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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…... Healthy Skin Allergens Water © 2001 Elliott/Cork/Cork Water Water Water Water Water Allergens Water Water Water Water Water Loss of Skin Barrier Loss of water Loss of water Loss of water Loss of fat Loss of fat allergens/irritants/infection into skin - skin reacts © 2001 Elliott/Cork/Cork Internal and External Factors Affecting Skin Cold Sun Trauma Central Heating Heredity Factors Infestation Skin General Health Pollution Infection Chemicals/ Allergens/ Irritants Nutrition Fluid intake Stress Drugs Ageing 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 Topical Steroids Lotion Gel Cream 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
