The Phenomenon Vernix Caseosa
THE ALL - IN - ONE - SKIN CARE PRODUCT
8 min read
Probably, the most asked question in the delivery room, after welcoming the baby and making sure it is healthy and vital, is ‘what is this white sticky matter on my baby‘s skin?’ When getting the answer, it is vernix caseosa, most new parents don’t even know where to begin to ask what it is and frankly, it is not the most important thing at that moment. So mostly, it falls into oblivion, which is a shame, since it is, to present knowledge, an amazing phenomenon uniquely found on the human body. It not only has developmental and protective functions for the unborn but also for the newborn.
In 1846, the Dunglison Dictionary of Medical Sciences firstly published the name ‚Vernix Caseosa‘. (1) It comes from the Latin meaning vernix = vanish and caseosa = cheesy. (2) To understand its necessity I will begin by explaining how it develops.
Development
It is presumed that one single layer of the epidermis, also known as the outer layer of the skin, can already be seen in an embryo in the third week of pregnancy. (3) This layer is a simple layer, meaning it only consists of a single layer of cube-like cells. By the 11th week of gestation, it has already developed into three individual layers. These are also known as basal, intermediate layer and the periderm. (4) The periderm provides a temporary protective barrier for the epidermis, to enable it to develop into four distinctive layers by the end of the fourth pregnancy month. (5) It additionally has permeable and metabolic activity. Until week 21 of gestation, the periderm cells are continuously being replaced. From then on, they are completely shed and are replaced by the stratum corneum. The shed cells then mix with secretion of the sebaceous glands, which are located in the walls of the epidermis, and combined they result in the first stage of the vernix caseosa. (6) Additionally, to the development of the skin, the organs have also developed, which now regulate the sebaceous gland activity of the infant in the womb. The glands now produce a superficial lipid film (film of organic combinations that are insoluble in water), which protects the skin from the environment, in this example from the amniotic fluid. This enables cornification of the underlying epidermis, which is completed by the 6 month of pregnancy. By the third trimester, the glands reach an activity peak. Together with the shed corneal cells and the overlying lipid film, they result in the white cheesy matter we see on the baby’s skin after birth — the vernix caseosa. In addition, the lanugo hair (first type of hair to develop in humans) starts to develop in the third month of pregnancy. It sheds at approximately 33–36 weeks of pregnancy and is an important binding source for the vernix, as well as controlling the tempo of the baby’s development rate in the womb. (7) One would presume that the vernix caseosa mostly consists of lipids, due to it is one of the main components that forms it but it actually consists to 81 % of water. (8) This is presented in the sponge-like seeded corneum cells, which enables the vernix to still have a high viscosity (thickness). (9) These sponges maintain and facilitate the cornification by prohibiting water movement over the skin. Additionally, the lipids form a hydrophobic (water repellent) barrier. The rest is 9 % lipids and 10 % protein. (8) Having explained its development, I will continue by describing its functions. This will show its necessity for the unborn and newborn.
Function for the baby in the womb
Studies have shown that vernix particles, which are also present in the amniotic fluid and swallowed by the baby in the last trimester of pregnancy, have potentially effects on the development of the gut. Glutamine is over 20 % of the amino acid content in the vernix. It is also known to be necessary for gut development and vital for the rapidly growing cells of the intestine epithelium. (10) As already described in the section ‘Development’, the vernix is a protective matter, which makes epidermal growth underneath it possible. It also protects the underlying skin from maceration through the amniotic fluid and prevents loss of fluids, as well as electrolytes from the baby’s organism. Studies indicate that the vernix, and the epidermis, contain antimicrobial components, which are known to defend against bacteria. Additionally, it also contains surfactant protein D, which maintains the bacterial balance of the airways in utero and protects it against intrauterine infection. (11) As many of us nowadays worry about development of bacterial resistance, the vernix may actually avoid that through its broad spectrum of antimicrobial proteins. (12)
Functions for the baby at birth
The vernix lubricates the baby’s skin to ease passage through the birth canal and protects the skin from the rich bacterial and acid pH in the mother’s vagina. (13) Firstly, it works as a mechanical barrier, but it also contains antimicrobial components and multifunctional proteins, which function in the antibacterial defence. (14)
Functions for the baby after birth
After birth, the skin of a newborn immediately adapts to the new environment. It slowly, meaning minutes to hours, decreases the hydration of the surface, decreases its skin pH and the stratum corneum dehydrates, whilst forming a ‘dry’ skin surface. Studies have shown that vernix may have a role in forming these processes. It is known that vernix loses its exogenous water slowly and leaving the vernix on the skin after birth, showed significantly more hydration of the skin with higher moisture and hydration rate. Also retaining the vernix after birth is connected with the maturation of enzymes, which are responsible for acidic components in it and presented acidification earlier, suggested by Visccher et al. This is important since it is believed that an acidic stratum corneum obstructs the growth of pathogenic bacteria and eases colonisation with commensal organisms on the skin surface. (15) Probably, most people know that vernix moisturises the skin. This is because of its high water content. It also contains proteins, which are called ‘Natural Moisturising Factor’, when broken down. This ‘Natural Moisturising Factor’ helps the stratum corneum to sustain plasticity and suppleness. (16) Additionally, it has been presented, that the vernix may have antioxidant quality, due to its additive vitamin E and melanin, which are known for their antioxidant properties. (17) It is still in debate if vernix is also beneficial for thermoregulation after birth. Some may speculate that it could provide thermal stability, but it is known not to be the primary factor. It has also been linked to reduce evaporative loss. The newest study by Visscher et al showed it has no significant effect on the temperature regulation when keeping it retained on the newborn’s skin. (18) However, it has several other benefits as listed above.
Functions in future medicine
Provided with all these benefits, scientists have been researching if the composition of the vernix can be used in other fields of medicine. It has been presented that vernix has shown an increased metabolism of the baby’s skin in utero. Additionally, it is known that the trans-epidermal water gradient is important in wound healing. This is the reason why it is being researched if the vernix could benefit patients with wound healing for trophic ulcers of lower extremities, perineal wounds following delivery and protect atopic dermatitis against bacterial skin infections. Moreover, burn trauma patients could benefit from it due to its barrier function, hydration, anti-infective and antioxidant effects. (19) Another study has shown that vernix not only has comparable efficiency to standard commercial skin cleansers, it also provides the skin with physiologically relevant lipids to the skin surface, additional moisturiser, antioxidants, and a barrier for controlling infection. (20)
Environment
Vernix caseosa is a natural resource, which does not have to be produced in factories, produces no garbage, minimal greenhouse gases and has a small water footprint.
Cost
Since the vernix is a product produced by the body itself, it’s free of charge.
Retention of the Vernix Caseosa on the newborns skin
In 1993 the World Health Organisation published its ‘Guideline for Thermal Control Of The Newborn’ saying: ‘ …do not remove vernix but wrap them in a clean, dry towel ensuring that the head is covered properly’ (‚them’ in this context = babies).(21) Additionally, a combined study by the Association of Women’s Health Obstetrical and Neonatal Nursing and the National Association of Neonatal Nursing came to the conclusion that ‘removal of all vernix is not necessary for hygienic reasons ‘and vernix may provide antibacterial promotion and wound healing’. (22) It is still being researched if vernix contains pheromones, which attract the caregivers to their newborn. Therefore, at present it is recommended to leave it on the baby’s skin until it vanishes on its own on around the 5th day after birth. It may take five more days to vanish completely from the body folds. (23)
Summary
Vernix caseosa is a phenomenon, which has to present knowledge only found on the human body. Vernix means vanish, and caseosa means cheesy in Latin. This is how it presents itself on the newborn’s skin, as a white cheesy matter, which vanishes on its own on day five after birth and can be seen in folds and creases of the body up to a further 5 days. It consists of seeded corneum skin cells, secretion of glands and lanugo hair. It is known that its components are divided in three groups: 81 % water, 9 % lipids, 10 % protein. It has important functions not only for the development of the baby in the womb but also for the newborn:
In the womb
Potentially effects on the development of the gut in utero.
Makes epidermal growth underneath it possible.
Protects the underlying skin from maceration through the amniotic fluid.
Prevents loss of fluids, as well as electrolytes from the baby’s organism.
Contains antimicrobial components, which are known to defend against bacteria and maintain the bacterial balance of the airways in utero, also protecting it against intrauterine infection.
Vernix may actually avoid resistance development of bacteria, through its broad spectrum of antimicrobial proteins.
During birth
Lubricates the baby’s skin, to ease passage through the birth canal.
Protects the skin from the rich pH and bacteria in the mother’s vagina, working as a mechanical barrier. It also contains antimicrobial components and multifunctional proteins, which function in the antibacterial defence.
After birth
If retained, skin stays more hydrated and moisturised.
Part of the process to obstruct growth of pathogenic bacteria and eases colonisation with commensal organisms on the skin surface
It may also have a function in future medicine, due to its unique composition and may help wound healing for trophic ulcers of lower extremities, perineal wounds following delivery, protect atopic dermatitis against bacterial skin infections, as well as burns. It is recommendable to retain vernix on the baby’s skin until it vanishes on its own since the Association of Women’s Health Obstetrical and Neonatal Nursing and the National Association of Neonatal Nursing came to conclusion that ‘removal of all vernix is not necessary for hygienic reasons ‘and ‘vernix may provide antibacterial promotion and wound healing.’ Of course, if you find stool, urine or blood on the baby’s skin you should remove it, which will also mean taking some of the vernix off the baby’s skin. It should also be said that some babies are covered in more vernix caseosa than others. This just means it has already been absorbed by the baby’s body. If you do not feel comfortable leaving the vernix on the baby’s skin, you should massage some of it into the skin, since it is the best All-In-One Skin Care product you will find.
Additional Sources
https://apps.who.int/iris/bitstream/handle/10665/60042/WHO_FHE_MSM_93.2.pdf;se
https://repositorium.ub.uni-osnabrueck.de/bitstream/urn:nbn:de:gbv:700-201201069048/2/thesis_wehler.pdf
https://onlinelibrary.wiley.com/doi/full/10.1111/pde.13482
https://embryology.med.unsw.edu.au/embryology/index.php/Integumentary_System_Development_-_Vernix_Caseosa
https://pubmed.ncbi.nlm.nih.gov/18305878/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2963132/
https://repositorium.ub.uni-osnabrueck.de/bitstream/urn:nbn:de:gbv:700-201201069048/2/thesis_wehler.pdf
https://pubmed.ncbi.nlm.nih.gov/2699731/
https://books.google.ee/books?hl=de&lr=&id=UYLgBwAAQBAJ&oi=fnd&pg=PA1&ots=eYs5JF26I6&sig=xN-WXrH1wiJLJij2c4zpSLj-2P4&redir_esc=y#v=onepage&q&f=false
https://pubmed.ncbi.nlm.nih.gov/7359008/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2763724/#CIT70
https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/jog.14103