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The role of emollients in maintaining skin integrity
Abstract
Patients with wounds may have compromised skin healing ability, and many will be older people; therefore, assessing and caring for surrounding skin is extremely important. The article will discuss the importance of skin health and skin barrier repair to prevent dry skin. It will provide practical guidance on understanding emollient use in wound care patients with vulnerable skin and discuss the evidence base for complete emollient therapy (CET). Information will be given on different types of emollients and guidance on good prescribing practice.
... There is also a loss and reduction in collagen and elastin (Wysocki, 2015), atrophy and contraction of the dermis (seen as wrinkles), thinning of blood vessel walls and a reduction in blood supply to the extremities. In addition, there is decreased activity of sweat glands and sebaceous glands (Moncrieff et al, 2015).Therefore, the skin may be at risk, becoming weakened and vulnerable because of the ageing process. ...
... Skin assessment is essential in identifying an appropriate preventive strategy (LeBlanc et al, 2018). Engaging patients as well as the carers is essential because they may be providing ■ Preserve the skin flap wherever possible ■ Use gentle, atraumatic dressings ■ If additional fixation is needed, consider securing the dressing with a tubular bandage (Consider contouring the dressing) ■ Adhesive dressings should be removed using a silicone medical adhesive remover (Moncrieff et al, 2015). These products are designed to protect the skin during dressing removal ■ Social factors and access to healthcare ■ Inadequate staff, relative and carer knowledge. ...
... Consider safety and use of padding/protection for furniture ■ Ensure patients and staff wear comfortable shoes to prevent falls ■ Provide a safe environment to prevent trauma ■ Provide adequate lighting (LeBlanc et al, 2018)Incontinence Protect skin from urine. Use emollients, barrier protection and pH-balanced soaps(Moncrieff et al, 2015) ■ Poor-quality nutritional intake: over-or undernutrition ■ Obese and undernourished patients can be at risk of adverse effects on tissue/ body structures and function ■ Malnutrition can result in impaired and prolonged healing of damaged skin and leave the patient vulnerable to infection ...
Skin tears are traumatic wounds caused by mechanical forces, which can be caused by the removal of adhesive dressing. Although they are common – especially in individuals with vulnerable skin, such as older people – their prevalence is underestimated, they are often misdiagnosed and they have a high risk of developing into complex, chronic wounds. However, skin tears are largely preventable. There are a number of intrinsic and extrinsic factors relating to skin tears and preventive strategies that may be undertaken. Health professionals, patients and caregivers/family members should aim to manage modifiable intrinsic and extrinsic factors to promote and maintain skin integrity to prevent skin tears. Where a skin tear does occur, an evidence-based approach should be taken to management, with referral to specialist care if necessary.
... Despite that, they are still recommended to be used as leave-on products, especially humectants with a prolonged transepidermal water loss (TEWL) impact and the application should be at least twice a day or more based on skin dryness severity [23,24]. Ingredients that exhibit humectant properties are glycerin, lactic acid, panthenol, butylene glycol, propylene glycol, sodium pyrrolidone carboxylic acid (PCA) and urea [25]. ...
... In tissue, it is converted to D-pantothenic acid (vitamin B5). Panthenol has the ability to facilitate wound healing and fibroblast proliferation in addition to its humectant properties [25]. Other commonly used alcohols with humectant properties include butylene glycol [29] and propylene glycol [30,31]. ...
... Propylene glycol has been regarded as a penetration enhancer that is occasionally used as a solvent and vehicle for compounds that are unstable or water-insoluble [31]. However, propylene glycol has been shown to be a sensitizing agent that contributes to irritation and contact dermatitis [25]. Propylene glycol is more irritating compared to butylene glycol [25]. ...
Moisturizers are one of the most widely used preparations in cosmetics and have been extensively used to soften the skin for consumers. Moisturizers work effectively in combating dry skin which may cause pain, tightness, itch, stinging, and/or tingling. The aim of this review is to evaluate published studies on the history, ingredients, preparation processes, characteristics, uses, and applications of moisturizers. Moisturizers bridge the gap between medicine and consumer goods by being used to make the skin more beautiful and healthy. In the future, in moisturizer therapy, the capacity to adapt specific agents to specific dermatological demands will be crucial. Cosmetically, moisturizers make the skin smooth by the mechanism of increasing the water content in the stratum corneum, hence exerting its most vital action, which is moisturizing action and maintaining a normal skin pH.
... A structured, individualised skin care regimen, consisting of gentle skin cleansing and moisturising is recommended (Lichterfeld et al., 2015;LeBlanc et al., 2018a;LeBlanc et al., 2018b;Wounds UK, 2018;. Traditional washing with water and alkaline soap should be avoided as it compromises skin barrier integrity and increases skin pH (Lichterfeld et al., 2015;Moncrieff et al., 2015;Wounds UK, 2018). The use of no-rinse cleansers or soap-free liquid wash products, reflecting the pH-range of the acid mantle of healthy skin (pH 4.5-6.5), ...
... Excessive cleansing should be avoided as this can cause skin dryness and irritation (Lichterfeld et al., 2015;. Frequency of bathing should be minimised where possible, the water temperature should be lukewarm (not hot), and the skin should be pat dry gently with a soft towel since drying the skin by rubbing causes additional friction (Moncrieff et al., 2015;LeBlanc et al., 2018b;. ...
... Cleansing is often followed by the application of leave-on products with moisturising properties such as lotions, creams or ointments (Lichterfeld et al., 2015). Skin moisturisers aim to repair or strengthen the skin barrier, retain or increase its water content, reduce TEWL, and restore or improve the intercellular lipid structure (Moncrieff et al., 2015;. Emollient therapy is considered a vital part of daily skin care in individuals with dry, frail skin in order to promote general skin health and reduce the risk of skin damage (Wounds UK, 2018;. ...
... Low environmental humidity induces the release of proinflammatory mediators such as interleukin-1. This may be related to the aggravation of several inflammatory skin disorders in dry environmental conditions [6,20]. Preventing skin dryness and maintaining the skin barrier homeostasis is the key to healthy and younger looking skin. ...
... For this purpose, an adequate skincare may have beneficial results. Among skincare products, emollients contribute to skin moisturization and improve skin condition, when they are used properly [5,8,20]. Emollient ingredients are able to reinforce lipid barrier function, to adjust the hydration level of SC and thus to improve different skin conditions [3,13,14,20]. ...
... Among skincare products, emollients contribute to skin moisturization and improve skin condition, when they are used properly [5,8,20]. Emollient ingredients are able to reinforce lipid barrier function, to adjust the hydration level of SC and thus to improve different skin conditions [3,13,14,20]. Emollient products usually contain occlusive ingredients, such as paraffin oil and petrolatum to decrease water loss, inducing the recovery of epidermal barrier along with intensive protection. Non-physiologic lipids form a hydrophobic layer at skin surface and do not penetrate beneath SC leading to a rapid decrease of TEWL values. ...
... The skin's pH is naturally acidic, which is important for antimicrobial defence, and to maintain a barrier against the loss of tissue water (Moncrieff et al, 2015). Skin barrier integrity typically diminishes from the age of 60, with the skin becoming thin and more fragile with a paper-like appearance, due to loss of collagen and elastin (Voegeli, 2007). ...
... Many soap products are alkaline, which can subsequently damage skin barrier function, cause irritation and increase the risk of infection and skin breakdown (Kirsner and Froelich, 1998). Once impaired, the skin is less able to withstand mechanical trauma or maintain immunological function (Moncrieff et al, 2015). ...
Older people are at an increased risk of developing skin damage related to incontinence, including pressure ulceration and incontinence-associated dermatitis (IAD). Factors exacerbating risk in older people include: a higher rate of faecal and urinary incontinence, reduced mobility, long-term conditions and changes to skin barrier function, as a result of the ageing process. Nurses have a key role to play in the assessment of continence, IAD prevention and management. This article explores nursing knowledge in relation to continence care on six inpatient wards for older people, and describes the implementation of improvement strategies, in order to reduce voidable harm.
... Therapeutic approach for the different skin manifestations associated with the infection is little explored, including different options such as antihistamines, topical and systemic steroids, low-molecular-weight heparins (14). Cosmeceuticals are not a therapeutic option, although moisturizers could be of help as adjunctive patient care in some cutaneous manifestations (15). ...
Introduction. Although COVID-19 is present in a milder form nowadays, systemic disorders caused by the virus lead to multiple organ malfunctions. Skin manifestations are the consequence of the disease itself but also the result of preventative measures taken to avoid the infection. They generally do not require pharmacotherapy except in severe cases. Depending on the severity of COVID-19-related skin disorder, cosmeceuticals are often recommended in their management. In this study, we highlighted skin adverse events related to all aspects of COVID-19 pandemic aiming to provide a comprehensive overview and enlighten the role of cosmeceuticals in the treatment of those skin issues, according to published studies and guidelines. Methods. Different steps were conducted in preparation of this review-identification of all factors that affect skin in pandemics (protective measures, disease itself, post-COVID syndrome), selection and classification of reported skin symptoms which could be managed using cosmeceuticals, according to relevant papers and guidelines. Discussion. Skin challenges in COVID-19 pandemics could be divided into three main categories: 1) Cutaneous manifestations of COVID-19 disease; 2) Cutaneous symptoms as a result of wearing protective equipment and using disinfectants, and 3) Cutaneous symptoms related to the post COVID-19 syndrome. Conclusion. Cosmeceuticals, a unique category of products between cosmetics and pharmaceuticals, are highly recommended in literature for the management of the aforesaid changes except in severe skin disorders. Since the introduction of cosmeceutical concept, those topicals have become an extremely important part of dermatologist's armamentarium. COVID-19 pandemic confirms their importance.
... Visto que, os jogos são capazes de proporcionar riqueza e espontaneidade de engajamento de seus participantes (Bailey et al., 2015). A implementação da gamificação pelo marketing, considera que as mídias sociais devem estruturar quais estratégias podem ser usadas em suas vendas diárias (Moncrieff et al., 2015). Com uma boa estruturação dessas estratégias, é possível impactar as vendas e até mesmo atrair mais clientes, devido aos estímulos causados por esses produtos, elaborados para cativar seus consumidores. ...
Este estudo teve como objetivo analisar de que maneiras as estratégias da gamificação tem impactado no engajamento de uso em aplicativos de serviços digitais. A partir de uma modelagem de equações estruturais, aplicou-se um questionário online com usuários de aplicativos gamificados, obtendo uma amostra com 109 respondentes. Os resultados demonstraram que a expectativa de desempenho, influência social, intenção de uso e uso afetam positivamente na intenção comportamental a utilização das plataformas gamificadas, ao contrário das condições facilitadoras e expectativa de esforço. Este estudo contribui para maior compreensão e aprimoramento de pesquisas relacionadas à eficácia da gamificação em aplicativos móveis.
... If such physiologic responses do not occur, skin integrity may be compromised because the skin's ability to withstand mechanical stress, balance homeostasis, 7,8 and maintain its immunologic function becomes impaired. 9 In this state, the skin becomes vulnerable to external and internal mechanical factors, possibly resulting in tissue breakdown. Further, elevated skin temperatures have been associated with a reduction of the cohesive strength of the integrity of the stratum corneum. ...
Objective:
To determine whether changes in skin temperature can affect the integrity of skin.
Methodology:
The authors conducted a systematic literature search as per the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. They searched the CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane, MEDLINE Complete, Academic Search Ultimate, and HyDi databases for articles examining the effects of skin temperature on skin integrity published through April 2020. Two independent reviewers scored the methodologic quality of the 13 included studies.
Results:
Only 11 studies were included in the qualitative analysis, as the other two articles had a critical risk of bias. There is strong evidence to indicate that an increase in skin temperature leads to changes in skin structure and function. However, ulcer formation was more affected by intrinsic and extrinsic factors, rather than by temperature alone.
Conclusion:
Further high-quality randomized controlled trials are required to investigate the direct effect of skin temperature on ulceration.
... Fatores de risco Guia de avaliação de risco de Lesão por Fricção 22 Figura 5 -Alterações da pele no envelhecimentoMudanças na pele com alterações da idade31 ...
Objetivo: identificar a prevalência e os fatores associados à lesão por fricção em idosos internados em uma unidade de terapia intensiva. Método: estudo transversal, com amostra de 133 idosos internados em um hospital de ensino, entre julho de 2017 a julho de 2018. A coleta de dados contemplou consulta ao prontuário para levantamento sociodemográfico e clínico, exame físico de pele para avaliação de Skin tears. Os dados foram analisados pelo software Stata® versão12. Resultado: constatou-se prevalência de lesão por fricção em 10,5% dos idosos, com associação significativa ao índice de massa corpórea (p=0,004). Conclusão: Acredita-se que os resultados do presente estudo possam contribuir para sensibilizar o enfermeiro e sua equipe, quanto à realização de ações efetivas de prevenção e de cuidado às lesões por fricção, com o objetivo de melhorar a qualidade de assistência prestada aos idosos.Descritores: Enfermagem Geriátrica; Idoso; Envelhecimento da Pele, Hospitais Universitários, Unidades de Terapia Intensiva.
... Past examinations revealed that medications containing antimicrobial, anti-fiery movement advanced the injury recuperating process through the quickened rebuilding of harmed tissue 19 , antioxidant action improves the mending of contaminated and non-tainted injuries by decreasing the harm brought about by free radicals 20 . Emollients are re-lubing the skin while purifying, as opposed to de-lubing it; they are additionally cradled so they maintain the ordinary surface pH 21 . The essential intension of utilizing any effective antiseptic is to decrease the germs forestalls disease, and diminish the heap of biofilm 22 . ...
The idea behind this research work is to investigate the phytochemical constituents from Petroleum ether concentrate of Ingudi (Balanites aegyptiaca L. Delile) seeds utilizing GC-MS (Gas chromatography-mass spectroscopy) and to clarify the customary utilization of Ingudi oil as an effective injury mending specialist. A sum of 100 gm Ingudi seeds coarsely powdered, air-dried were macerated and extracted in Petroleum ether (1 Liter) at 60-80 0 C for 72 hours. The petroleum ether concentrate was exposed to GC-MS investigation. The GC-MS examination of the Petroleum ether concentrates of Ingudi shows presence of seven functional groups which are alcohol, carboxylic corrosive, ester, ether, silyl ether, and phenol. The compounds present are Tetradecamethylcycloheptasiloxane, Feruloyl-caffeoyl-glycerol, Decamethylcyclopentasiloxane, 17-Octadecynoic Acid, 2-Hydroxy Succinic Acid, Dec-4-Anyl Undecyl Ester, Stigmasterol Trimethylsilyl Ether, Succinic corrosive butyl ester 4-hydroxy-12-methyl-tridecyl ester. The extract shows antibacterial, antioxidant, wound recuperating action, antifungal, immunomodulatory, antistatic, emollient, humectants, anti-provocative, hypocholesterolemic, malignancy preventive, hepatoprotective, nematicide, insectifuge, antihistaminic, antieczemic, antiacne, 5-Alpha reductase inhibitor, antiandrogenic, antiarthritic, anticoronary, antipsychotic, insectifuge, antimicrobial movement, larvicidal, thyroid hindering action, and hypoglycemic action. This examination assists to anticipate the equation and structure of dynamic particles which can be utilized as a decent and effective injury recuperating operator. This outcome additionally improves the customary use of Ingudi oil. The medicinal use of this oil was reported in Sanskrit literature (Abhigyan shakuntalam).
... Maintaining optimal skin health will help maintain skin integrity and thus reduce the risk of medical adhesiverelated skin injuries. 30 Table 11 (overleaf) outlines components of good skin care. Health professionals should be encouraged to think about how they can incorporate pain-minimisation strategies into their routine practice when using adhesive medical devices. ...
... Wounds are commonly categorized as chronic or acute and could rise from any traumatic damage or through a collapse of an unharmed skin [1]. Healthy people have strong skin that is resistant and with a signi icant ability for healing but skin can be exposed to outer and inner harm brought about by older age and changed in physiology [2]. This can be intrinsic or extrinsic in nature. ...
Antioxidants are indispensable in protecting the skin from oxidative stress caused by environmental factors such as ultraviolet (UV) radiation, pollution, and lifestyle-related influences. This review examines the essential role of antioxidants in modern cosmetology, highlighting their dual functionality as protective agents and active components in skincare formulations. Oxidative stress, primarily driven by an imbalance between reactive oxygen species (ROS) production and the skin’s defense mechanisms, accelerates aging processes, damages cellular structures, and compromises skin integrity. Antioxidants, whether natural or synthetic, act by neutralizing ROS, reducing inflammation, and promoting cellular repair, effectively mitigating these harmful effects. This comprehensive analysis synthesizes findings from 280 studies accessed via key databases, including PubMed, Scopus, and ScienceDirect. It investigates the biochemical mechanisms of antioxidant activity, emphasizing compounds such as vitamins (C, E, A), carotenoids, polyphenols, peptides, and minerals, alongside bioactive extracts derived from algae, fungi, lichens, and plants. Carotenoids, including ꞵ-carotene, lutein, lycopene, and astaxanthin, demonstrate potent antioxidant activity, making them crucial for photoprotection and anti-aging. Phenolic compounds, such as ferulic acid, resveratrol, hesperidin, and xanthohumol, play a significant role in neutralizing oxidative stress and improving skin health. This review also highlights bioactives from algae, fungi, and lichens. Algae, particularly microalgae like Haematococcus pluvialis, known for astaxanthin production, are highlighted for their extraordinary photoprotective and anti-aging properties. Brown algae (Fucus vesiculosus) and red algae (Porphyra) provide polysaccharides and bioactive molecules that enhance hydration and barrier function. Fungi contribute a wealth of antioxidant and anti-inflammatory compounds, including polysaccharides, ꞵ-glucans, and enzymes, which support cellular repair and protect against oxidative damage. Lichens, through unique phenolic metabolites, offer potent free-radical-scavenging properties and serve as effective ingredients in formulations targeting environmental stress. Plant-derived antioxidants offer a diverse range of benefits. Plant-derived antioxidants, such as flavonoids, phenolic acids, and carotenoids, further amplify skin resilience, hydration, and repair mechanisms, aligning with the growing demand for nature-inspired solutions in cosmetics. The integration of these diverse natural sources into cosmetic formulations reflects the industry’s commitment to sustainability, innovation, and efficacy. By harnessing the synergistic potential of bioactives from algae, fungi, lichens, and plants, modern cosmetology is advancing toward multifunctional, health-conscious, and eco-friendly products. Future research directions include optimizing delivery systems for these bioactives, enhancing their stability and bioavailability, and expanding their applications to meet evolving dermatological challenges.
Kronik Yara Kavramı ve Çeşitleri Kıvanç ÖNCÜ Yara İyileşmesinin Fizyolojisi Dilek SAĞIR Yara İyileşmesinde Büyüme Faktörleri ve Sitokinlerin Etkileri Burcu DEMİREL YILMAZ Kronik Yara Tedavisi ve Bakımı Anıl ÇELEBİ Hilal Büşra KAYA ÇELEBİ Biyofiziksel ve Biyolojik Teknolojiler İle Yara İyileşmesinin Yönetimi: Negatif Basınçlı Yara Tedavisi Özhan ÖZCAN Biyofiziksel ve Biyolojik Teknolojiler İle Yara İyileşmesinin Yönetimi: Elektriksel Stimülasyon, Işın Tedavisi, Topikal Oksijen Tedavisi, Ozon Tedavisi, Larva Tedavisi, Jet Lavage İrrigasyon Sistemi, Düşük Yoğunluklu Lazer Tedavisi ve Ultrasound Tedavisi Özhan ÖZCAN Hiperbarik Oksijen Tedavisi ile Yara İyileşmesi Hatice CEYLAN Yara İyileşmesinde Kök Hücre Tedavisi Canan VEJSELOVA SEZER Yara Bakımında Kullanılan Pansuman Materyalleri Sezgin UZUN Yara Gelişiminin Önlenmesi ve Yönetimi Bilge BAL ÖZKAPTAN
It is the duty of a nurse to act as the patient’s advocate, especially so for the neonatal nurse, whose charges cannot speak of their sufferings and cannot protect themselves by either flight or fight. This inability to ‘speak for themselves’ has led many people to doubt that newborn babies can feel pain at all. If you are obliged to inflict pain for the good of others, the task is made easier if you can pretend they do not feel it. This absolves you of all guilt and allows you to proceed without worrying about the distress you may be causing. But research has shown that babies given analgesia during heart surgery tend to be less stressed, both during and after the operation, than those who have had to do without (Anand and Hickey, 1987).
Recent studies have provided new insights into the occurrence, causes, and pathogenetic consequences of changes in the skin pH in atopic dermatitis, particularly with respect to skin barrier function and colonization with Staphylococcus aureus. Growing evidence suggests an impaired release of proton donors, such as amino acids, urocanic acid, and lactic acid, to the stratum corneum in atopic dermatitis, as a result of reductions in filaggrin proteolysis and sweat secretion. In addition, an impaired formation of free fatty acids from sebaceous lipids and epidermal phospholipids seems to be involved. Because both lipid organization and lipid metabolism in the stratum corneum requires an acidic pH, these alterations might contribute to the disturbance of skin barrier function observed in atopic dermatitis. Furthermore, bacterial growth and virulence of S. aureus, as well as defensive host mechanisms, have increasingly been delineated as pH dependent, giving rise to a new understanding of the pathophysiology underlying increased skin colonization seen in atopic dermatitis.
A cluster randomised controlled trial was conducted to evaluate the effectiveness of a twice-daily moisturising regimen as compared to ‘usual’ skin care for reducing skin tear incidence. Aged care residents from 14 Western Australian facilities (980 beds) were invited to participate. The facilities were sorted into pairs and matched in terms of bed numbers and whether they provided high or low care. One facility from each matched pair was randomised to the intervention group. Consenting residents in an intervention facility received a twice-daily application of a commercially available, standardised pH neutral, perfume-free moisturiser on their extremities. Residents in the control facilities received ad hoc or no standardised skin-moisturising regimen. Participant numbers were sufficient to detect a 5% difference in incidence rate between the two groups with 80% power and a significance level of P = 0·05, and the inter-cluster correlation coefficient was 0·034. Data were collected over 6 months. A total of 1396 skin tears on 424 residents were recorded during the study. In the intervention group, the average monthly incidence rate was 5·76 per 1000 occupied bed days as compared to 10·57 in the control group. The application of moisturiser twice daily reduced the incidence of skin tears by almost 50% in residents living in aged care facilities.
Emollients and moisturizing creams are used to break the dry skin cycle and to maintain the smoothness of the skin. The term ‘moisturizer’ is often used synonymously with emollient, but moisturizers often contain humectants in order to hydrate the stratum corneum. Dryness is frequently linked to an impaired barrier function observed, for example, in atopic skin, psoriasis, ichthyosis, and contact dermatitis.
Dryness and skin barrier disorders are not a single entity, but are characterized by differences in chemistry and morphology in the epidermis. Large differences also exist between moisturizing creams. Moisturizers have multiple functions apart from moistening the skin. Similar to other actives, the efficacy is likely to depend on the dosage, where compliance is a great challenge faced in the management of skin diseases. Strong odor from ingredients and greasy compositions may be disagreeable to the patients. Furthermore, low pH and sensory reactions, from lactic acid and urea for example, may reduce patient acceptance. Once applied to the skin, the ingredients can stay on the surface, be absorbed into the skin, be metabolized, or disappear from the surface by evaporation, sloughing off, or by contact with other materials.
In addition to substances considered as actives, e.g. fats and humectants, moisturizers contain substances conventionally considered as excipients (e.g. emulsifiers, antioxidants, preservatives). Recent findings indicate that actives and excipients may have more pronounced effects in the skin than previously considered. Some formulations may deteriorate the skin condition, whereas others improve the clinical appearance and skin barrier function. For example, emulsifiers may weaken the barrier. On the other hand, petrolatum has an immediate barrier-repairing effect in delipidized stratum corneum. Moreover, one ceramide-dominant lipid mixture improved atopic dermatitis and decreased transepidermal water loss (TEWL) in an open-label study in children. In double-blind studies moisturizers with urea have been shown to reduce TEWL in atopic and ichthyotic patients. Urea also makes normal and atopic skin less susceptible against irritation to sodium laurilsulfate. Treatments improving the barrier function may reduce the likelihood of further aggravation of the disease.
In order to have optimum effect it is conceivable that moisturizers should be tailored with respect to the epidermal abnormality. New biochemical approaches and non-invasive instruments will increase our understanding of skin barrier disorders and facilitate optimum treatments. The chemistry and function of dry skin and moisturizers is a challenging subject for the practicing dermatologist, as well as for the chemist developing these agents in the pharmaceutical/cosmetic industry.
To enhance the learner's competence with knowledge regarding utilization of a tool kit to aid in the prevention, assessment, and treatment of skin tears.
This continuing education activity is intended for physicians and nurses with an interest in skin and wound care.
After participating in this educational activity, the participant should be better able to:1. Demonstrate knowledge of skin tear prevention and classification as presented in the International Skin Tear Advisory Panel's tool kit.2. Apply information from the skin tear tool kit to patient care scenarios.
The International Skin Tear Advisory Panel has created a tool kit for the prevention, identification, and treatment of skin tears. The tool kit is based on extensive literature reviews, international input from healthcare professionals, and on expert opinion. It has undergone a modified Delphi process.
The article examines general skin care for older people, skin barrier function and the skin changes associated with the ageing process. Skin assessment and the use of washing products and emollients are discussed. Methods by which older people and nursing staff can help to promote and improve skin health are identified.
The emollient aqueous cream BP is frequently used for the treatment of atopic dermatitis (AD), yet it is associated with a high rate of adverse cutaneous reactions. It contains the harsh anionic surfactant sodium lauryl sulphate, a known negative environmental factor associated with the exacerbation of AD.
To investigate the effect of aqueous cream BP on stratum corneum (SC) integrity and skin barrier function in volunteers with a predisposition to a defective skin barrier.
Thirteen volunteers with a previous history of AD (no symptoms for 6 months) applied aqueous cream BP twice daily to the volar side of one forearm for 4 weeks. The other forearm was left untreated as a control. Permeability barrier function and SC integrity were determined before and after treatment by measuring transepidermal water loss (TEWL) in conjunction with tape-stripping. For comparison, 13 volunteers with current AD were recruited for assessment, without treatment, of SC integrity and skin barrier function at unaffected sites.
Topical application of aqueous cream BP resulted in significant elevation of baseline TEWL and a concomitant decrease in SC integrity. Measurements made after no treatment in volunteers with current AD, at unaffected sites, suggest that application of aqueous cream BP negatively affects the skin barrier towards the damaged state associated with onset of flares of the disease.
Aqueous cream BP used as a leave-on emollient caused severe damage to the skin barrier in volunteers with a previous history of AD. Aqueous cream BP should not be used as a leave-on emollient in patients with AD.
Dry skin is characterized by a decreased lipid content and a delayed reconstitution of the epidermal barrier after skin irritation. These are problems of high relevance in the aged population, especially in the development of irritant contact dermatitis. Asteatotic and perineal irritant dermatitis are the most important subtypes of irritant contact dermatitis in the elderly. This contribution presents a compressed survey on these subtypes and elucidates their relation to an impaired barrier function. Typical irritants affecting aged individuals are explained and compared with irritants that seem to be more significant in younger people. Results of biophysical investigations, such as measurement of transepidermal water loss, are discussed regarding their age-dependence. Transepidermal water loss decreases with age, which was formerly interpreted as an indication of a decreased sensitivity. Today, we know that reconstitution of the epidermal barrier after irritation is delayed once it has been impaired. Reasons are decreased activities of enzymes involved in lipid synthesis and processing, a changed cytokine profile, a reduced acidification of aged skin, and alterations in the function of epidermal stem cells. Owing to these new insights, a reevaluation of the sensitivity of aged skin has to be initiated, especially with regard to occupational dermatology.
Eczematous conditions are common in all age ranges; this article focuses on conditions that affect adults. The principles of assessment and the use of emollients and topical corticosteroids covered in the article apply to the majority of eczematous conditions.
Breakdown of the skin barrier is the first event in the development of atopic eczema (atopic dermatitis). Research over the past five years has indicated that this arises as a result of the interaction of environmental agents such as soap and other detergents with the products of changes in several genes. These genetic changes predispose to the breakdown of the skin barrier, which allows the penetration of allergens, triggering a flare of atopic eczema. This new understanding of how breakdown of the skin barrier is the first event in the development of atopic eczema provides a rationale for a renaissance in the use of a complete emollient therapy regimen in atopic eczema and related skin barrier breakdown diseases, such as asteatotic eczema and irritant contact dermatitis.
This study explored the extent to which a new skin care protocol comprising a skin cleanser, barrier cream and barrier film could be implemented in nursing homes, and its effects on patients' skin condition, staff time and associated costs. A pre- and post-intervention study design was used. Data were collected on current skin condition and skin care procedures, before and after the introduction of a new skin care protocol. Nurses and carers were observed as they undertook skin care following episodes of incontinence. The time taken, products and amounts used were recorded. The presence and severity of incontinence dermatitis was recorded, together with the presence and severity of pressure ulceration. A supportive education programme was delivered to staff. All patients with incontinence and all staff working in six nursing homes were included in this study. Two nursing homes were randomly selected to participate in detailed skin assessments, documentation of skin care procedures and product usage. A total of 164 patients were included in detailed assessments, 79 pre-intervention, 85 post-intervention; 49 were male (29.9%) and 115 were female (70.1%). Their mean age was 83.44 years (standard deviation = 8.38). Only 3% of patients were under 70 years of age, with 72% over 80 years of age. Pre-intervention 29.1% were incontinent of urine only, 64.6% were doubly incontinent and 6.3% were catheterised. Post-intervention 29.4% had urinary incontinence, 65.9% were doubly incontinent, and 4.7% were catheterised. Skin condition was maintained or improved using the new skin care protocol. The presence of grade 1 pressure ulcers was found to significantly decrease over time (p = 0.042). The presence of incontinence dermatitis was found to be significantly lower after introducing the skin care protocol (p = 0.021). There was significant reduction in time taken to deliver skin care post-intervention (p < 0.001) with a mean time saving of 4 minutes and 2 seconds, per patient per procedure. On average this procedure was carried out 8.5 times per day, giving a time saving of 34 minutes and 17 seconds per patient per day using the new skin care protocol. This was associated with an average saving per patient per day of 8.83 Pounds for qualified staff and 3.43 Pounds for unqualified staff. Staff adherence to the new skin care protocol was good, with only one observed episode when the protocol was not followed, suggesting a high degree of success in its implementation. This study demonstrated that the introduction of a new skin care protocol, supported by an educational programme, maintained or improved patients' skin condition, and significantly reduced the resources used in delivering nursing care.
The geriatric population is composed of persons over 65 years of age, and few studies are available on the dermatologic diseases in this group.
Data on a total of 4099 geriatric patients admitted between the years 1999-2003 were analyzed. Hospital-based patient registry records were used for data collection. The data were analyzed according to age, sex, and time of admittance.
The five most frequently encountered diseases in elderly patients were eczematous dermatitis, fungal infections, pruritus, and bacterial and viral infections. The most common disorders in males were fungal, bacterial, and viral infections, disorders of the feet, cutaneous ulcers, and vesiculo-bullous diseases, whereas, in females, they were immune-rheumatologic diseases and disorders of the mucous membranes. The five most frequently encountered diseases were significantly different in geriatric age subgroups. In the younger age group, pruritus, disorders due to sun exposure, and precancerous lesions and skin carcinomas were less common, whereas eczematous dermatitis was more common. The frequencies of some diseases showed significant seasonal variations. Infestations were more common in spring and summer, fungal infections were more common in summer but less so in winter, pruritus was more common in autumn but less so in spring, disorders due to sun exposure were more common in spring, and benign neoplasia were more common in autumn. In 2003, benign neoplasia, precancerous lesions and skin carcinomas, and immune-rheumatic disorders were more common, but vesicular and bullous diseases, fungal infections, and cutaneous lymphomas were less common when compared with the year 1999.
This study provides important data on the frequency of dermatologic diseases in elderly patients, and shows variations in the frequency depending on age, gender, and season. We believe that this study will create awareness about the extent and patterns of dermatologic problems in geriatric patients.