1. Barbara Page Dermatology Liaison Nurse Specialist NHS Fife
Skin Integrity – the basics of skin care Emollients and use of Topical Steroids
Barbara Page
Dermatology Liaison Nurse Specialist
NHS Fife

2. Functions of the Skin Barrier Temperature control Sensory
Vitamin D synthesis
Communication & display

3. Promoting Healthy Skin……. The Basics of Skin Care
Emollients……
Emollients…...

4. Healthy Skin Allergens Water Water Water Water Water Water Water Water
Normal healthy skin
Looking at the top layer of skin which is known as the epidermis or the “cell factory” of the skin where cells develop through a number of stages until they form the stratum corneum
From base to surface this takes around 28 days……..much slower as the skin ages. The skin cells produce natural lipids which hold the skin cells together.
If we can relate this simply to a brick wall ……… bricks are the cells ……..mortar, the natural lipids ……… surface is intact, like a smooth coping stone on top of the wall ……… what happens when the surface layer (stratum corneum/coping stone) is not intact ……… there is a loss of barrier function
Water
Water
Water
Water
© 2001 Elliott/Cork/Cork 4

5. Loss of Skin Barrier Loss of water Loss of water Loss of water
Loss of fat
Loss of fat
Loss of skin barrier………. entry point for :
Allergens
Irritants
Infection
allergens/irritants/infection
into skin - skin reacts
© 2001 Elliott/Cork/Cork 5

6. Internal and External Factors Affecting Skin
Cold
Trauma
Nutrition
Fluid intake
Sun
Central
Heating
Infestation
Heredity
Factors
Skin
General Health
Pollution
Infection
Stress
Hormone
Change
Drugs
Chemicals/
Allergens/
Irritants
Ageing
Lifestyle

7. Emollients play a vital role in the management of skin disease
Definition and function
Classification
When to apply
How to apply
Which emollient

8. Emollients providing partial occlusion that hydrates and
“ 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

9. Emollient……Definition and Function
Medical term for moisturiser
Safe
Simple
Effective
Steroid sparing
Intrinsic anti-inflammatory action

10. Emollients also help to…………
Replace water lost from the skin
Lubricate the skin
Reduce scaling
Seal the Stratum Corneum

11. 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
Lotions and gels are very light and more suitable to apply to hairy areas eg scalp or chest of a male
Creams contain preservatives which contain potential sensitisers – refer to your emollient chart to identify if a problem occurs with emollient therapy
Ointments do not contain any preservatives – preferred treatment for very dry skin
A cream could be applied day time and a greasier ointment at night to give optimum therapy 11

12. Classification cont………………
Bath oils
Clean and hydrate - trap water in skin
Soap substitutes
Not astringent - not alkaline - do not dry out
the skin

13. Emollients…..when to apply
As frequently and liberally as possible
At least 3 times per day
After bathing when the skin is still moist

14. 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

15. Emollient………the choice
Paramount importance
Cosmetic acceptability essential
Compromise between efficiency and cosmetic acceptability

16. Which Emollient ? The very best emollient for any individual is…………….
the one they prefer

17. Emollient Base……... Important point to remember………
Use a cream base for moist/wet skin
Use an ointment base for dry/cracked skin

18. Quantities of Emollient
For an adult with dry or compromised skin
Bath additives 300mls per month
Creams or ointments 2000gr per month

19. Emollient Chart

20. Emollient Chart

21. 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

22. Topical Steroids
Lotion
Gel
Cream
Ointment
Impregnated tape

24. Which Steroid ? Always use the least potent strength
necessary to gain maximum effectiveness

25. Mild Topical Steroids Use for mild inflammatory skin conditions
May be used on the face

26. Moderate Topical Steroid
More suited to prolonged use of topical
steroid for inflammatory skin condition

27. Potent Topical Steroids
Acute inflammatory skin condition
When titrating from very potent steroid

28. 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

29. Points of Note Steroids may be combined with other agents Antibiotics
Antifungal agents
Both of the above

30. 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

31. Use the “fingertip unit” (FTU)
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

32. Useful Web Sites www.dermnetnz.com