Assessment of Paediatric Skin Barrier Function Using Non-invasive Technology: Establishing Reference Values for Long-Term Burn Healing

Background Long-term evaluation of burn wound healing in children is still predominantly based on subjective clinical assessment and visual scar scoring. The absence of objective, standardized reference values limits reproducibility, comparability and personalization of follow-up. Recent non-invasive technologies allow quantitative assessment of skin physiology and may offer a reliable alternative for objective monitoring. Aims To establish age and pigmentation adjusted reference values for key skin barrier parameters in healthy paediatric patients using non-invasive measurement technology, providing a benchmark for objective long-term evaluation of burn healing. Methods A prospective study was conducted in 153 healthy paediatric subjects aged 0–18 years. Skin barrier function was assessed using a standardized non-invasive device measuring trans-epidermal water loss (TEWL), melanin index and erythema index. Measurements were performed at four anatomical sites frequently involved in paediatric burns (palm, arm, back and thigh), with three repeated measurements per site. Participants were stratified by age group and skin phototype according to the Fitzpatrick scale. Statistical analysis included non-parametric comparisons and linear regression models. Results TEWL values showed a strong anatomical dependency, with significantly higher values at the palm compared to trunk sites (p < 0.001, Figure 1). No clinically relevant differences were observed across age groups. Skin phototypes alone did not reliably discriminate TEWL values (Figure 2). However, a significant inverse association was identified between melanin index and TEWL at both palmar and trunk sites, independent of age (p = 0.012 and p = 0.018, respectively, Figure 3). Conclusion This study demonstrates the feasibility and clinical relevance of non-invasive skin barrier assessment technology in paediatric populations. The established reference values provide a standardized, objective framework for long-term evaluation of skin healing after burns and support the integration of quantitative skin physiology measurements into future paediatric burn follow-up and personalized scar management strategies.