CATEGORIES OF SKIN CARE PRODUCTS FOR THE ODLER PERSONThere are many categories of skin care products on the market which are essentially developed to help maintain skin integrity or manage or treat common dermatological conditions such as dry skin and fungal infections. Many of these specifically address what is called the periwound skin (the immediate area around the wound) but it is important to note that they are not indicated for use in open wounds.
The categories of skin care products you may come across include: cleansing products, moisture barriers and powders, moisturizers, sealants and protectants, tape, antimicrobial or antifungal preparations and topical anti-inflammatory and antipruritic (anti-itching) preparations.
To further increase the number ofskin care products, these products can come in tubes, jars, bottles, foam applicators, spray pumps, gels, ointments, wipes, creams, pastes, powders, and swabs. There are also fluid container products such as dressings, briefs or underpads.
First and foremost, however, follow the recommendations and expertise of your health care professional to ensure the optimum products for your situation.
Our appendix of skin care product brand names and websites to obtain further information.
Skin care products are usually broken down into two basic categories:
a) Physical barriers are defined as a permanent interface between two surfaces to protect skin integrity.
b) Protectants are defined as indirect temporary techniques or applications to maintain the integrity of skin at high risk.
We will review the pros and cons of each category; you can then refer to the brand names listed at the back of this book.
Physical barrier skin products
1. Zinc oxide preparations
These are the most widely used barrier preparations and have been used for a long time and have been used routinely to protect the periwound skin. In babies, for diaper rash and people with sensitive skin, including the elderly, these zinc oxide and petroleum based skin barrier products have proven to be very helpful.
These products are stiff in texture, easily accessible and inexpensive, making them conducive for general use and the most part generally effective. There is significant product variability between preparations especially with regard to stiffness; sometimes ingredients such as perfumes can be allergenic which can in turn be detrimental to the skin.
Although inexpensive, you have to consider that the application of these products is labour-intensive and there is sometimes a danger of bacterial contamination.
Further, due to their stiff texture they can clog containment devices and interfere with absorbency, adhesion and antimicrobial properties of topical treatments. They are often messy and difficult to remove.
A further significant problem for the caregiver is that the underlying skin can be “masked” and not easy to assess.
2. Adhesive dressings
Films or thin hydrocolloid dressings are also skin care products that are used as skin barriers. They are applied using a picture window framing technique, where a hole is cut in the dressing to allow for the movement of effluent into a management device such as an absorbent dressing, while protecting the skin around the wound margin. Framing the surrounding skin prevents effluent from attacking healthy skin by forming a solid interface between the two components.
This approach has the benefit of providing a constant barrier that does not require frequent changing (providing more patient comfort) but allows visualization of the underlying skin through the dressing. However, it must be pointed out that skills are needed by the caregiver/health professional to choose the optimum “draining” aperture.
There can be some disadvantages in that the dressing edge rolls or lifts, trapping the exudates and perhaps leading to the growth of bacteria. Hydrocolloid dressings can contribute to a developing odour which can cause problems and there is always a possibility of an allergic reaction.
3. Liquid forming barriers
These products are relatively new and provide some important user benefits, as follows:
They are user-friendly in that they are flexible, conformable and easy-to-use, allow uniform application, resist wash off, do not trap containments and enable the caregiver or health practitioner to see the underlying skin.
Unlike some of the zinc oxide and petroleum products, some of these products work well with adhesive dressings and do not interfere with containment devices.
Skill is required to apply these products, just like with the adhesive products. There are also differences between the brands so you should make sure you use the brand of caregiver or health practitioner.
4. Zinc Oxide and petroleum based preparations
These are the most widely used barrier preparations to protect sensitive skin such as periwound skin, diaper rash and fragile elderly skin.
They also often inhibit the absorbency and adhesion of other devices.
Protectant skin products
Skin cleansers or cleansing regimens
These products, which are known as surfactants, meaning they lower the surface tension, are designed to remove debris from the skin surface. They should not be used for open wounds where they can have a detrimental effect on healing.
Skin cleansers are characteristically mild, non-irritating and non-drying and are available in a wide variety of forms such as wipes, swabs, foams, washcloths, and bottles. They can be used in the bath, locally or in the shower.
There are more specialized periwound cleansers which gently dissolve and remove feces and urine, without having to scrub which could create more damage to the skin. They are also soapless and non-irritating.
It is always important to check that the right product is being used – there are further category variables such as sterile or non-sterile, ionic and non-ionic, and some are more toxic than others. Overuse can cause problems such as drying the skin and adversely changing the skin pH. There can also be sensitizers present.
These products are vital to ensure healthy skin maintenance and must be applied regularly.
The top layer of the skin needs 10% moisture content to maintain integrity. As previously described in skin structure, the very top layer of skin is the epidermis (next to the deeper, thicker dermis). It is this horny layer (stratum corneum) that provides protection from water loss. This is the layer of skin that must be kept supple and moist to ensure its integrity and this is where moisturizers can help.
You should evaluate whether the environment can be a risk factor; for example, warm climates or even an above average room temperature can deplete the body of protective moisture.
A further consideration is to ensure the moisturizer is applied to intact skin, otherwise there may be a sensation of stinging or burning.
Moisturizers, which usually consist of urea or lactic acid preparations, act as hydrators or lubricants. They act by binding moisture within the skin and their function is to preserve the suppleness of the skin and also act as a protection against harmful factors.
Guide to Mosturizers
|Less Effective: LOTIONS||More Effective: CREAMS||Most Effective: OITMENTS|
|Consists of 90% or more water containing dissolved crystals held in suspension by surfactants. On application, feels cool, but evaporates quickly and must be applied frequently.||Consists of oil and water which is more occlusive than lotions and work more by preventing moisture loss due to evaporation rather than replenishing skin moisture. Creams need only to be applied 3- 4 times a day.Value||Consist of oil (usually lanolin or petroleum) and water in a proportion that has more occlusive properties ensuring a longer lasting form of moisturizer. They need much less applications than lotions or creams.|
These are absorbent devices that remove fluids from the skin surface, the common ones being diapers/underpads and dressings.
There are many different categories of dressings and although absorbency may be a common feature, each type of dressing absorbs differently. An alginate dressing, for example, has the ability to absorb a huge amount of fluid whereas others just wick away fluid from the skin and soon create a seepage situation where fluid is leaking from the dressing. Other dressings provide a dynamic equilibrium on the wound surface. In any event, fluid leaking from dressings causing “strike through” can damage the skin.
Diapers or underpads vary a great deal in functional qualities. You should be aware of the recommended products available from your facility or provider and follow the instructions.
Ostomy bags are another example of a fluid container. These are pouches attached to patients to relieve excretion after intestinal surgery. While the health care provider has the expertise in this area and is responsible for selection of the relevant product, patient education and training is vital.
These two categories, protectants and moisturizers, make up most of the numerous skin care products available. However, there are some other generic categories such as:
These are available as creams, pastes and powders, both over the counter and with prescription to treat bacterial or fungal infections.
Mucosal care products
These are used for the cleaning and care of mucosal membranes and oral lesions
Although these are technically cleansers and in the category of moisturizers, they deserve a special mention because there are a lot of brands in this category. There is a great demand for these products for the elderly because of factors such
– These specialized products are available as sprays, gels, ointments and wipes and are sometimes used on irritated skin or burns. It is very important to read and understand the instructions and indications for use before applying these products to irritated or broken skin.