Journal Mobile Options
Table of Contents
Vol. 17, No. 2, 2004
Issue release date: March–April 2004
Skin Pharmacol Physiol 2004;17:57–66

Stratum Corneum Maturation

A Review of Neonatal Skin Function

Chiou Y.B. · Blume-Peytavi U.
Department of Dermatology and Allergy, Center for Clinical Research on Hair and Skin Physiology, Charité University of Medicine Berlin, Berlin, Germany

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


The importance of the stratum corneum and its barrier function for infants, especially for newborns, is clinically evident. Research regarding the maturation of the stratum corneum in neonates, i.e. when full barrier function is obtained, has produced varying results. Based on transepidermal water loss and percutaneous absorption studies, term infants seem to possess stratum corneum with adult barrier properties. Additionally, postnatal life is thought to accelerate stratum corneum maturation, so that even preterm infants have barrier function similar to term infants at 2–3 weeks of gestational age. However, a look at other parameters, such as skin thickness, skin pH and stratum corneum hydration, shows that neonatal skin is always adjusting to the extrauterine environment in contrast to the steady state of adult skin. This suggests that barrier stabilization may be dependent on achieving a balance between different parameters. However, it is still in question, which parameters, what balance and what timing. This paper provides an up-to-date overview on the neonatal skin barrier based on the review of current literature.

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. Kravchenko I, Maibach H: Percutaneous penetration; in Hoath SB, Maibach HI (eds): Neonatal Skin: Structure and Function. New York, Marcel Dekker, 2003, pp 285–298.
  2. Cetta F, Lambert G, Ros S: Newborn chemical exposure from over-the-counter skin care products. Clin Pediatr 1991;30:286–289.
  3. Kalia Y, Nonato L, Lund H, Guy R: Development of skin barrier function in premature infants. J Invest Dermatol 1998;111:320–326.
  4. Rutter N, Hull D: Water loss from the skin of term and preterm babies. Arch Dis Child 1979;54:858–868.
  5. Harpin VA, Rutter N: Barrier properties of newborn skin. J Pediatr 1983;103:419–425.

    External Resources

  6. Holbrook K: Embryogenesis of the skin; in Harper J, Oranje A (eds): Textbook of Pediatric Dermatology. Oxford, Blackwell Science, 2000, vol 1, pp 3–42.
  7. Visscher M, Chatterjee R, Munson K, Pickens W, Hoath S: Changes in diapered and nondiapered infant skin over the first month of life. Pediatr Dermatol 2000;17:45–51.
  8. Evans NJ, Rutter N: Development of the epidermis in the newborn. Biol Neonate 1986;49:74–80.
  9. Okah F, Wickett R, Pickens W, Hoath S: Surface electrical capacitance as a noninvasive bedside measure of epidermal barrier maturation in the newborn infant. Pediatrics 1995;96:688–692.
  10. Rutter N: Physiology of the newborn skin; in Harper J, Oranje A (eds): Textbook of Pediatric Dermatology. Oxford, Blackwell Science, 2000, vol 1, pp 43–47.
  11. Siegfried E, Shah P: Neonatal skin and skin care. Dermatol Clin 1998;16:437–446.
  12. Elias P: The stratum corneum revisited. J Dermatol 1996;23:756–758.
  13. Coderch L, Lopez O, de la Maza A, Parra JL: Ceramides and skin function. Am J Clin Dermatol 2003;4:107–129.
  14. Aszterbaum M, Menon G, Feingold K, Williams M: Ontogeny of the epidermal barrier to water loss in the rat: Correlation of function with stratum corneum structure and lipid content. Pediatr Res 1992;31:308–317.
  15. Chamlin S, Kao J, Frieden I, Sheu M, Fowler A, Fluhr J, Williams M, Elias P: Ceramide-dominant barrier repair lipids alleviate childhood atopic dermatitis: Changes in barrier function provide a sensitive indicator of disease activity. J Am Acad Dermatol 2002;47:198–208.
  16. Jain A, Rutter N, Cartlidge P: Influence of antenatal steroids and sex on maturation of the epidermal barrier in the preterm infant. Arch Dis Child Fetal Neonatal Ed 2000;83:F112–F116.

    External Resources

  17. Norlen L: Skin barrier formation: The membrane folding model. J Invest Dermatol 2001;117:823–829.
  18. Norlen L: Skin barrier structure and function: The single gel phase model. J Invest Dermatol 2001;117:830–836.
  19. Tsuruta D, Green K, Getsios S, Jones J: The barrier function of skin: How to keep a tight lid on water loss. Trends Cell Biol 2002;12:355–357.
  20. Kao J, Garg A, Mao-Qiang M, Crumrine D, Ghadially R, Feingold K, Elias P: Testosterone perturbs epidermal permeability barrier homeostasis. J Invest Dermatol 2001;116:443–451.
  21. Schaefer H, Lademann J: The role of follicular penetration. Skin Pharmacol 2001;24(suppl 1):23–27.

    External Resources

  22. Barth JH: The hair in infancy and childhood; in Rook A, Dawber R (eds): Diseases of the Hair and Scalp. London, Blackwell Science, 1991, pp 51–56.
  23. Montagna W: The Structure and Function of Skin. New York, Academic Press, 1962.
  24. Holbrook K, Odland G: Regional development of the human epidermis in the first trimester embryo and the second trimester fetus (ages related to the timing of aminocentesis and fetal biopsy). J Invest Dermatol 1980;80:161–168.
  25. Ersch J, Stallmach T: Assessing gestational age from histology of fetal skin: An autopsy study of 379 fetuses. Obstet Gynecol 1999;94:753–757.
  26. Serri F, Cerimele A: The embryology of human hair; in Orfanos C, Happle R (eds): Hair and Hair Diseases. Berlin, Springer, 1990, pp 1–17.
  27. Giacometti L: The anatomy of the human scalp; in Montagna W (ed): Advances in Biology of the Skin. Oxford, Pergamon Press, 1964, vol 6, p 97.
  28. Saadat M, Khan M, Gutberlet R, Heald F: Measurements of Hair in Normal Newborns. Pediatrics 1976;57:960–962.
  29. Tsambaos D, Nikiforidis G, Zografakis C, Mantagos S, Malamitis-Puchner A, Georgiou S, Monastirli A, Pasmatzi E: Mechanical behaviour of scalp hair in premature and full-term neonates. Skin Pharmacol 1997;10:303–308.
  30. Holbrook K, Smith L: Ultrastructural aspects of human skin during the embryonic, fetal, premature, neonatal, and adult periods of life. Birth Defects Orig Artic Ser 1981;17:9–38.
  31. Harpin VA, Rutter N: Sweating in preterm babies. J Pediatr 1982;100:614–619.
  32. Goldsmith L: Biology of eccrine and apocrine sweat glands; in Irwin M, et al (eds): Fitzpatrick’s Dermatology in General Medicine, ed 5. New York, McGraw Hill, 1999, vol 1, pp 155–163.
  33. Murakami M, Ohtake T, Dorschner R, Schittek B, Garbe C, Gallo R: Cathelicidin antimicrobial peptide expression in sweat. An innate defense system for the skin. J Invest Dermatol 2002;119:1090–1095.
  34. Williams M, Hincenbergs M, Holbrook K: Skin lipid content during early fetal development. J Invest Dermatol 1988;91:263–268.
  35. Agache P, Blanc D, Barrand C, Laurent R: Sebum levels during the first year of life. Br J Dermatol 1980;103:643–649.
  36. Henderson CA, Taylor J, Cunliffe WJ: Sebum excretion rates in mothers and neonates. Br J Dermatol 2000;142:110–111, 2000.
  37. Stewart M, Quinn M, Downing D: Variability in the fatty acid composition of wax esters from vernix caseosa and its possible relation to sebaceous gland activity. J Invest Dermatol 1982;78:291–285.
  38. Hoeger P, Schreiner V, Klaassen IA, Enzmann C, Friedrichs K, Bleck O: Epidermal barrier lipids in human vernix caseosa: Corresponding ceramide pattern in vernix and fetal skin. Br J Dermatol 2002;146:194–201.
  39. Hoath S, Pickens W: The biology of the vernix; in Hoath SB, Maibach HI (eds): Neonatal Skin: Structure and Function. New York, Marcel Dekker, 2003, pp 193–210.
  40. Sator P, Schmidt J, Hönigsmann H: Comparison of epidermal hydration and skin surface lipids in healthy individuals and in patients with atopic dermatitis. J Am Acad Dermatol 2003;48:352–358.
  41. Downing D, Stewart M, Wertz P, Colton S, Abraham W, Strauss J: Skin lipids: An update. J Invest Dermatol 1987;88:2s–8s.

    External Resources

  42. Metze D, Jurecka W, Gebhart W, Schmidt J, Mainitz M, Niebauer G: Immunohistochemical demonstration of immunoglobulin A in human sebaceous and sweat glands. J Invest Dermatol 1988;91:13–17.
  43. Thody A, Shuster S: Control and function of sebaceous glands. Physiol Rev 1989;69:383–416.
  44. Wille J, Kydonieus A: Palmitoleic acid isomer (C16:1delta6) in human skin sebum is effective against gram-positive bacteria. Skin Pharmacol Appl Skin Physiol 2003;16:176–187.
  45. Packer L, Valacchi G: Antioxidants and the response of skin to oxidative stress: Vitamin E as a key indicator. Skin Pharmacol Appl Skin Physiol 2002;15:282–290.
  46. Ramasastry P, Downing D, Pochi P, Strauss J: Chemical composition of human skin surface lipids from birth to puberty. J Invest Dermatol 1970;54:139–144.
  47. Downing DT, Stewart M, Strauss J: Changes in sebum secretion and the sebaceous gland. Dermatol Clin 1986;4:419–423.
  48. Yamamoto A, Serizawa S, Ito M, Sato Y: Effect of aging on sebaceous gland activity and on the fatty acid composition of wax esters. J Invest Dermatol 1987;89:507–512.
  49. Stewart M, Downing D: Unusual cholesterol esters in the sebum of young children. J Invest Dermatol 1990;95:603–606.
  50. Schaefer H, Redelmeier T: Skin Barrier: Principles of Percutaneous Absorption. Basel, Karger, 1996.
  51. Holbrook KA: A histologic comparison of infant and adult skin; in Maibach H, Boisets KE (eds): Neonatal Skin, Structure, and Function. New York, Marcel Dekker, 1982, pp 3–31.
  52. Fairley J, Rasmussen J: Comparison of stratum corneum thickness in children and adults. J Am Acad Dermatol 1983;8:652–654.
  53. Tan CY, Statham B, Marks R, Payne P: Skin thickness measurement by pulsed ultrasound: Its reproducibility, validation and variability. Br J Dermatol 1982;106:657–667.
  54. Zhen Y, Suetake T, Tagami H: Numbers of cell layers of the stratum corneum in normal skin – Relationship to the anatomical location on the body, age, sex, and physical parameters. Arch Dermatol Res 1999;291:555–559.
  55. Gammal S, Gammel C, Kaspar K, Pieck C, Altmeyer P, Vogt M, Ermert H: Sonography of the skin at 100 MHz Enables in vivo visualization of stratum corneum and viable epidermis in palmar skin and psoriatic plaques. J Invest Dermatol 1999;113:821–829.
  56. Rippke F, Schreiner V, Schwanitz HJ: The acidic milieu of the horny layer. Am J Clin Dermatol 2002;3:261–272.
  57. Chikakane K, Takahashi K: Measurement of skin pH and its significance in cutaneous diseases. Clin Dermatol 1995;13:299–306.
  58. König-Eberlein B, Schäfer T, Huss-Marp J, Darsow M, Möhrenschlager, Herbert O, Abeck D, Krämer U, Behrendt H, Ring J: Skin surface pH, stratum corneum hydration, trans-epidermal water loss and skin roughness related to atopic eczema and skin dryness in a population of primary school children. Acta Derm Venereol 2000;80:188–191.
  59. Dikstein S, Zlotogorski A: Measurement of skin pH. Acta Derm Venereol Suppl (Stockh) 1994;185:18–20.
  60. Braun-Falco O, Korting HC: Normal pH value of human skin. Hautarzt 1986;37:126–129.
  61. Fluhr JW, Pfisterer S, Gloor M: Direct comparison of skin physiology in children and adults with bioengineering methods. Pediatr Dermatol 2000;17:436–439.
  62. Giusti F, Martella A, Bertoni L, Seidenari S: Skin barrier, hydration, and pH of the skin of infants under 2 years of age. Pediatr Dermatol 2001;18:93–96.
  63. Fox C, Nelson D, Wareham J: The timing of skin acidification in very low birth weight infants. J Perinatol 1998;18:272–275.
  64. Green M, Bernard C, Behrendt H: Physiologic skin pH patterns in infants of low birth weight. The onset of acidification. Am J Dis Child 1968;115:9–16.
  65. Behne M, Barry N, Hanson K, Aronchik I, Clegg R, Gratton E, Feingold K, Holleran W, Elias P, Mauro T: Neonatal development of the stratum corneum pH gradient: Localization and mechanisms leading to emergence of optimal barrier function. J Invest Dermatol 2003;120:998–1006.
  66. Gfatter R, Hackl P, Braun F: Effects of soap and detergents on skin surface pH, stratum corneum hydration and fat content in infants. Dermatology 1997;195:258–262.
  67. Korting H, Kober M, Mueller M, Braun-Falco O: Influence of repeated washings with soap and synthetic detergents on pH and resident flora of the skin of forehead and forearm. Acta Derm Venereol 1987;67:41–47.
  68. Behrendt H, Green M: Skin pH pattern in the newborn infant. Am J Dis Child 1958;95:35–49.
  69. Hoeger P, Enzmann C: Skin Physiology of the neonate and young infant: A prospective study of functional skin parameters during early infancy. Pediatr Dermatol 2002;19:256–262.
  70. Corneometer CM825 product information:
  71. Sato J, Yanai M, Hirao T: Water content and thickness of the stratum corneum contribute to skin surface morphology. Arch Dermatol Res 2000;292:412–417.
  72. Pierard GE, Goffin V, Hermanns-Le T, Pierard-Franchumont C: Corneocyte desquamation. Int J Mol Med 1991;6:217–221.
  73. Engelke M, Jensen JM, Ekanayake-Mudiyanselage S, Proksch E: Effects of xerosis and aging on epidermal proliferation and differentiation. Br J Dermatol 1997;137:219–225.
  74. Berardesca E, Maibach H: Transepidermal water loss and skin surface hydration in the noninvasive assessment of stratum corneum function. Derm Beruf Umwelt 1990;38:50–53.
  75. Berardesca E, Fideli D, Borroni G, Rabbiosi G, Maibach H: In vivo hydration and water-retention capacity of stratum corneum in clinically uninvolved skin in atopic and psoriatic patients. Acta Derm Venereol 1990;70:400–404.
  76. Watanabe M, Tagami H, Horii I, Takahashi M, Kligman AM: Functional analyses of the superficial stratum corneum in atopic xerosis. Arch Dermatol 1991;127:1689–1692.
  77. Warner R, Stone KJ, Boissy Y: Hydration disrupts human stratum corneum ultrastructure. J Invest Dermatol 2003;120:275–284.
  78. Held E, Agner T: Effect of moisturizers on skin susceptibility to irritants. Acta Derm Venereol 2001;81:104–107.
  79. Yosipovitch G, Maayan-Metzger A, Merlob P, Sirota L: Skin barrier properties in different body areas in neonates. Pediatrics 2000;106:105–108.
  80. Loden M, Lindberg M: The influence of a single application of different moisturizers on the skin capacitance. Acta Derm Venereol 1991;71:79–82.
  81. Nopper A, Horii K, Sookdeo-Drost S: Topical ointment therapy benefits premature infants. J Pediatr 1996;128:660–669.
  82. Hammarlund K, Nilsson GE, Oberg P, Sedin G: Transepidermal water loss in newborn infants. 1. Relation to ambient humidity and site of measurement and estimation of total transepidermal water loss. Acta Paediatr Scand 1977;66:553–562.

    External Resources

  83. Sedin G, Hammarlund K, Nilsson G, Strömberg B, Öberg A: Measurements of transepidermal water loss in newborn infants. Clin Perinatol 1985;12:79–99.
  84. Hammarlund K, Nilsson G, Oberg P, Sedin G: Transepidermal water loss in newborn infants. 2. Relation to activity and body temperature. Acta Paediatr Scand 1979;68:371–376.
  85. Hammarlund K, Sedin G: Transepidermal water loss in newborn infants. 3. Relation to gestational age. Acta Paediatr Scand 1979;68:795–801.
  86. Hammarlund K, Sedin G: Transepidermal water loss in newborn infants. 4. Small for gestational age infants. Acta Paediatr Scand 1980;69:377–383.
  87. Sedin G, Hammarlund K, Strömberg B: Transepidermal water loss in full-term and pre-term infants. Acta Paediatr Scand Suppl 1983;305:27–31.
  88. Rutter N, Hull D: Water loss from the skin of term and preterm babies. Arch Dis Child 1979;54:858–868.
  89. Kalia Y, Nonato L, Lund H, Guy R: Development of skin barrier function in premature infants. J Invest Dermatol 1998;111:320–326.
  90. Ägren J, Sjörs G, Sedin G: Transepidermal water loss in infants born at 24 and 25 weeks of gestation. Acta Paediatr 1998;87:1185–1190.
  91. Harpin VA, Rutter N: Barrier Properties of Newborn Skin. J Pediatr 1983;103:419–425.

    External Resources

  92. Rutter N: Percutaneous drug absorption in the newborn: Hazards and uses. Clin Perinatol 1987;14:911–930.
  93. Nachman R, Esterly N: Increased skin permeability in preterm infants. J Pediatr 1971;79:628–632.
  94. West D, Halket J, Harvey D, Hadgraft J, Phil D, Solomon L, Harper J: Percutaneous absorption in preterm infants. Pediatric Dermatol 1987;4:234–237.
  95. Barrett D, Rutter N: Transdermal delivery and the premature neonate. Crit Rev Ther Drug Carrier Syst 1994;11:1–10.
  96. Reed J, Ghadially R, Elias P: Skin type, but neither race nor gender, influence epidermal permeability barrier function. Arch Dermatol 1995;131:1134–1138.
  97. Kompaore R, Marty J, Dupont C: In vivo evaluation of the stratum corneum barrier function in blacks, Caucasians and Asians with two noninvasive methods. Skin Pharmacol 1993;6:200–207.
  98. Wildnauer R, Kennedy R: Transepidermal water loss of human newborns. J Invest Dermatol 1970;54:483–486.

    External Resources

  99. Cunico R, Maibach H, Khan H, Bloom E: Skin barrier properties in the newborn. Biol Neonate 1977;32:177–182.
  100. Örsmark K, Wilson D, Maibach H: In vivo transepidermal water loss and epidermal occlusive hydration in newborn infants: Anatomical region variation. Acta Derm Venereol 1980;60:403–407.
  101. Wilson D, Maibach H: Transepidermal water loss in vivo. Biol Neonate 1980;37:180–185.
  102. Saijo S, Tagami H: Dry skin of newborn infants: Functional analysis of the stratum corneum. Pediatr Dermatol 1991;8:155–159.

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