Skin Integrity – the basics of skin careSkin Integrity – the basics of skin careEmollients and use of Topical SteroidsEmollients and use of Topical Steroids

Barbara Page

Dermatology Liaison Nurse Specialist

NHS Fife

Functions of the SkinFunctions of the Skin

Barrier

Temperature control

Sensory

Vitamin D synthesis

Communication & display

Promoting Healthy Skin……. Promoting Healthy Skin……. The Basics of Skin CareThe Basics of Skin Care

Emollients……

Emollients……

Emollients…...

AllergensAllergens

Healthy Skin

Water

WaterWater

Water Water

WaterWater Water

WaterWater

Water

© 2001 Elliott/Cork/Cork

Loss of Skin Barrier

allergens/irritants/infection into skin - skin reacts

© 2001 Elliott/Cork/Cork

Loss of waterLoss of waterLoss of water Loss of fat Loss of fat

Internal and External Factors Internal and External Factors Affecting SkinAffecting Skin

SkinGeneral Health

Central Heating

Cold SunTrauma

HeredityFactors

Infection

Chemicals/ Allergens/Irritants

Stress

Ageing

Drugs

Lifestyle

HormoneChange

Pollution

Infestation

Nutrition Fluid intake

Emollients play a vital role in the Emollients play a vital role in the management of skin diseasemanagement of skin disease

Definition and function

Classification

When to apply

How to apply

Which emollient

EmollientsEmollients

“ 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 FunctionEmollient……Definition and Function

Medical term for moisturiser Safe Simple Effective Steroid sparing Intrinsic anti-inflammatory action

Emollients also help to…………Emollients also help to…………

Replace water lost from the skin

Lubricate the skin

Reduce scaling

Seal the Stratum Corneum

Classification of Emollients….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………………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 applyEmollients…..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 effectivelyEmollients….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

EmollientEmollient………………the choicethe choice

• Paramount importance

• Cosmetic acceptability essential

• Compromise between efficiency and cosmetic acceptability

Which Emollient ?Which Emollient ?

The very best emollient for any

individual is…………….

the one they prefer

Emollient Base……...Emollient Base……...

Important point to remember………

Use a cream base for moist/wet skin

Use an ointment base for dry/cracked skin

Quantities of EmollientQuantities of Emollient

For an adult with dry or compromised skin

Bath additives 300mls per month

Creams or ointments 2000gr per month

Emollient ChartEmollient Chart

Emollient ChartEmollient Chart

Topical SteroidsTopical 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 SteroidsTopical Steroids Lotion Gel Cream

Ointment

Impregnated tape

Which Steroid ?Which Steroid ?

Always use the least potent strength

necessary to gain maximum effectiveness

Mild Topical SteroidsMild Topical Steroids

Use for mild inflammatory skin conditions

May be used on the face

Moderate Topical SteroidModerate Topical Steroid

More suited to prolonged use of topical

steroid for inflammatory skin condition

Potent Topical SteroidsPotent Topical Steroids Acute inflammatory skin condition

When titrating from very potent steroid

Very Potent Topical SteroidsVery 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 NotePoints of Note

Steroids may be combined with other agents

Antibiotics Antifungal agents Both of the above

Points of notePoints 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 ?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 SitesUseful 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