Dry Skin is Graffiti: Treatment for the Prevention of Wounds

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by Aletha Tippett MD

Because of neuropathy, peripheral vascular disease, or age, most if not all of the patients seen for wound care have dry skin. This dry skin increases the risk of infection, skin tears, bruises and ulcers.

The microfissures in dry skin are a perfect entryway for bacteria, hence increasing the risk of infection. Dry skin is very fragile and brittle, with more likelihood of skin tears and bruises. And, dry skin has more friction against a surface, thus increasing risk of pressure ulcers. Our patients have dry skin because, due to disease or age, their bodies have lost the ability to produce and secrete the oils that would normally lubricate the skin.

Therefore, don’t just accept dry skin as normal, instead consider dry skin like graffiti. Suppose you drive into an area with graffiti—what is the impression? You think, this area is not taken care of, this area might be unsafe. Same with dry skin. If the skin is dry, the patient is not safe; they are at risk for skin tears, bruises, infection and ulcers. Dry skin is not being taken care of—the body is not able to make its own oils, so the caregiver must provide this. If a patient was unable to eat, the caregiver would feed them; the same goes for if a person cannot lubricate their own skin, the caregiver must do it for them. This dry skin needs aggressive emollient therapy, “greasing up” with lanolin or oil, not just a usual hand lotion. Lanolin or oil needs to be applied daily to all dry skin. Usually the feet and legs are in greatest need of emollient therapy.

Now as to what lanolin to use—my favorite is Bag Balm (originally made for cows’ udders) which is inexpensive and available in all drug stores in the lotion section. If the patient is at home, this is very easy to use. Some nursing homes will allow it, but some will not, and usually hospitals will not. In this case, an inexpensive substitute is A&D ointment. Some patients prefer oil, such as olive oil, and this is a good emollient also. There are a number of specially formulated therapeutic moisturizers on the market, as well.

If you are caring for your patients and notice dry skin, think “graffiti”. Then take proper steps to eradicate the graffiti. Daily emollient therapy for skin care has other advantages as well. First, the patient is being touched, which is so necessary for healing and caring, the human connection. Second, while touching and applying emollient, there is the chance to observe the patient and their skin, observe their pressure support and their surroundings. Nurses and physicians who work in environments with this kind of care will tell you that skin issues are very rare. This technique can be used as a key element in a pressure ulcer prevention program (1). So a very important, if not the most important, part of skin care is treat the dry skin and get rid of the graffiti.

(1) Tippett, A. Reducing the Incidence of Pressure Ulcers in Nursing Home Residents: A Prospective 6-year Evaluation. OWM 2009; 55(11):52-58

About the Author
Aletha Tippett MD is a family medicine and wound care expert, founder and president of the Hope of Healing Foundation®, family physician, and international speaker on wound care.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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Just an important caveat, some patients may be allergic to lanolin, so I don't usually recommend it, I prefer an emollient without it. I also tend to be a little leary of preparations that were originally created for non-human applications, especially in todays litiginous climate.

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