1. Skin care product selection

2. The PH of the skin is 5.5 Urine and faeces are alkaline which cause a chemical reaction when a patient is incontinent

3. Identify some common skin conditions

4. Common skin problems Maceration Excoriation Dryness Fragility Blistering Skin stripping Scarring

5. Maceration Softening and breaking down of the skin from prolonged exposure to moisture. Proteases found in chronic wound exudate actively damage healthy tissue. Maceration is more common in chronic wounds

6. Maceration may delay healing enlarge wounds Increase pain

7. Treatment Manage exudate appropriately. Use of barrier film such as cavilon.

8. Excoriation

9. excoriation Identify and resolve incontinence Use of barrier creams Urine collection devices

10. ECZEMA

11. Signs and symptoms Itching/ puritis Redness Vesicles / blisters

12. Contact sensitivity Dressings Bandages Lotions / creams Topical antibiotics Consider patch testing / dermatology referral

13. Skin dryness/ dehydration Hydration normally maintained by sebum secreation and intact stratum corneum

14. Cardiff and Vale NHS Trust Ymddiriedolaeth GIG Caerdydd a’r Fro

15. Causes of dryness Systematic dehydration Dermatological conditions Inappropriate dressings Ageing – hormonal changes Enviromental – soap Medications – steroids interfere with epidermal regeneration and collagen synthesis.

16. Emollients Regular use of emollients or mosturisers will prevent dry skin and acute flares thereby improving skin health (British dermatology nursing group 2010)

17. Dry skin is usually itchy and leads to inflammation this is usually the first in the development of atopic eczema. These skin changes lead to a decrease in natural moisturising factors.

18. Washing with alkaline soap reduces the thickness and number of layers within the skin. Excess use of soaps / detergents can interfere with the water holding capacity of the skin and alter PH

19. Emollients are available in many formulations and patients should be encouraged to replace soaps with emmollient washes.

20. Which product to use? Patient preference Consistency required Ingredients Cost

21. Patient preference May not like the thick ointments that stain clothes – lighter creams are more easliy absorbed. May not like odour. Bath additives Soap substitutes Leave on emmollients

22. Consistency Creams Lighter in consistency Spreads easily but absorbed quicker Ointments Thicker and are more greasy. Have occlusive effect and retain water in the skin Better when high exudate.

23. Humectants Humectant moisturisers replace the skins natural moisturising factors (e.g Urea and glycerol) therby attracting and retaining water in the skin cells. eg hydromol

24. Aqueous cream Recent research ahs found that if aqeous cream may cause irritation due to sodium lauryl sulphate which damages the skins barrier properties ( Cork et al 2003)

25. Ingredients May include known sensitisers such as lanolin preservatives and fragrance (eg E45). Nut derivatives ( eg arachais oil)

26. Emollient guidelines (PCDS/BAD atopic eczema 2006) Apply liberally and frequently – every four hours (qds) Patients underestimate quantity needed and application frequency – large quantities should be prescribed – 600g/week Quantity and frequency should be far greater than steroid therapy. Education on how to use emollients is important