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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
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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
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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
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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