Cellulitis 101 – importance of routine skin care

Many patients with lower limb cellulitis have pre-existing venous stasis dermatitis, solar damage or other skin conditions that impair the natural skin barrier.  This posting is derived from an existing HICSIG patient handout . 

Healing skin or skin affected by dermatitis or eczema often appears shiny. This indicates that the normal protective top scaly layer, the  stratum corneum is absent or damaged. By protecting this abnormal skin using the routine below, the body will gradually restore the skin to its usual thickness. This may take 4-6 weeks. Restored normal skin will then look dull rather than shiny and this will provide better protection from infection or allergic reaction to substances that contact the skin.

Most of us overuse soap, and shower more frequently than required. Both of these may damage the skin by removing important oils that cannot be replaced, except via the diet. As well, the action of roughly drying the skin with a towel may actually remove some of stratum corneum (top skin layer).

Recommendations to reduce skin drying, dermatitis and infection

1. Avoid the use of soap when bathing or showering. DO NOT routinely use antiseptic solutions. If you need to use something, chose a soap substitute. In fact the sorbolene (below) comes off in the shower and has a cleansing effect.

2. When drying with a towel, be gentle- pat dry your skin. Avoid rubbing the skin.

3. Reduce the overall frequency of bathing or showering. A short shower (3 minutes) is better than a bath in terms of its effect on the skin.

4. Use a simple sorbolene based-cream on your skin PRIOR to showering and immediately after drying. Especially protect healing or dry areas of skin in this way. The function of the cream is to act as a barrier- preventing further loss of essential fatty acids from the skin – and also as a moisturiser (adding moisture to the skin). Don’t use a cream with a vaseline base or with perfumes or other additives. Your skin is more likely to be irritated by these products.

5. Make sure that you clean and cover any skin cuts or grazes that occur. Try to avoid picking or biting fingernails and the skin around the nails! Keep your fingernails clipped short and clean to reduce problems caused by scratching.

Simple Options for Itchy Skin

  • Practice the general principles of skin care above. These can make a real difference to itchiness!
  • Avoid perfumed or other complex preparations on to the skin – contact allergy can result.
  • Gently massage sorbolene-based cream into itchy areas instead of scratching it
  • Short fingernails always; consider wearing old cotton gloves at night to prevent trauma from scratching
  • Consider a long-acting non-sedating antihistamine. However make sure that you are not taking medication that will interact with this drug type.
  • Oil of primrose capsules (1 to 3 per day) may also improve skin health and reduce itch.

Reference
Am J Clin Dermatol. 2003;4(11):771-88. Role of topical emollients and moisturizers in the treatment of dry skin barrier disorders.Lodén M.

4 comments

  1. […] have previously discussed issues relevant to nursing home AMS including UTI and cellulitis management. There was also a recent MJA article describing novel ways of treating nursing home […]

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  2. […] Improving the condition of your skin- treatment of dermatitis, scabies or other conditions that make it easier for infection to take hold. See also Routine Skin Care. […]

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  3. […] by going away or other distractions. To ensure that your skin is in good condition, follow the Routine Skin Care principles to reduce drying and enhance healing. Unless advised, do not start while you have any […]

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