When considering cleansing skin, there are no significant differences between infant and adult skin. Infants produce skin surface lipids similar to adults, with a varied ratio of sebum to keratinocyte lipids compared to adults. During childhood these lipids are decreased. Starting in pre-adolescence, increases in circulating hormones (adrenal androgens followed by gonadal androgens) stimulate production of sebum. In many adolescents the increased sebum leads to more oily complexion and hair, contributing to acne and seborrhea [7].

Most studies on tolerance of skin care products have been in children with certain disease states such as atopic dermatitis. We lack evidence as to how often to bathe children with a normal skin barrier, what cleansers to use, how often to shampoo hair, and how often to use emollients. At this point we can only extrapolate information from studies on infants and children with skin barrier defects and atopic dermatitis to determine skin care for those children with normal skin. It must be considered that children with skin barrier defects have drier, more sensitive skin. Most soaps are made of animal or vegetable fats to remove dirt and oils and are alkaline in nature. Because the skin surface is acidic (acid mantle), synthetic detergents have been developed to protect the pH of the skin. The use of these neutral and even acidic pH cleansers are likely more important for children with skin barrier defects. Most normal children can tolerate the soap and shampoo their parents prefer to use [3, 7].

Sun protection throughout childhood and adolescence is important. Studies indicate that at least 25–50 % of lifetime sun exposure occurs before age 18 years. In the first 2 years of life melanin production is limited, and skin may be more susceptible to UV damage. After 2 years, the skin of a child is similar to an adults’ skin, however, the dermal papillae may be closer to the skin surface, leading to increased UV exposure to the basal layer. As children enter pre-adolescent ages they often become more independent in their skin care, so education of proper sun protection at that time is paramount to preventing damage from UV that can lead to skin cancers later in life [5].

To date there is not evidence that any of the sun filters used in sunscreen harm children, however, controversy exists over the safety of organic protectors such as oxybenzone (benzophenone-3). Studies have shown absorption of oxybenzone with excretion in the urine, however, no known adverse effects have been seen. Allergic contact dermatitis can develop to organic blockers, leading to advice to avoid them, especially in children with skin barrier defects. Risk is minimized by using inorganic sunscreens (zinc oxide and titanium dioxide), where even the micronized nanoparticle forms do not absorb systemically through the skin, and no cytotoxic or genotoxic effects have been found. The combination of N,N-dimethyl-meta-toluamide (DEET) insect repellent and sunscreen leads to increased absorption of the DEET. For this reason, the combination sunscreen-insect repellent products should be avoided, as well as concomitant application of both products. In addition, sunscreen needs to be applied more frequently than insect repellent [5, 7].

No evidence-based guidelines are available for pediatric skin care. Goals are to maintain clean skin and protect against drying and sun damage.