Transcript Infections and Infestations
Skin Integrity – the basics of skin care Emollients and use of Topical Steroids Barbara Page Dermatology Liaison Nurse Specialist NHS Fife
Functions of the Skin
Barrier
Temperature control Sensory Vitamin D synthesis Communication & display
Promoting Healthy Skin……. The Basics of Skin Care
Emollients…… Emollients…… Emollients…...
H
ealthy Skin
Allergens Allergens
Water Water Water Water Water Water Water Water Water Water Water © 2001 Elliott/Cork/Cork
Loss
of Skin Barrier
Loss of water Loss of fat Loss of water Loss of water Loss of fat
© 2001 Elliott/Cork/Cork
allergens/irritants/infection into skin - skin reacts
Internal and External Factors Affecting Skin
Cold Central Heating Heredity Factors Infection Sun Trauma Skin General Health Nutrition Fluid intake Infestation Pollution Chemicals/ Allergens/ Irritants Stress Ageing Drugs Hormone Change Lifestyle
Emollients play a vital role in the management of skin disease
Definition and function Classification When to apply How to apply Which emollient
Emollients
“ Emollients are oils that spread easily on the skin, providing partial occlusion that hydrates and improves the Stratum Corneum” Rawlings A.V. et al., Dermatologic Therapy, Vol. 17, 2004, 49-56
Emollient……Definition and Function
Medical term for moisturiser Safe Simple Effective Steroid sparing Intrinsic anti-inflammatory action
Emollients also help to…………
Replace water lost from the skin Lubricate the skin Reduce scaling Seal the
Stratum Corneum
Classification of Emollients….
Lotions / Gels
Contain more water and less fat than cream
Creams
Contain a mixture of water and fat
Ointments
Do not contain water
Classification cont………………
Bath oils
Clean and hydrate - trap water in skin
Soap substitutes
Not astringent - not alkaline -
do not dry out the skin
Emollients…..when to apply
As frequently and liberally as possible At least 3 times per day After bathing when the skin is still moist
Emollients….how to apply effectively
Bathing Generously but gently Do not rub vigorously - may cause itching or irritation Smooth emollient along arms, legs and body following the natural hair growth
Emollient ……… the choice
• Paramount importance • Cosmetic acceptability essential • Compromise between efficiency and cosmetic acceptability
Which Emollient ?
The very best emollient for any individual is…………….
the one they prefer
Emollient Base……...
Important point to remember……… Use a
cream
base for
moist/wet
skin Use an
ointment
base for
dry/cracked
skin
Quantities of Emollient
For an adult with dry or compromised skin Bath additives 300mls per month Creams or ointments 2000gr per month
Emollient Chart
Emollient Chart
Topical Steroids
Used in the treatment of inflammatory skin conditions other than those due to an infection Act as an immuno-suppressant Reduce inflammation Help to alleviate itch Should not be used in ulcerated skin May worsen secondarily infected lesions
Lotion Gel Cream
Topical Steroids
Ointment Impregnated tape
Which Steroid ?
Always use the least potent strength necessary to gain maximum effectiveness
Mild Topical Steroids
Use for mild inflammatory skin conditions May be used on the face
Moderate Topical Steroid
More suited to prolonged use of topical steroid for inflammatory skin condition
Potent Topical Steroids
Acute inflammatory skin condition When titrating from very potent steroid
Very Potent Topical Steroids
Severe inflammatory skin conditions Not responding to less potent steroids Short term use – usually under specialist supervision Titrate after 7 days – less potent steroid
Points of Note
Steroids may be combined with other agents Antibiotics Antifungal agents Both of the above
Points of note
Mild /moderate steroids rarely cause side effects Prolonged use of potent steroids can cause side effects eg. thinning, striae, atrophy, telangiectasia, perioral dermatitis, depigmentation Caution when applying under occlusion as potency is increased Caution when applying to specific sites Always prescribe enough topical treatment for correct application
How much to apply ?
Use the “fingertip unit” (FTU)
1 FTU is distance from tip of an adult index finger to the first crease 1 FTU is approx. 500mgm 1 FTU sufficient to cover an area twice that of the flat adult hand 3-4 FTUs to cover lower leg 7 FTUs to cover whole leg
Useful Web Sites
www.dermnetnz.com
www.nhsfife.scot.nhs.uk/skinintegrity www.nhsfife.scot.nhs.uk/skincare www.bad.org.uk
www.bdng.org
www.sdns.co.uk
www.eczema.org
www.pathways.scot.nhs.uk/dermatology