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