Citation: Fatma Akpinar, Ayla Balci, Gulcan Ozomay, Ayca Sozen, Esra Kotan, Gulendam Kocak, Feyzullah Cetinkaya. Baby-skin care habits from different socio-economic groups and its impact on the development of atopic dermatitis[J]. AIMS Allergy and Immunology, 2018, 2(1): 1-9. doi: 10.3934/Allergy.2018.1.1
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Barrier function of the skin begins to develop in the prenatal period and undergoes substantial development within the first year of life [1]. Epidermal barrier has immunological and antioxidant functions as well as tasks including defense against infections, protection from ultraviolet rays, and modulation of water balance of the skin. Many of these functions occur in the stratum corneum. The disruption of the structural and functional integrity of the stratum corneum leads to xerotic and eczematous skin changes in atopic dermatitis [2]. In addition, environmental factors such as skin care and cleaning routines also create skin barrier damage and result in development of atopic dermatitis [3]. Infant skin is more prone to the development of irritant or allergic contact dermatitis than adult skin [4]. For this reason, age-appropriate skin care is very important. Skin care practices of children vary among communities and are based on experience, tradition and culture.
In this study, we aimed to detect the skin care habits of children in different socioeconomic groups, and to investigate the effects of these habits in development of diaper dermatitis and atopic dermatitis.
This cross-sectional study was conducted in three hospitals where children from three different socio-economic groups admit in Istanbul between January–June 2014. The hospitals were Sisli Pediatric Education and Research Hospital (Group Ⅰ, lower socio-economic group), Maltepe University Hospital (Group Ⅱ, middle socio-economic group), and Istanbul Acibadem International Hospital (Group Ⅲ, higher socio-economic group).
Mothers of children under 2 years of age were recruited from the pediatric outpatient departments of these hospitals. A questionnaire with 38 items related to demographic variables, feeding habits, and baby-skin care were distributed to the mothers and asked to fill at sight (Table 1).
| Questions in the questionnaire |
| 1. Do you breastfeed your child currently? |
| 2. How long have you been breastfeeding (months)? |
| 3. How long have you been breastfeeding with addional food (months)? |
| 4. If you don't breastfeed nowadays, what is the main food for your child? |
| 5. From whom have you got the information to care your baby? |
| 6. How often do you bath your child? |
| 7. Which products do you use for your child's bath? |
| 8. Which products do you use for your child's skin after bath? |
| 9. Which products do you use for cleaning the diaper area of your child? |
| 10. When has your child experienced the first diaper dermatitis? |
| 11. When has your child experienced the last diaper dermatitis? |
| 12. How often does he/she have diaper dermatitis? |
| 13. Have you changed your diaper care habits for this child according to your older children? |
| 14. If you have changed your diaper care habits, why? |
| 15. Which products do you use to prevent the development of diaper dermatitis? |
| 16. Which products do you use for the treatment of diaper dermatitis? |
| 17. What are the sources of your information for the care of diaper dermatitis? |
| 18. What type of detergents do you use to wash the clothes of the child? |
| 19. Has your child ever had pruritic skin dryness especially in the cheeks and extansor sides of the extremities? |
| 20. Is there any allergic disease in your family? |
| 21. Has your child ever been diagnosed as asthma or atopic dermatitis by a medical doctor? |
| 22. Has your child ever taken vitamin D? Does he/she take currently? |
DownLoad: CSVThe study protocol was approved by the ethical committee of Maltepe University Faculty of Medicine.
Definitive statistics were expressed as mean ± standard deviation for continuously measured variables, and as case number and (%) for nominal variables. Fisher's exact mid-P method was used to compare the effects of the categorical variables on the development of atopic dermatitis, and t-test was used for continuous variables. P ≤ 0.05 was considered significant for both cases. Statistical analyses were performed using Matlab R2012a.
A total of 207 children, 69 from group Ⅰ, 92 from group Ⅱ, and 46 from group Ⅲ were included into the study. Male/female ratio was similar in all three groups, and mean age was 8.48, 8.74, and 10.98 months, respectively (Table 2).
| Group Ⅰ (n = 69) | Group Ⅱ (n = 92) | Group Ⅲ (n = 46) | |
| Mean age (months) | 8.74 | 10.98 | 8.48 |
| Female, n (%) | 28 (41) | 39 (42) | 25 (54) |
| Male, n (%) | 41 (59) | 53 (58) | 21 (46) |
| Group Ⅰ vs Ⅱ | Group Ⅰ vs Ⅲ | Group Ⅱ vs Ⅲ | |
| OR | 0.93 | 0.57 | 0.62 |
| Fisher's exact p-mid | 0.41 | 0.08 | 0.09 |
| Type of delivery, n (%) | |||
| Spontaneous delivery | 35 (50.7) | 10 (10.9) | 12 (26.1) |
| Caesarean section | 34 (49.3) | 82 (89.1) | 34 (73.9) |
| Group Ⅰ vs Ⅱ | Group Ⅰ vs Ⅲ | Group Ⅱ vs Ⅲ | |
| OR | 8.44 | 2.91 | 0.34 |
| Fisher's exact p-mid | 0.0001 | 0.0045 | 0.0141 |
| Mean gestational age (weeks) | 38.8 | 38.4 | 38.4 |
| Mean birthweight (gr) | 3146.8 | 3261.5 | 3121.9 |
| Mean height at birth (cm) | 49.5 | 49.7 | 49.6 |
| Mean head circumference at birth (cm) | 34.8 | 35.1 | 34.4 |
| Proportion of breastfeeding, n (%) | |||
| Yes | 67 (97.1) | 91 (98.9) | 45 (97.8) |
| No | 2 (2.9) | 1 (1.1) | 1 (2.2) |
| Vitamin D intake, n (%) | |||
| Yes | 66 (95.7) | 92 (100) | 43 (93.5) |
| No | 3 (4.3) | 0 (0) | 3 (6.5) |
| Physician diagnosed atopic dermatitis, n (%) | 6 (9) | 9 (9) | 9 (19) |
| Group Ⅰ vs Ⅱ | Group Ⅰ vs Ⅲ | Group Ⅱ vs Ⅲ | |
| OR | 0.88 | 0.39 | 0.45 |
| Fisher's exact p-mid | 0.41 | 0.05 | 0.06 |
| Diaper dermatitis, n (%) | 49 (71) | 44 (48) | 30 (65) |
| Group Ⅰ vs Ⅱ | Group Ⅰ vs Ⅲ | Group Ⅱ vs Ⅲ | |
| OR | 2.67 | 1.30 | 0.48 |
| Fisher's exact p-mid | 0.0017 | 0.25 | 0.03 |
| Age of mother (yr), n (%) | |||
| ≤20 | 3 (4.3) | 0 (0) | 0 (0) |
| 21–30 | 37 (53.6) | 36 (43.9) | 21 (45.7) |
| 31–40 | 26 (37.7) | 49 (59.8) | 24 (52.2) |
| 41–50 | 3 (4.3) | 7 (8.5) | 1 (2.2) |
| Educational status of the mother, n (%) | |||
| Illiterate | 11 (15.9) | 0 (0) | 0 (0) |
| Primary school | 26 (37.7) | 7 (8.5) | 3 (6.5) |
| Secondary school | 14 (20.3) | 9 (11) | 0 (0) |
| High school | 14 (20.3) | 17 (20.7) | 12 (26.1) |
| University | 4 (5.8) | 59 (72) | 31 (67.4) |
| Age of father (yr), n (%) | |||
| 21–30 | 31 (44.9) | 15 (18.3) | 3 (6.5) |
| 31–40 | 27 (39.1) | 60 (73.2) | 37 (80.4) |
| 41–50 | 11 (15.9) | 14 (17.1) | 5 (10.9) |
| ≥51 | 0 (0) | 3 (3.7) | 1 (2.2) |
| Educational status of the father, n (%) | |||
| Illiterate | 3 (4.3) | 0 (0) | 0 (0) |
| Primary school | 31 (44.9) | 6 (7.3) | 3 (6.5) |
| Secondary school | 10 (14.5) | 7 (8.5) | 2 (4.3) |
| High school | 22 (31.9) | 21 (25.6) | 10 (21.7) |
| University | 3 (4.3) | 58 (70.7) | 31 (67.4) |
| Allergic disease in the family, n (%) | |||
| Yes | 24 (34.8) | 42 (45.7) | 25 (54.3) |
| No | 45 (65.2) | 50 (54.3) | 21 (45.7) |
| Group Ⅰ vs Ⅱ | Group Ⅰ vs Ⅲ | Group Ⅱ vs Ⅲ | |
| OR | 0.63 | 0.44 | 0.70 |
| Fisher's exact p-mid | 0.08 | 0.02 | 0.17 |
DownLoad: CSVAtopic dermatitis was detected in 19% of children in group Ⅲ, and 9% of children in groups Ⅰ and Ⅱ (p > 0.05) (Table 2). Atopic dermatitis was higher in females in group Ⅲ (24%), while it was higher in males from other groups (13% and 10%, respectively, p = 0.05). Family history of allergic disease was found to be higher in children with atopic dermatitis compared to those without atopic dermatitis (p < 0.05).
There was no statistically significant difference between children with and without atopic dermatitis in terms of gestational age, type of delivery, birth weight, age of mother, education level of mother, age of father, education level of father in all 3 groups (p > 0.05) (Table 3).
| Atopic Cases | Non-atopic Cases | ||
| Gestational age | Mean StdDev | Mean StdDev | p (t-test) |
| 38.8, 1.28 | 38.59, 2 | 0.326 | |
| Type of delivery, n | OR Fisher's exact p-mid | ||
| Spontaneous delivery | 8 | 49 | 1.37, 0.256 |
| Caesarean section | 16 | 134 | |
| Birth weight | Mean StdDev | Mean StdDev | p (t-test) |
| 3238.3,314.82 | 3186.7,538.97 | 0.323 | |
| Age of mother (Years) | OR Fisher's exact p-mid | ||
| ≤30 | 10 | 87 | 0.79, 0.299 |
| > 30 | 14 | 96 | |
| Education level of mother, n | OR Fisher's exact p-mid | ||
| University | 8 | 86 | 0.56, 0.107 |
| High school and others | 16 | 97 | |
| Age of father (Years) | OR Fisher's exact p-mid | ||
| ≤30 | 5 | 44 | 0.83, 0.379 |
| > 30 | 19 | 139 | |
| Education level of father, n | OR Fisher's exact p-mid | ||
| University | 13 | 79 | 1.55, 0.159 |
| High school and others | 11 | 104 | |
| StdDev: Standart Deviation | |||
DownLoad: CSVMean age for diaper dermatitis was 3.68 months in group Ⅲ, 2.89 months in group Ⅱ, and 2.63 months in group Ⅰ. The proportion of children who had "less or none" diaper dermatitis was significantly lower in group Ⅲ (61%) compared to group Ⅱ (91%, p < 0.05) and group Ⅰ (72%, p = 0.05).
Frequency of using wet wipes for diaper care was not statistically different among groups, but was statistically lower in atopic children (38%) compared to non-atopic children (56%) (OR = 0.48, p = 0.05) (Table 4). Using soap with water was found to be more frequent in group Ⅲ (30%) than in group Ⅱ (1%) and group Ⅰ (8%). Using dexpanthenol as a preventive product for diaper rash was significantly higher in children with atopic dermatitis (24%) compared to those without atopic dermatitis (8%) (OR = 3.73, p = 0.012). The proportion of not using any preventive product for diaper rash was lower in children with atopic dermatitis (7%) compared to those without atopic dermatitis (16%) (OR = 0.48, p = 0.178), and this proportion was higher in group Ⅰ (29%) than that of group Ⅱ (5%) and group Ⅲ (4%). Using of dexpanthenol for diaper rash was significantly more frequent in children with atopic dermatitis (40%) compared to those without atopic dermatitis (25%) (OR = 2.13, p = 0.05). A mixture of steroid and antifungal agents in group Ⅲ (26%), Hamamelis virginiana distillate in group Ⅱ (27%) and powder in group Ⅰ (21%) were detected to be used more frequently.
| Atopic Cases N% | Non-atopic Cases N% | OR (95% CI) Fisher's exact p-mid | |
| Wet wipes for diaper care (line number deleted) | |||
| Yes | 9 (38%) | 102 (56%) | 0.48, 0.05 |
| No | 15 (62%) | 81 (44%) | |
| Using dexpanthenol preventive | |||
| Yes | 6 (24%) | 15 (8%) | 3.73, 0.012 |
| No | 18 (76%) | 168 (92%) | |
| No using preventive products | |||
| Yes | 2 (7%) | 29 (16%) | 0.48, 0.178 |
| No | 22 (93%) | 154 (84%) | |
| Use dexpanthenol for diaper rash | |||
| Yes | 10 (40%) | 46 (25%) | 2.13, 0.05 |
| No | 14 (60%) | 137 (75%) | |
| Using soap powder as washing product | |||
| Yes | 13 (54%) | 64 (35%) | 2.20, 0.05 |
| No | 11 (46%) | 119 (65%) |
DownLoad: CSVThere was not any difference between the groups in terms of bath products. The percent of not using any care products after bath was found to be lower in children with atopic dermatitis (8%). The frequency of using olive oil after bath was not found statistically different between children with and without atopic dermatitis, was found similar in group Ⅲ and group Ⅰ (11% and 15%, respectively).
Soap powder as washing product was detected to be used more frequently in children with atopic dermatitis (54%) compared to those without atopic dermatitis (35%) (OR = 2.20, p = 0.05) (Table 4).
The mothers from groups Ⅱ and Ⅲ learned baby care mostly from pediatricians (29% and 35%, respectively), and group Ⅰ learned from the grandmothers (28%). All three groups learned diaper care products mostly from the pediatricians (33%).
It was found that all children in this study had used vitamin D except six children without atopic dermatitis.
Atopic dermatitis is a chronic, inflammatory skin disease resulting from the interaction between the skin barrier and genetic, environmental, pharmacological and immunological factors [5]. It has been shown that about 20% of newborns develop atopic dermatitis within the first 6 months of life [6]. In a study of 373 infants, development of atopic dermatitis was reported within the first 2 years of life [7]. The development of atopic dermatitis is a result of the interaction between genetic and environmental factors, with the indication of family history in several studies [8,9]. In our study, a family history of allergic disease made a statistically significant difference.
Skin dryness is a common feature of atopic dermatitis and results from disruption of normal skin barrier. Proteases provide normal desquamation in low pH values and their function increases in high pH values of stratum corneum. In addition, lipid regulating enzymes decrease. Water loss through skin and decrease in surface lipids results in disruption of structure of stratum corneum [8]. Considering that the frequency of hospital admissions because of atopic dermatitis increased from year to year, protective and preventive recommendations in addition to treatment also become important [8,9,10]. Guidelines recommend using emollients after bathing of the babies who carry the risk of atopic dermatitis [6]. Consistent with this knowledge, our study showed that the proportion of not using any care products after bathing was significantly lower in children with atopic dermatitis.
In this study, the least incidence of the children without diaper dermatitis in group Ⅲ might be due to less incidence of atopic dermatitis in this hospital and an increased risk of the development of irritant contact dermatitis. Additionally, the proportion of not using any rash prevention products was found to be lower in group Ⅲ and in children with atopic dermatitis.
Olive oil has been shown to cause erythema in skin by disrupting the integrity of the stratum corneum [11]. Despite coming from very different socio-economic environments, Group Ⅰ and Group Ⅲ reported that they were using olive oil to moisturize the skin of their children at similar rates, but their children had different incidences of atopic dermatitis. These results suggest that olive oil is traditionally known by all segments of society in our country and trusted because it is natural, and the development of atopic dermatitis is mainly determined by genetic factors.
Although cleaning the diaper area with water and cotton, towel or cloth is the gold standard, disposable wet wipes has become a practical alternative in recent years. Even wet wipes with acidic pH containing emollient cleanser and not containing alcohol and detergent were reported to protect skin barrier better than water and cloth [12]. Using soap with water was found more frequent in the group Ⅲ. This may be associated with the hard water. Some studies had found that water hardness is a risk factor for atopic dermatitis in children [13,14,15]. Although baby powder is not recommended because of the risk of inhalation and irritant contact dermatitis [16], some of the mothers in our study reported that they had used it regularly. Barrier paste is recommended to be used in every diaper exchange to treat and prevent diaper dermatitis. It protects the skin from the moisture and the irritants by forming a lipid layer on the skin. It contains mainly zinc oxide, petrolatum or both [17]. In spite of this fact, we found that dexpanthenol had been used most commonly by the mothers to prevent and treat diaper dermatitis in our study. Dexpanthenol increases water content of stratum corneum and decreases inflammation [18].
This study has some limitations: Firstly, we have no control of potential confounders. Secondly, the study has small power to detect significant differences of risk factors. The third limitation is that the participation rate is not indicated.
Differences between the groups in terms of sources of information for babysitting lead to the different approaches in babysitting and suggest that environmental factors may be important as well as genetic factors in the development of atopic dermatitis.
Frequency of atopic dermatitis was found to be higher among children of families coming from higher socioeconomic group. In addition, skin care after bath seems important in the development of atopic dermatitis.
All authors declare no conflicts of interest in this paper.
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Fatma Akpinar, Ayla Balci, Gulcan Ozomay, Ayca Sozen, Esra Kotan, Gulendam Kocak, Feyzullah Cetinkaya. Baby-skin care habits from different socio-economic groups and its impact on the development of atopic dermatitis[J]. AIMS Allergy and Immunology, 2018, 2(1): 1-9. doi: 10.3934/Allergy.2018.1.1
| Questions in the questionnaire |
| 1. Do you breastfeed your child currently? |
| 2. How long have you been breastfeeding (months)? |
| 3. How long have you been breastfeeding with addional food (months)? |
| 4. If you don't breastfeed nowadays, what is the main food for your child? |
| 5. From whom have you got the information to care your baby? |
| 6. How often do you bath your child? |
| 7. Which products do you use for your child's bath? |
| 8. Which products do you use for your child's skin after bath? |
| 9. Which products do you use for cleaning the diaper area of your child? |
| 10. When has your child experienced the first diaper dermatitis? |
| 11. When has your child experienced the last diaper dermatitis? |
| 12. How often does he/she have diaper dermatitis? |
| 13. Have you changed your diaper care habits for this child according to your older children? |
| 14. If you have changed your diaper care habits, why? |
| 15. Which products do you use to prevent the development of diaper dermatitis? |
| 16. Which products do you use for the treatment of diaper dermatitis? |
| 17. What are the sources of your information for the care of diaper dermatitis? |
| 18. What type of detergents do you use to wash the clothes of the child? |
| 19. Has your child ever had pruritic skin dryness especially in the cheeks and extansor sides of the extremities? |
| 20. Is there any allergic disease in your family? |
| 21. Has your child ever been diagnosed as asthma or atopic dermatitis by a medical doctor? |
| 22. Has your child ever taken vitamin D? Does he/she take currently? |
DownLoad: CSV| Group Ⅰ (n = 69) | Group Ⅱ (n = 92) | Group Ⅲ (n = 46) | |
| Mean age (months) | 8.74 | 10.98 | 8.48 |
| Female, n (%) | 28 (41) | 39 (42) | 25 (54) |
| Male, n (%) | 41 (59) | 53 (58) | 21 (46) |
| Group Ⅰ vs Ⅱ | Group Ⅰ vs Ⅲ | Group Ⅱ vs Ⅲ | |
| OR | 0.93 | 0.57 | 0.62 |
| Fisher's exact p-mid | 0.41 | 0.08 | 0.09 |
| Type of delivery, n (%) | |||
| Spontaneous delivery | 35 (50.7) | 10 (10.9) | 12 (26.1) |
| Caesarean section | 34 (49.3) | 82 (89.1) | 34 (73.9) |
| Group Ⅰ vs Ⅱ | Group Ⅰ vs Ⅲ | Group Ⅱ vs Ⅲ | |
| OR | 8.44 | 2.91 | 0.34 |
| Fisher's exact p-mid | 0.0001 | 0.0045 | 0.0141 |
| Mean gestational age (weeks) | 38.8 | 38.4 | 38.4 |
| Mean birthweight (gr) | 3146.8 | 3261.5 | 3121.9 |
| Mean height at birth (cm) | 49.5 | 49.7 | 49.6 |
| Mean head circumference at birth (cm) | 34.8 | 35.1 | 34.4 |
| Proportion of breastfeeding, n (%) | |||
| Yes | 67 (97.1) | 91 (98.9) | 45 (97.8) |
| No | 2 (2.9) | 1 (1.1) | 1 (2.2) |
| Vitamin D intake, n (%) | |||
| Yes | 66 (95.7) | 92 (100) | 43 (93.5) |
| No | 3 (4.3) | 0 (0) | 3 (6.5) |
| Physician diagnosed atopic dermatitis, n (%) | 6 (9) | 9 (9) | 9 (19) |
| Group Ⅰ vs Ⅱ | Group Ⅰ vs Ⅲ | Group Ⅱ vs Ⅲ | |
| OR | 0.88 | 0.39 | 0.45 |
| Fisher's exact p-mid | 0.41 | 0.05 | 0.06 |
| Diaper dermatitis, n (%) | 49 (71) | 44 (48) | 30 (65) |
| Group Ⅰ vs Ⅱ | Group Ⅰ vs Ⅲ | Group Ⅱ vs Ⅲ | |
| OR | 2.67 | 1.30 | 0.48 |
| Fisher's exact p-mid | 0.0017 | 0.25 | 0.03 |
| Age of mother (yr), n (%) | |||
| ≤20 | 3 (4.3) | 0 (0) | 0 (0) |
| 21–30 | 37 (53.6) | 36 (43.9) | 21 (45.7) |
| 31–40 | 26 (37.7) | 49 (59.8) | 24 (52.2) |
| 41–50 | 3 (4.3) | 7 (8.5) | 1 (2.2) |
| Educational status of the mother, n (%) | |||
| Illiterate | 11 (15.9) | 0 (0) | 0 (0) |
| Primary school | 26 (37.7) | 7 (8.5) | 3 (6.5) |
| Secondary school | 14 (20.3) | 9 (11) | 0 (0) |
| High school | 14 (20.3) | 17 (20.7) | 12 (26.1) |
| University | 4 (5.8) | 59 (72) | 31 (67.4) |
| Age of father (yr), n (%) | |||
| 21–30 | 31 (44.9) | 15 (18.3) | 3 (6.5) |
| 31–40 | 27 (39.1) | 60 (73.2) | 37 (80.4) |
| 41–50 | 11 (15.9) | 14 (17.1) | 5 (10.9) |
| ≥51 | 0 (0) | 3 (3.7) | 1 (2.2) |
| Educational status of the father, n (%) | |||
| Illiterate | 3 (4.3) | 0 (0) | 0 (0) |
| Primary school | 31 (44.9) | 6 (7.3) | 3 (6.5) |
| Secondary school | 10 (14.5) | 7 (8.5) | 2 (4.3) |
| High school | 22 (31.9) | 21 (25.6) | 10 (21.7) |
| University | 3 (4.3) | 58 (70.7) | 31 (67.4) |
| Allergic disease in the family, n (%) | |||
| Yes | 24 (34.8) | 42 (45.7) | 25 (54.3) |
| No | 45 (65.2) | 50 (54.3) | 21 (45.7) |
| Group Ⅰ vs Ⅱ | Group Ⅰ vs Ⅲ | Group Ⅱ vs Ⅲ | |
| OR | 0.63 | 0.44 | 0.70 |
| Fisher's exact p-mid | 0.08 | 0.02 | 0.17 |
DownLoad: CSV| Atopic Cases | Non-atopic Cases | ||
| Gestational age | Mean StdDev | Mean StdDev | p (t-test) |
| 38.8, 1.28 | 38.59, 2 | 0.326 | |
| Type of delivery, n | OR Fisher's exact p-mid | ||
| Spontaneous delivery | 8 | 49 | 1.37, 0.256 |
| Caesarean section | 16 | 134 | |
| Birth weight | Mean StdDev | Mean StdDev | p (t-test) |
| 3238.3,314.82 | 3186.7,538.97 | 0.323 | |
| Age of mother (Years) | OR Fisher's exact p-mid | ||
| ≤30 | 10 | 87 | 0.79, 0.299 |
| > 30 | 14 | 96 | |
| Education level of mother, n | OR Fisher's exact p-mid | ||
| University | 8 | 86 | 0.56, 0.107 |
| High school and others | 16 | 97 | |
| Age of father (Years) | OR Fisher's exact p-mid | ||
| ≤30 | 5 | 44 | 0.83, 0.379 |
| > 30 | 19 | 139 | |
| Education level of father, n | OR Fisher's exact p-mid | ||
| University | 13 | 79 | 1.55, 0.159 |
| High school and others | 11 | 104 | |
| StdDev: Standart Deviation | |||
DownLoad: CSV| Atopic Cases N% | Non-atopic Cases N% | OR (95% CI) Fisher's exact p-mid | |
| Wet wipes for diaper care (line number deleted) | |||
| Yes | 9 (38%) | 102 (56%) | 0.48, 0.05 |
| No | 15 (62%) | 81 (44%) | |
| Using dexpanthenol preventive | |||
| Yes | 6 (24%) | 15 (8%) | 3.73, 0.012 |
| No | 18 (76%) | 168 (92%) | |
| No using preventive products | |||
| Yes | 2 (7%) | 29 (16%) | 0.48, 0.178 |
| No | 22 (93%) | 154 (84%) | |
| Use dexpanthenol for diaper rash | |||
| Yes | 10 (40%) | 46 (25%) | 2.13, 0.05 |
| No | 14 (60%) | 137 (75%) | |
| Using soap powder as washing product | |||
| Yes | 13 (54%) | 64 (35%) | 2.20, 0.05 |
| No | 11 (46%) | 119 (65%) |
DownLoad: CSV| Questions in the questionnaire |
| 1. Do you breastfeed your child currently? |
| 2. How long have you been breastfeeding (months)? |
| 3. How long have you been breastfeeding with addional food (months)? |
| 4. If you don't breastfeed nowadays, what is the main food for your child? |
| 5. From whom have you got the information to care your baby? |
| 6. How often do you bath your child? |
| 7. Which products do you use for your child's bath? |
| 8. Which products do you use for your child's skin after bath? |
| 9. Which products do you use for cleaning the diaper area of your child? |
| 10. When has your child experienced the first diaper dermatitis? |
| 11. When has your child experienced the last diaper dermatitis? |
| 12. How often does he/she have diaper dermatitis? |
| 13. Have you changed your diaper care habits for this child according to your older children? |
| 14. If you have changed your diaper care habits, why? |
| 15. Which products do you use to prevent the development of diaper dermatitis? |
| 16. Which products do you use for the treatment of diaper dermatitis? |
| 17. What are the sources of your information for the care of diaper dermatitis? |
| 18. What type of detergents do you use to wash the clothes of the child? |
| 19. Has your child ever had pruritic skin dryness especially in the cheeks and extansor sides of the extremities? |
| 20. Is there any allergic disease in your family? |
| 21. Has your child ever been diagnosed as asthma or atopic dermatitis by a medical doctor? |
| 22. Has your child ever taken vitamin D? Does he/she take currently? |
| Group Ⅰ (n = 69) | Group Ⅱ (n = 92) | Group Ⅲ (n = 46) | |
| Mean age (months) | 8.74 | 10.98 | 8.48 |
| Female, n (%) | 28 (41) | 39 (42) | 25 (54) |
| Male, n (%) | 41 (59) | 53 (58) | 21 (46) |
| Group Ⅰ vs Ⅱ | Group Ⅰ vs Ⅲ | Group Ⅱ vs Ⅲ | |
| OR | 0.93 | 0.57 | 0.62 |
| Fisher's exact p-mid | 0.41 | 0.08 | 0.09 |
| Type of delivery, n (%) | |||
| Spontaneous delivery | 35 (50.7) | 10 (10.9) | 12 (26.1) |
| Caesarean section | 34 (49.3) | 82 (89.1) | 34 (73.9) |
| Group Ⅰ vs Ⅱ | Group Ⅰ vs Ⅲ | Group Ⅱ vs Ⅲ | |
| OR | 8.44 | 2.91 | 0.34 |
| Fisher's exact p-mid | 0.0001 | 0.0045 | 0.0141 |
| Mean gestational age (weeks) | 38.8 | 38.4 | 38.4 |
| Mean birthweight (gr) | 3146.8 | 3261.5 | 3121.9 |
| Mean height at birth (cm) | 49.5 | 49.7 | 49.6 |
| Mean head circumference at birth (cm) | 34.8 | 35.1 | 34.4 |
| Proportion of breastfeeding, n (%) | |||
| Yes | 67 (97.1) | 91 (98.9) | 45 (97.8) |
| No | 2 (2.9) | 1 (1.1) | 1 (2.2) |
| Vitamin D intake, n (%) | |||
| Yes | 66 (95.7) | 92 (100) | 43 (93.5) |
| No | 3 (4.3) | 0 (0) | 3 (6.5) |
| Physician diagnosed atopic dermatitis, n (%) | 6 (9) | 9 (9) | 9 (19) |
| Group Ⅰ vs Ⅱ | Group Ⅰ vs Ⅲ | Group Ⅱ vs Ⅲ | |
| OR | 0.88 | 0.39 | 0.45 |
| Fisher's exact p-mid | 0.41 | 0.05 | 0.06 |
| Diaper dermatitis, n (%) | 49 (71) | 44 (48) | 30 (65) |
| Group Ⅰ vs Ⅱ | Group Ⅰ vs Ⅲ | Group Ⅱ vs Ⅲ | |
| OR | 2.67 | 1.30 | 0.48 |
| Fisher's exact p-mid | 0.0017 | 0.25 | 0.03 |
| Age of mother (yr), n (%) | |||
| ≤20 | 3 (4.3) | 0 (0) | 0 (0) |
| 21–30 | 37 (53.6) | 36 (43.9) | 21 (45.7) |
| 31–40 | 26 (37.7) | 49 (59.8) | 24 (52.2) |
| 41–50 | 3 (4.3) | 7 (8.5) | 1 (2.2) |
| Educational status of the mother, n (%) | |||
| Illiterate | 11 (15.9) | 0 (0) | 0 (0) |
| Primary school | 26 (37.7) | 7 (8.5) | 3 (6.5) |
| Secondary school | 14 (20.3) | 9 (11) | 0 (0) |
| High school | 14 (20.3) | 17 (20.7) | 12 (26.1) |
| University | 4 (5.8) | 59 (72) | 31 (67.4) |
| Age of father (yr), n (%) | |||
| 21–30 | 31 (44.9) | 15 (18.3) | 3 (6.5) |
| 31–40 | 27 (39.1) | 60 (73.2) | 37 (80.4) |
| 41–50 | 11 (15.9) | 14 (17.1) | 5 (10.9) |
| ≥51 | 0 (0) | 3 (3.7) | 1 (2.2) |
| Educational status of the father, n (%) | |||
| Illiterate | 3 (4.3) | 0 (0) | 0 (0) |
| Primary school | 31 (44.9) | 6 (7.3) | 3 (6.5) |
| Secondary school | 10 (14.5) | 7 (8.5) | 2 (4.3) |
| High school | 22 (31.9) | 21 (25.6) | 10 (21.7) |
| University | 3 (4.3) | 58 (70.7) | 31 (67.4) |
| Allergic disease in the family, n (%) | |||
| Yes | 24 (34.8) | 42 (45.7) | 25 (54.3) |
| No | 45 (65.2) | 50 (54.3) | 21 (45.7) |
| Group Ⅰ vs Ⅱ | Group Ⅰ vs Ⅲ | Group Ⅱ vs Ⅲ | |
| OR | 0.63 | 0.44 | 0.70 |
| Fisher's exact p-mid | 0.08 | 0.02 | 0.17 |
| Atopic Cases | Non-atopic Cases | ||
| Gestational age | Mean StdDev | Mean StdDev | p (t-test) |
| 38.8, 1.28 | 38.59, 2 | 0.326 | |
| Type of delivery, n | OR Fisher's exact p-mid | ||
| Spontaneous delivery | 8 | 49 | 1.37, 0.256 |
| Caesarean section | 16 | 134 | |
| Birth weight | Mean StdDev | Mean StdDev | p (t-test) |
| 3238.3,314.82 | 3186.7,538.97 | 0.323 | |
| Age of mother (Years) | OR Fisher's exact p-mid | ||
| ≤30 | 10 | 87 | 0.79, 0.299 |
| > 30 | 14 | 96 | |
| Education level of mother, n | OR Fisher's exact p-mid | ||
| University | 8 | 86 | 0.56, 0.107 |
| High school and others | 16 | 97 | |
| Age of father (Years) | OR Fisher's exact p-mid | ||
| ≤30 | 5 | 44 | 0.83, 0.379 |
| > 30 | 19 | 139 | |
| Education level of father, n | OR Fisher's exact p-mid | ||
| University | 13 | 79 | 1.55, 0.159 |
| High school and others | 11 | 104 | |
| StdDev: Standart Deviation | |||
| Atopic Cases N% | Non-atopic Cases N% | OR (95% CI) Fisher's exact p-mid | |
| Wet wipes for diaper care (line number deleted) | |||
| Yes | 9 (38%) | 102 (56%) | 0.48, 0.05 |
| No | 15 (62%) | 81 (44%) | |
| Using dexpanthenol preventive | |||
| Yes | 6 (24%) | 15 (8%) | 3.73, 0.012 |
| No | 18 (76%) | 168 (92%) | |
| No using preventive products | |||
| Yes | 2 (7%) | 29 (16%) | 0.48, 0.178 |
| No | 22 (93%) | 154 (84%) | |
| Use dexpanthenol for diaper rash | |||
| Yes | 10 (40%) | 46 (25%) | 2.13, 0.05 |
| No | 14 (60%) | 137 (75%) | |
| Using soap powder as washing product | |||
| Yes | 13 (54%) | 64 (35%) | 2.20, 0.05 |
| No | 11 (46%) | 119 (65%) |
