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Choosing soap substitutes, bath additives and
leave-on emollients can seem complicated...
8
SKIN CARE TODAY
2015,Vol 1, No 1
WHY IS COMPLETE EMOLLIENT
THERAPY BENEFICIAL?
Emollients aim to prevent trans-
epidermal water loss by creating an
occlusive layer on the surface of the
skin, which increases water in the
stratum corneum. This, in turn, helps
to restore the skin’s barrier function
— keeping allergens and irritants out
and moisture in (Cork, 1997; Cork and
Danby, 2009;
Figure 1
).
Emollient formulations vary, as
do the way in which they work. For
example, they may:
i
Have an occlusive effect, trapping
water within the stratum corneum
i
Have a humectant effect, attracting
water into the epidermis from the
dermis (Penzer and Ersser, 2010).
And, some products do both —
providing occlusive and humectant
effects.
Dry skin is a problem for
many, particularly those who have
endogenous skin conditions such as
eczema, psoriasis and ichthyosis. The
natural ageing process alongside the
use of detergents can also lead to dry
skin. Environmental factors, stress,
ill health and some medications may
also affect the hydration levels of
the skin.
ASSESSMENT
It is important to consider the
condition of the skin, whether it is wet
or weeping, dry, flaky or scaly, fissured
with deep cracks if very dry, infected,
blistered, eczematous, psoriatic, or
vulnerable.The site that needs treating
or protecting should also be assessed,
as a combination of preparations may
be appropriate for different body sites,
e.g. the scalp, face, body, limbs, hands,
palms, feet, soles, flexures and sensitive
areas. Furthermore, the ability of the
patient or carer to apply the treatment
should be taken into account.
Dry skin can also look different
depending on the skin type, e.g.
EMOLLIENTS AT A GLANCE
i
Tanya Flavell, lead clinical nurse specialist in
dermatology, community tier 2 dermatology service,
Bolton NHS Foundation Trust
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grey or ashy in people with darkly-
pigmented skin.
The impact of dry, vulnerable skin
management and itch on patients’
and/or their family’s quality of life
may need to be addressed.
PATIENT CHOICE
Patients should have a choice of
emollients, as personal preference
of emollient preparations vary
significantly. Some patients prefer
heavier, greasy emollients for night
time and lighter emollients for day
time use, while others prefer an
enhanced humectant and occlusive
product that may only need to be
applied two to three times daily.
Cosmetic acceptability of
products is very important for
patients (Best Practice Statement,
2009), and supports concordance
with the agreed management plan
(British Dermatological Nursing
Group [BDNG], 2012).
MANAGING DRY SKIN
Emollient therapy is essential
for the treatment of all dry and
vulnerable skin conditions (BDNG,
2012; Moncrieff, 2013). Complete
emollient therapy refers to the use of
bath additives, soap-free cleansers,
or soap substitutes and leave-on
emollients. There are a number of
Figure 1.
Effect of emollient therapy on dysfunctional skin.
.
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