim AM, Hoath SB, Ponec M, Bouwstra JA: New insights into ultrastructure, lipid composition and organization of vernix caseosa. J Invest Dermatol 2006;126:1823–1833.
  52. 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;91:546–554.
  53. Yang L, Mao-Qiang M, Taljebini M, Elias PM, Feingold KR: Topical stratum corneum lipids accelerate barrier repair after tape stripping, solvent treatment and some but not all types of detergent treatment. Br J Dermatol 1995;133:679–685.
  54. Kessner D, Ruettinger A, Kiselev MA, Wartewig S, Neubert RH: Properties of ceramides and their impact on the stratum corneum structure. 2. Stratum corneum lipid model systems. Skin Pharmacol Physiol 2008;21:58–74.
  55. Elias PM, Mao-Qiang M, Thornfeldt CR, Feingold KR: The epidermal permeability barrier: effects of physiologic and non-physiologic lipids; in Hoppe U (ed): The Lanolin Book. Hamburg, Beiersdorf AG, 1999, pp 253–279.
  56. Man MM, Feingold KR, Thornfeldt CR, Elias PM: Optimization of physiological lipid mixtures for barrier repair. J Invest Dermatol 1996;106:1096–1101.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50