Skin care product selection

The PH of the skin is 5.5Urine and faeces are alkaline which

cause a chemical reaction when a patient is incontinent

Identify some common skin conditions

Common skin problems• Maceration• Excoriation• Dryness• Fragility• Blistering• Skin stripping• Scarring

Maceration

•Softening and breaking down of the skin from prolonged exposure to moisture.•Proteases found in chronic wound exudate actively damage healthy tissue.•Maceration is more common in chronic wounds

Maceration may delay healingenlarge woundsIncrease pain

Treatment• Manage exudate appropriately.• Use of barrier film such as cavilon.

Excoriation

excoriation

•Identify and resolve incontinence •Use of barrier creamsUrine collection devices

ECZEMA

Signs and symptomsItching/ puritisRednessVesicles / blisters

Contact sensitivityDressingsBandagesLotions / creamsTopical antibioticsConsider patch testing /

dermatology referral

Skin dryness/ dehydration

Hydration normally maintained by sebum

secreation and intact stratum corneum

Cardiff and Vale NHS TrustYmddiriedolaeth GIG Caerdydd a’r Fro

Causes of dryness

Systematic dehydrationDermatological conditionsInappropriate dressingsAgeing – hormonal changesEnviromental – soapMedications – steroids interfere with

epidermal regeneration and collagen synthesis.

Emollients

Regular use of emollients or mosturisers will prevent dry skin and acute flares thereby improving skin health

(British dermatology nursing group 2010)

Dry skin is usually itchy and leads to inflammation this is usually the first in the development of atopic eczema.

These skin changes lead to a decrease in natural moisturising factors.

Washing with alkaline soap reduces the thickness and number of layers within the skin.

Excess use of soaps / detergents can interfere with the water holding capacity of the skin and alter PH

Emollients are available in many formulations and patients should be encouraged to replace soaps with emmollient washes.

Which product to use?• Patient preference• Consistency required• Ingredients• Cost

Patient preference

May not like the thick ointments that stain clothes – lighter creams are more easliy absorbed.

May not like odour.• Bath additives• Soap substitutes• Leave on emmollients

Consistency

Creams•Lighter in consistency •Spreads easily but absorbed quicker

Ointments•Thicker and are more greasy.•Have occlusive effect and retain water in the skin•Better when high exudate.

Humectants

Humectant moisturisers replace the skins natural moisturising factors (e.g Urea and glycerol) therby attracting and retaining water in the skin cells.

eg hydromol

Aqueous cream

Recent research ahs found that if aqeous cream may cause irritation due to sodium lauryl sulphate which damages the skins barrier properties ( Cork et al 2003)

Ingredients

May include known sensitisers such as lanolin preservatives and fragrance (eg E45).

Nut derivatives ( eg arachais oil)

Emollient guidelines(PCDS/BAD atopic

eczema 2006)Apply liberally and frequently – every four

hours (qds)Patients underestimate quantity needed and

application frequency – large quantities should be prescribed – 600g/week

Quantity and frequency should be far greater than steroid therapy.

Education on how to use emollients is important