Moisture Related Skin Breakdown
by Louise Taylor, Stoma Care Nurse Specialist
CASE STUDIES
With reduction of pain
baby could mobilise
and return to normal
activities.
4 days
Paediatric Surgical Nurse
Results
The photographs portray a dramatic improvement to the skin integrity
of all three patients whilst also detailing an impressive drop in pain levels
once using ILEX Skin Protectant. The number of clinical hours the patients
required for wound treatment and support also decreased.
Conclusion
ILEX has been shown to be a useful treatment for wounds that need
to be protected from moisture. It provides the health care professional
with an effective treatment option that is also cost effective in terms of
reducing numbers of dressings required and clinical time taken.
41001 Oakmed ILEX A4 Landscape Flyer.indd 1
before
application
Pain Score
2/10
following
application
Day 3 The wound
area was 95%
improved.
Pain relief could be
stopped almost immediately.
Pain Score
Day 7 There was good signs
of improvement.
Wound was
fully healed
at day 20.
Day 5 The wound
was 98% healed
and a seal and
stoma bag
could be used.
1
DA
Y
Pain Score
0/10
before
application
2
Results
Day 2 Once ILEX
commenced the pain
score was 0/10.
10/10
DA
Y
Up to 10 stoma bags used a day plus up to an
hour of stoma care each time to change a bag.
Results
Day 1 Pain score
immediately decreased
to 2/10 on application
of ILEX.
4-5/10
Day 4 (26.11.12) Skin surrounding
the wound is no longer excoriated
or broken.
Pain score is now 2/10
before application
of ILEX and 0/10
afterwards.
Healed in
Case study by Karen Dick,
Specialist, Southampton Children’s Hospital.
Pain Score
4
3
FIG
Parents found they used far less
ILEX than other barrier creams as
ILEX is not fully removed at each
nappy change.
Over 7 weeks many treatments were tried and failed.
Reduced to 1/10 immediately after
application.
Day 4 of using ILEX wound is
healed (3).
before
application
Before ILEX
Pain score is 10/10. 7 weeks of
treatment with stoma bags, assorted
seals, foley catheter and other
dressings had failed. Dressings were
being changed on an hourly basis. 9
hours of Specialist nursing care had
been used.
Pain Score
following
application
Wound
98%
healed
3
Pain score 4-5/10
before ILEX is
applied.
10/10
Baby’s peristomal skin and umbilicus were
extremely excoriated due to faecal contents
spilling on the skin.
Patient: 10 month old baby girl with
severely excoriated peristomal skin. There​​was
erythema and broken skin covering a large​a​ rea
on the left hand side of the abdomen​, around
her stoma and down to her thigh​.
5
following
application
before
application
Pain Score
1
2/10
Results
Day 1 (22.11.12)
Deep wound size
20cm x 10cm
with paper thin
excoriated, broken
skin surrounding it.
10/10
DA
Y
Day 2 of using ILEX
wound size decreased
to 2cm x 3cm (2).
Pain Score
FIG
Results
Day 1 Pain score
2/10 immediately after
applying ILEX.
1
(1) Many other treatments had been tried with
little effect over 6 months. Many clinical hours
taken up with reassurance and helping the families cope.
Increased length of stay in hospital due to pain levels.
A different dressing, changed daily, had been
used for 4 weeks with poor results.
Pain Score
Before ILEX
Pain score of 10/10. Morphine and chloral
hydrate to try and control pain.
DA
Y
before
application
CASE STUDY 4
Patient: 3 month baby boy who had very poor nutrition,
respiratory disease and a devascularised poorly sited stoma due
to a medical emergency.
7
10/10
Before ILEX
Dehisced laparotomy wound with fistula.
Excoriated skin due to the output from the
fistula surrounding the deeper wound.
1
Pain Score
CASE STUDY 3
Patient: 56 year old female with poor mobility, nutrition and
on steroids and anticoagulants.
DA
Y
Before ILEX
Pain score was 10/10 each time he had his
bowels open or urinated. Wound size would
alter but was 8cm x 10cm just before using ILEX.
ILEX contains a copolymer which is hydroactive, causing a barrier to be
instantly created on contact with moisture. ILEX can also be used in
conjunction with other treatments if required such as antibacterial or
antifungal creams - it is just applied over the treatment layer.
DA
Y
CASE STUDY 2
Patient: 1yr 4mths baby boy who had had pull through
surgery, resulting in very frequent bowel motions and very
excoriated skin.
DA
Y
CASE STUDY 1
Reducing the risk factors associated with the occurrence of moisture lesions
will limit their incidence (Colwell J 2011, Gray 2012). Daily inspection of the
skin and cleaning with a cleansing foam or pH neutral soap will help. Protection
of intact or broken/weeping skin with a skin protectant or skin barrier is
recommended, (Gary M et al 2012, Beeckman et al 2010, Colwell J et al 2011)
ILEX Skin Protectant has been evaluated in the following case studies with
often dramatic results.
20
Urinary and/or faecal incontinence challenges the integrity of the skin by
breaking down its natural barriers (Brunner M 2012, Gray M et al 2012).
Four risk factors play a part in skin breakdown related to incontinence:
moisture (urine, perspiration, stool, wound exudate), skin pH, colonisation with
microorganisms and friction. Prolonged contact with the moisture leads to
maceration of the skin resulting in a change to an alkaline base (Beldon P 2013,
Beeckman D et al 2010, Colwell J et al 2011, Bianchi J 2012). Friction causes
Method
To monitor whether ILEX Skin Protectant is both a clinically effective and cost
effective treatment option a series of case studies have been collated with
the help of health care professionals and parents. Consent was obtained
for publication. In each case ILEX has been used after several other
treatments on excoriated skin have failed. The wounds have been caused
by prolonged contact with moisture. Often the patient has also found the
wounds very painful before commencing treatment with ILEX.
destruction of the macerated epidermis from bed linen or incontinence
pads and bacteria continue to grow in the moisture (Gray 2007, Beeckman et
al 2009).
DA
Y
Introduction
Faecal and urinary output along with other exudate can contribute to moisture
associated skin damage leading to mild erythema, chemical erosion and moisture
lesions. This is especially challenging in acute care settings where patients are
less mobile with multiple, compromising health problems (Brunner et al 2012).
DA
Y
An Effective Treatment Option
0/10
following
application
Case study by Anna Boyles & Cathy Walker,
Stoma Care Nurse Specialists, Kings College Hospital.
References
Beeckman D (2010) What is the Most Effective Method of Preventing and Treating
Incontinence Associated Dermatitis. Nursing Times 106 (38) 22-25
Beeckman D (2009) Prevention and Treatment of Incontinence Associated Dermatitis:
Literature Review. Journal of Advanced Nursing 65 (6) 1141-1154
Beldon P (2013) The Use of Barrier Films in Patients with Moisture Lesions. LBF No
Sting Barrier Film: Clinical Evaluation.Wounds UK p1-9
Bianchi J (2012) Causes and Strategies for Moisture Lesions. Nursing Times 108 (5) 20-22
Brunner M et al (2012) Prevention of Incontinence Related Skin Breakdown for Acute
and Critical Care Patients: A Comparison of Two Products. Urologic Nursing 32 (4)
214-219
Case study by Sara McGarry, Surgical Outreach Specialist Nurse, St Mary’s Hospital.
Colwell J et al (2011) Peristomal Moisture Associated Dermatitis and Periwound
Moisture Associated Dermatitis: A Consensus. Journal of Wound, Ostomy and
Continence Nursing 38 (5)541-553
Gray M et al (2012) Incontinence- Associated Dermatitis: A Comprehensive Review
and Update.
Journal of Wound, Ostomy and Continence Nursing. 39 (1) 61-74
Gray M et al (2011) Moisture Associated Skin Damage: An Overview. Journal of Wound
Ostomy and Continence Nursing 38 (3) 233-241
Gray M et al (2007) Incontinence Associated Dermatitis: A Consensus. . Journal of Wound
Ostomy and Continence Nursing 34 (1) 45-54
Case study by Sara McGarry, Surgical Outreach Specialist Nurse, St Mary’s Hospital.
ILEX Health Products Ltd
www.ILEXhealthproducts.com
ILEX® is a registered trademark of ILEX Health
Products Ltd. UK
03/11/2014 16:51