Skin Care World

This article originates from the Tubifast Garments Healthcare Professional Guide

THE SKIN

The skin is the largest, most visible organ of the body and performs many important functions.

Functions of the skin include:

• A protector to external irritants
• Keeps the body temperature regulated
• It is a sensory organ
• It produces vitamin D – an important factor for our bones
• Psychosocial factors. (1)

At a healthcare level, in the UK 33% of the population suffer with a skin complaint at some time. Skin problems also amount to approximately 15% of a GP’s workload, 6% of prescriptions and almost 8% of the 66% of calls to NHS Direct that are triaged by nurses, relate to skin problems.(2)

ATOPIC ECZEMA - A COMMON SKIN CONDITION

76% of dermatology consultations in primary care arise from a small number of conditions: eczema, psoriasis, acne and leg ulcers, but the most prevalent is eczema.(2)

Eczema occurs when this skin barrier malfunctions,(3) and atopic eczema is one of the most common inflammatory skin diseases,(4,5) affecting some 15%-20% of children. Over the past 30 years, it’s occurrence has increased 2-3 fold (6) and although most children will grow out of the condition in their teens, it is very time consuming for families to manage during childhood.

Atopic eczema can be identified by its positioning on the body, usually seen in the flexures of the body such as elbows, knees, wrists and ankles. In very young children, it can also affect the trunk as well as the arms and legs. It is also often associated with other family atopys – asthma and hay fever – and can be hereditary.

Atopic eczema should not be confused with other types of eczema, including seborrhoeic eczema which affects sites such as the scalp, ears, back and chest in men; and contact eczema which is triggered by irritants such as jewellery, rubber, adhesives and so can affect any part of the body.

Therefore, correct diagnosis of the eczema type is vital in order to manage the condition effectively. A complete assessment of the patient and their lifestyle can highlight important information and aid the prescription of the correct treatment.

SYMPTOMS OF ATOPIC ECZEMA (7)

• Itching and scratching
• Redness
• Blistering
• Scabbing
• Cracks in the skin
• Pigmentation
• Lichenification/hardening of the skin.

THE CAUSES OF ATOPIC ECZEMA

Although the exact causes are unknown, a lack of natural oils in the skin is acknowledged as a major factor. The problem is exacerbated by the use of soap, shampoo and by exposure to detergents.

Sufferers can be susceptible to allergies such as pet hair, dust, pollen and certain foods. Temperature extremes may also make the condition worse, as can certain clothing, such as woolly jumpers and non-cotton items.(8) The result is dry, scaly, itchy skin.

The natural reaction is to scratch the skin to relieve the itch, but this can become a vicious cycle, worsening the condition and, in some cases, leading to infection. Breaking the cycle is not easy, but understanding the external triggers can aid the management of the condition.

DEALING WITH ATOPIC ECZEMA

The therapy

One simple answer is to moisturise the skin with an emollient. This will not only help relieve the urge to itch, but also give the skin the chance to heal itself. However, in order to optimise its effectiveness, the emollient needs to be kept in contact with the skin for as long as possible.

The value of wrapping

Regular application of emollients may be difficult due to resistance from the child, and the time needed by parents busy with work, home and other commitments. This is why wet or dry wrapping is used to keep the emollients in place for longer. Wet wrapping in particular has improved the quality of life for children through improved sleeping patterns and reduced hospital admissions.(9,10)

Wet wrapping involves applying liberal amounts of a suitable emollient, such as Epaderm, to the skin, followed by two layers of Tubifast Garments, the bottom layer damp and the top layer dry.

The potential benefits of wet wrapping

• Steroid usage can be reduced where indicated by your healthcare professional (9)
• Reduces hospital admissions for a chronic condition (9)
• Interrupts the itch scratch cycle (9)
• Cools and soothes the skin as the water evaporates (9)
• >Acts as a mechanical barrier preventing further damage to the skin
• Sleep patterns can be significantly improved (9)
• Prevents the emollient being wiped off and protects clothing
• A wet garment may help to increase the penetration of the topical treatments (3)
• Keeps the skin hydrated (9)
• Emollients help reduce inflammation (3)
• >Emollients help reduce allergen load (3)

For some, dry wrapping is preferred where a single dry layer is applied over an emollient.

Choosing the right emollient

An emollient provides a barrier over the skin reducing water loss and so maintaining skin hydration (4). The choice of emollient is a very important decision and one that must be suitable for the patient. Many prescribed bath oils and moisturisers contain perfume, preservatives or additives that are known to cause skin rashes, specially in those already suffering from eczema.

Epaderm acts as a film barrier aiding moisture retention within the skin. Many people find its 3-in-1 formulation much easier to use as it can be used on the skin, in the bath or as a soap alternative. This also coincides with the concept of complete emollient therapy whereby washing, bathing and moisturising with emollients are part of the treatment of dry skin conditions.

It contains no fragrances, colourings or additives, and was originally developed by the Royal Victoria Infirmary, Newcastle-upon-Tyne. Supplied in convenient 125g and 500g tubs, it is available on Drug Tariff. (10)

Tubifast Garments for wet wrapping

New ready-made Tubifast Garments are the latest development from the leaders in dressing retention. Ideal for convenient, quick and simple wet wrapping, Tubifast Garments are suitable for use on children from six months.

• Available in full-sleeved vests, tights, leggings and socks
• Ideal for dressing retention, wet wrapping and dry wrapping
• They allow complete freedom of movement through the two-way stretch construction
• Flat seams help to prevent irritation of sensitive skin
• Comfortable to wear under nightwear and ordinary clothes, so helping to promote fully active days and restful nights
• Convenient, quick and simple way to wet wrap so aiding compliance
• Wet wrapping can help to reduce the itch of atopic eczema.

Wet wrapping - instructions for use

1. Select the right sized garment for the child’s age.
2. Bathe the child and pat dry.
3. Ensure the garment is seam side out.
4. Place the chosen garment into warm water.
5. Where indicated by the healthcare professional use an appropriate topical application on badly affected areas.
6. Apply emollient liberally over the whole body, using a downward motion
7. Squeeze the water out of the wet Tubifast Garments. Apply the vest, leggings, tights and/or socks while still warm and damp; apply as you would normal clothing.
8. In the same way apply the dry Tubifast Garments as a top layer.
9. Normal clothes can then be applied.

Dry wrapping - instructions for use

1. Select the right sized garment for the child’s age.
2. Bathe the child and pat dry.
3. Ensure the garment is seam side out.
4. Where indicated by the healthcare professional use an appropriate topical application on badly affected areas.
5. Apply emollient liberally over the whole body, using a downward motion to stop hair follicles becmoning blocked.
6. Apply the vest, leggings, tights and/or socks directly over the emollient. The garments are applied as normal clothing.
7. Normal clothes can then be applied.

EPADERM PRESCRIBING INFORMATION

Active Ingredients: Yellow Soft Paraffin BP 30% w/w.
Presentation: Dispensed in containers with 125g or 500g of ointment.
Pharmacology: Epaderm forms an occlusive film on the surface of the skin, thereby reducing the loss of water.
Uses: For general use as an emollient to moisturise and soften dry skin. It may be used instead of soap.
Dosage and Administration: Epaderm should be massaged into the skin as often as required. It may be added to a bath by first melting it with hot water. When used as a bath additive, care should be taken as it will make the bath slippery. If Epaderm has been prescribed by a physician, follow his/her instructions regarding use. Consult a pharmacist if you are unsure.
Contraindications, warnings, etc:
Contraindications: Hypersensitivity to any of the ingredients.
Warnings: For external use only.
Interactions: None known.
Use in pregnancy and lactation: The effect of Epaderm during pregnancy and lactation has not been established. There are no recommendations.
Overdosage: Overdose is unlikely to occur. If necessary, medication should be removed by washing with warm water.
Pharmaceutical precautions: Store below 25C in a dry place.
Legal category: GSL.
Product Licence Number: 11314/0114.
Product Licence Holder: Seton Products Limited, Tubiton House, Oldham, OL1 3HS.
Basic NHS Prices: 125g: £3.67; 500g: £6.21.
Date of Preparation: February 2003. Further information on request from the product licence holder.