Skin Care

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					    Skin Care
Information for patients
    Notes

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Why does skin become dry?
The following are all factors which can affect the skin’s natural ‘moisturisers’:

•	 Ageing—skin	becomes	drier	as	we	get	older.
•	 Inflammatory	disease—for	example,	psoriasis.
•	 Lack	of	bodily	fluids—dehydration.
•	 Exposure	to	skin	irritants.

How do you keep your skin from getting too dry?
•	 Avoid	factors	which	can	dry	your	skin.
•	 Use	emollients	(moisturisers)	to	help	conserve	your	skin’s	natural	moisture.

What is an emollient?
Emollients	(moisturisers)	contain	bland	oil	or	water-based	substances.	Like	all	things	
there	is	an	element	of	personal	preference	so	you	should	experiment	until	you	find	
one	that	suits	you.

Skin	dryness	can	vary	for	many	reasons	and	you	may	find	that	you	collect	a	range	of	
emollients	suitable	for	all	eventualities.

A	bath	or	shower	with	an	oil	should	be	part	of	your	daily	skin	care	plan.

Bathing
Emollient	(moisturising)	bath	oils	improve	the	texture	of	the	skin	to	the	touch	by	leaving	
an	occlusive	layer	on	the	surface	of	the	skin	under	which	fluid	is	then	trapped	in	the	
skin	cells.

How to use bath oils correctly
Emollient	bath	oils	can	be	used	in	the	bath	or	shower,	applied	directly	to	the	skin	or	
sponged	on.

•	 Put	straight	onto	the	skin	or	use	a	sponge	to	apply.
•	 Pat	your	skin	dry—rubbing	can	irritate	and	cause	itching.
•	 Hot	water	makes	your	blood	vessels	open.	This	can	leave	your	skin	very	red,	irritable	
   and	itchy.
•	 Keep	bath	or	shower	time	down	to	10	minutes	as	too	long	in	the	water	makes	your	
   skin	flaky	and	wrinkly.
•	 Apply	emollients	as	soon	as	you	get	out	of	the	bath	or	shower.	Your	skin	does	not	
   need	to	be	completely	dry	before	application.
                                                                                              3
    Bathing children
    Babies	and	children	have	more	delicate	skin	than	adults.	The	temperature	of	the	
    water	in	a	shared	bath	should	be	the	right	one	for	the	baby/child.	This	might	feel	cool	
    to	you—remember	the	elbow	test.	If	the	water	is	too	hot	on	your	elbow	it	will	be	too	
    hot	for	a	youngster.

    Use	a	very	mild	shampoo	when	washing	babies’	hair.	Wash	hair	separately	from	the	
    bath.	This	reduces	contact	with	detergent	shampoos.

    Soap substitutes
    These	are	very	helpful	as	ordinary	soap	can	dry	your	skin	causing	irritation	or	sensitising.	
    Try	to	keep	them	handy.

    •	 Keep	a	tube	by	the	sink	and	washbasin.
    •	 Keep	one	in	your	handbag.
    •	 Take	a	supply	to	use	at	work	or	school.
    •	 Remember	‘natural’	is	not	always	safe—natural	products	can	contain	substances	
       which	may	cause	skin	irritation.
    •	 Always	read	labels	to	check	the	ingredients.	If	you	are	allergic	to	wool	alcohols	or	
       other	substances	check	with	the	pharmacist.

    You	should	avoid	the	following	as	they	can	cause	dryness	and	sensitivity:

    •	 Soap	or	bubble	bath.
    •	 Antiseptics	such	as	Dettol	or	TCP.

    Topical	(for	applying	externally)	oils	and	emollients	are	available	over	the	counter.	You	can	
    also	get	them	on	prescription	for	certain	conditions.	They	do	not	contain	medication.

    How to apply your emollient
    •	 Apply	in	smooth	downward	stokes.
    •	 Do not	rub	in—this	can	cause	blocked	hair	follicles	(folliculitis).
    •	 Light	frequent	applications	are	better	than	a	single	heavy	coating	(enough	to	leave	
       a	shine	on	the	skin).
    •	 You	may	need	to	use	it	for	the	rest	of	your	life	to	maintain	your	skin	in	good	
       condition.

    Apply as many times as you like.
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You	need	to	make	sure	you	do	not	contaminate	the	pot	of	emollient	with	bacteria	as	
some	types	can	cause	skin	infections.	These	are	likely	to	be	introduced	by	different	
fingers	dipping	into	the	pot.	Here	are	a	couple	of	tips.

•	 Some	emollients	come	in	tubes	or	pump	dispensers—these	are	more	hygienic	than	
   tubs	or	pots.
•	 You	can	decant	enough	emollient	from	the	pot	or	tub	for	an	application	into	a	small	
   dish	using	clean	spoon.

Itchy skin
If	your	skin	is	itchy	then	it	is	possibly	dehydrated	(lacking	moisture).

•	 Apply	an	emollient.
•	 Avoid	scratching—this	can	damage	skin	and	leave	it	open	to	infection.

Make	the	application	of	emollient	part	of	your	regular	skin	care	programme.	Skin	is	the	
largest	organ	of	your	body—and	it	has	to	last	a	lifetime.

Scratching your head?
Don’t	forget	your	scalp	can	also	become	dry	and	itchy.	A	bland	oil	can	help.

•	 Massage	oil	gently	into	your	scalp.
•	 Cover	with	a	plastic	shower	cap—leave	for	1	hour	or	if	hair	is	uncovered,	leave	
   overnight.
•	 Wash	out	using	your	favourite	shampoo.

Using steroid creams or lotions as part of your treatment
•	 Apply	an	emollient	first—emollients	make	the	skin	shiny.	This	can	help	you	target	
   the	areas	that	need	steroid	application.
•	 Leave	emollient	to	soak	in	(for	30	minutes	if	possible).
•	 Finally	apply	the	steroid.

Tip:	Before	you	go	to	bed	in	the	evening	moisturise	your	skin	so	that	it	doesn’t	dry	out	
too	much	during	the	night.

Check regularly with your doctor that use of a steroid cream is still appropriate
to your treatment.

Keeping emollients in the right place
Emollients	are	good	for	your	skin—but	use	them	appropriately.	If	you	apply	them	when	
you	are	too	warm	they	will	keep	your	body	heat	in,	causing	you	to	itch.	If	you	put	too	
much	oily	emollient	on	you	could	end	up	smearing	it	all	over	the	house.	Little	and	often	
is	the	best	way.
                                                                                            5
    Emollients	may	stain	your	clothing	and	can	weaken	elastic.	Children	with	eczema	may	
    have	trouble	with	underwear	falling	down.	Oils	can	also	cause	trouble	with	the	rubber	
    seal	on	your	washing	machine.

    Don’t	put	too	much	emollient	on	at	one	application	but	use	it	often.	That	way	you	will	
    keep	your	skin	moisturised	without	waste	and	mess.

    Variety gives you choice
    The	condition	of	your	skin	and	your	eczema	can	change.	If	you	have	a	range	of	different	
    emollients	to	choose	from	you	will	be	able	to	pick	the	one	most	suitable	for	your	eczema	
    at	any	given	time.

    Oily	ones	can	make	your	body	temperature	go	up—unsuitable	in	hot	weather	when	you	
    want	to	barbecue	food,	not	your	skin!

    The environment
    The	environment	affects	the	skin		in	different	ways.	The	sun	can	burn,	dry	and	age	the	
    skin	so	you	should	always:

    •	 Use	a	sunscreen	for	protection.
    •	 Moisturise	after	exposure	to	the	sun.

    Swimming	is	a	good	healthy	exercise	but	chemicals	in	the	pool	can	dry	your	skin	so	
    you	should	always:

    •	 Shower	after	swimming.
    •	 Use	a	soap	substitute.
    •	 Moisturise.

    Wind	and	rain	can	affect	skin	dryness	so	you	should	always:

    •	 Carry	an	emollient	with	you	for	use	any	time	your	skin	starts	to	feel	dry.

    Central	heating	and	air	conditioning	can	over-dry	your	skin	so	you	should	always:

    •	 Keep	heating	turned	down.
    •	 Moisturise	frequently.

    Household	cleaning	agents	may	irritate	the	skin	or	cause	dryness	so	you	should	
    always:

    •	 Wear	cotton	gloves—or	better	still,	get	someone	else	to	do	the	job!
    •	 When	washing	or	gardening	wear	cotton	gloves	with	rubber	over-gloves.
    •	 Read	labels	to	check	the	contents	of	products.	If	you	are	allergic	to	anything	(such	
       as	wool	alcohols	like	lanolin),	ask	your	pharmacist	for	advice.
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If	you	are	worried	or	need	further	advice:

•	Ask	your	doctor.
•	Talk	to	your	dermatology	nurse.

Your questions answered
Q Which (moisturiser) emollient is best?
A	 No	one	emollient	is	the	best.	You	should	experiment	and	try	different	creams	until	
   you	find	one	you	like.

Q Do emollients contain steroids?
A	 No.	Emollients	do	not	contain	any	steroids.

Q Are bath oils dangerous to use?
A	 Care	does	need	to	be	taken.	Bath	oils	can	make	the	bath	surface	very	slippery.	Do	
   not	use	more	oil	than	is	recommended	on	the	label.	Clean	the	bath	out	after	use	
   with	a	detergent	cleaner	that	will	remove	the	oil.	But	remember	to	wear	rubber	gloves	
   with	cotton	liners	to	protect	your	skin.

Q How often is it safe to apply an emollient?
A	 Emollients	are	very	safe	to	use.	You	can	apply	them	as	often	as	you	need	or	wish.	
   A	good	timetable	to	follow	is:

  •	 Apply	when	you	get	up	in	the	morning.
  •	 Re-apply	at	lunchtime.
  •	 Apply	again	when	you	get	home	from	work	or	school.
  •	 Re-apply	after	your	evening	meal.
  •	 A	final	application	before	you	go	to	bed	at	night.

	 If	you	feel	the	need	to	apply	more	frequently	because	your	skin	is	feeling	‘prune-like’	
  then	it	is	perfectly	safe	to	do	so	without	any	worries.

Membership and Patient Advice &
Liaison Service (M-PALS)
Chelsea	and	Westminster	Hospital’s	Membership	and	Patient	Advice	&	Liaison	Service	
(M-PALS)	is	located	on	the	ground	floor	of	the	hospital,	opposite	the	escalators.

They	can	help	if	you	have	any	concerns	about	any	aspect	of	our	services,	need	any	
information	about	accessing	healthcare,	or	have	any	suggestions	or	queries.

The	team	provide	a	confidential	service	and	can	be	emailed	at	pals@chelwest.nhs.uk	
or	telephoned	on	020	8846	6727.
                                                                                             7
369	Fulham	Road
London
SW10	9NH

Main Switchboard
020	8746	8000	

Website
www.chelwest.nhs.uk
January	2010

				
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