Skin care product selection
The PH of the skin is 5.5
Urine and faeces are alkaline which cause
a chemical reaction when a patient is
incontinent
Identify some common skin
conditions
Common skin problems
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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 healing
enlarge wounds
Increase pain
Treatment
• Manage exudate appropriately.
• Use of barrier film such as cavilon.
Excoriation
excoriation
•Identify and resolve
incontinence
•Use of barrier creams
Urine collection
devices
ECZEMA
Signs and symptoms
Itching/ puritis
Redness
Vesicles / blisters
Contact sensitivity
Dressings
Bandages
Lotions / creams
Topical antibiotics
Consider patch testing / dermatology
referral
Skin dryness/ dehydration
Hydration normally maintained by
sebum secreation and intact
stratum corneum
Cardiff and Vale NHS Trust
Ymddiriedolaeth GIG Caerdydd a’r Fro
Causes of dryness
Systematic dehydration
Dermatological conditions
Inappropriate dressings
Ageing – hormonal changes
Enviromental – soap
Medications – 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?
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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