28
SKIN CARE TODAY
2015,Vol 1, No 1
FOCUS ON INCONTINENCE-RELATED SKIN DAMAGE
i
and water found that individuals
were less likely to suffer IAD
or, if IAD was already present,
they suffered less severe lesions
(Beeckman et al, 2011).
Moisturisers
Skin moisturisers are designed to aid
protection and repair of damaged
skin by maintaining the natural
moisture within the skin, preventing
its loss through the epidermis and
repelling excess moisture in the form
of urine (Grey et al, 2012). They differ
from barrier creams, whose purpose
is to protect and repel excessive
moisture from the skin.
Barrier creams
Barrier creams are often used in
continence care, and many now
contain dimethicone, a silicone
substance which is both moisture
repellent and smooths the surface
of the skin. These are superior to the
older generation of barrier creams,
that the pad is capable of absorbing
the volume of urine the individual
voids. It is advisable that pads are
changed every 3–4 hours during the
day and that they can be left
in situ
up
to eight hours at night (McCoy, 2008).
However, as mentioned above,
before resorting to the use of
continence pads, the individual
must have a continence assessment
performed. This will avoid the use of
unnecessary pads, which are neither
comfortable nor dignified, and ensure
that the root cause of the continence
problem is addressed (Masuko, 2005).
Cleansers
Skin cleansing should not include
the use of soap. The majority of soaps
have an alkaline base and so would
raise the skin’s pH, altering it from
its usual acidic base. In addition, the
combination of soap and hard water
produces a precipitate which remains
on the skin (Timby, 1996). Soaps also
adversely affect the skin by removing
natural oils and causing dryness
(Voegli, 2010). It is recommended
that a skin cleanser is used. These are
available in several forms — sprays,
foams and cloth cleansers (
Table 1
).
Essentially, the cleanser
should contain an emulsifier or
surfactant to aid removal of dirt/
faeces, without altering the pH of
the skin. Proprietary cleansers do
not require rinsing and so become
a time-effective treatment. Many
also contain a moisturiser, which
precludes the use of an additional
emollient for skin protection. Such
cleansers are available as foams,
sprays, mousse, cream or wash
cloths impregnated with cleansers,
which reduce the time spent by
healthcare professionals and so
encourage adherence to a regimen
of best practice (Warshaw et al,
2002). Studies comparing 3-in-1
washcloths against pH neutral soap
Table 2:
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3URGXFW
$FWLYH LQJUHGLHQWV
%HQHÀWV
$SSOLFDWLRQ LQVWUXFWLRQV
3UHFDXWLRQV
LBF™ Barrier
cream (range also
available as No
Sting Barrier Film
Spray; Sterile No
Sting Barrier Film
Foam Applicator;
and Sterile No
Sting Barrier
Wipes)
(Clinimed)
Dimethicone
12-hour waterproof
formulation, resist wash off
pH balanced
Will not block pads
Highly concentrated, small
amounts cover large area
of skin
(LBF range designed to provide
a barrier against irritation from
bodily fluids and to protect
the skin from incontinence-
associated skin damage
and friction)
Cleanse and dry the skin before application Should not be used on
broken or infected skin
Cavilon™ Barrier
cream (3M)
Dimethicone
Acrylate Terpolymer
Dicpryladpidate
Coconut oil
Mineral oil Acrylate
Terpolymer
Non-petroleum based, will not
block pads. Wash-off resistant
Allows tape/dressing adherence
to skin
Hypoallergenic and
pH balanced
Apply sparingly (pea-size amounts)
Available in sachets or tube
Not to be used on
infected areas of the skin,
e.g. fungal infection
Cavilon™ No-
sting barrier film
(3M)
Hexamethyldisiloxane
Acrylate Terpolymer
Polyphenylmethylsilolaxane
Isoctane
Primary barrier to bodily fluids,
may be used peri stoma and
wounds to protect against fluid
Protective barrier against
medical devices
Apply using either sponge applicator or spray
Allow to dry completely before applying
devices or clothing
Not to be used on
infected areas of the skin,
e.g. fungal infection
Use of additional barrier
creams may reduce
effectiveness and
is unnecessary
Secura ™ barrier
cream (Smith and
Nephew)
Contains 5% dimethicone
Protects skin from breakdown
due to excessive moisture
Available in sachet or tube. Apply sparingly
Could affect adherence of
adhesive products
Proshield Plus™
H&R Healthcare)
Dimethicone-based skin
protectant containing
copolymer bio-adhesives
May be used on both intact
skin and that injured
by incontinence
Available in a tube, to be used sparingly
None stated by company
