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OLDER PERSON SKIN CARE PATHWAY Aim: The aim of this pathway is to provide guidance on the appropriate management of the skin in older people. Adequate skin care is a major strategy for maintaining the skin barrier, skin integrity and skin health. For some people the use of routine leave on emollients (creams or ointments) will be adequate however this pathway provides guidance on skin that is at risk of further drying and dehydration. Untreated dry skin may become irritated and result in rashes, eczema, cellulitis and secondary bacterial infection. Ageing skin Skin becomes thinner and more translucent. An increase in pigmented spots in sun exposed areas is common. Dry Skin that is leathery in appearance is a sign of reduced elasticity. Skin bruises more easily A decrease in the sweat gland activity reduces the amount of oil present in the skin which leads to dryness 2. Apply a leave on emollient such as o Zeroderm ointment or Zerobase cream. If this is not effective consider Hydromol ointment, Cetraben cream or Doublebase gel . Apply 3-4 x a day 3. If the skin is very dehydrated then apply a Urea based leave on emollient - Balneum cream. Apply ONCE a day I Ageing skin Dehydrated, very dry. 1.Use a soap substitute / wash, bath or shower emollient such as Zerolatum bath additive, Zeroderm Ointment or Aqueous cream (Hospital only) Very dry dehyrated skin Skin that is not hydrated can develop fissures and crack s and become very painful. Itchy skin Dry skin is a common cause of itching in older people 1.Use a soap substitute / wash, bath or shower emollient such as Zerolatum, Zeroderm Ointment or Aqueous cream (Hospital only) 2. Apply a Urea based leave on emollient - Balneum cream ONCE a day. Avoid using on broken / cracked skin as it can cause stinging 3.Apply a leave on emollient such as Zeroderm cream or ointment, Hydromol or Doublebase gel 3-4 times daily 4.Use Balneum Plus cream TWICE daily for itchy skin Good Practice Use Ointments rather than bland creams for dry skin as they keep the skin moist for longer Avoid over use of harsh soaps or chemicals as this removes the oil from the skin Zeroderm and Hydromol can be used as soap substitutes as well as emollients so you may not require a bath additive as well. Aqueous cream is to be used as a soap substitute only. Refer to the Emollient formulary fact sheet regarding suitable quantities/expiry dates Apply emollients in the direction of the hair line to avoid increased risk of infection Warm water Is less drying than hot water References: Wounds UK (2012) Best Practice Statement: Care of the Older Persons Skin (2nd Edition) Wounds UK London Kotter J, Lichterfeld A, Blume-Peytav iU (2013) Maintaining skin integrity in the aged: a systematic review. British Journal of Dermatology (169) Moncrief G et al (2013) Use of emollients in dry skin conditions: consensus statement. Clinical and Experimental Dermatology Vol 38 No 3. Wiley Blackwell KCCG (2014) Medicines optimisation formulary factsheet prescribing emollients. https://www.eclipsesolutions.org/Cornwall/info.aspx?sectionid=64