Wound Care Made Incredibly Easy

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External threats to skin integrity

Modifiable factors that can compromise skin Factor Common effect on skin

Interventions

The key is using the lowest-potency steroid and lowest dose effective for the condition being treated. Vitamin A supplementation may increase collagen content (Krasner et al., 2007, p. 132), and use of vitamin A analogs such as retinol sometimes reverses steroid effects on wound healing (Krasner et al., 2007, p. 293). Atrophy may be permanent, but the sooner the steroid is discontinued the better. Topical tretinoin may encourage collagen production to prevent or reverse atrophy. For longer than 15 minutes of sun exposure, apply sun protection factor 30 or higher to exposed skin.

Long-term systemic steroid use

Skin atrophy (thinning) most commonly in the skin folds; purpura; fragility; telangiectasia; acne; susceptibility to bacterial, fungal, and viral skin infections; slow wound healing Permanent stretch marks with severe pruritus; localized atrophy with resulting fragility Ultraviolet (UV) light damages collagen and elastin fibers, which give skin its toughness and elas ticity, and results in wrinkles and more fragile skin as well as an increased risk of skin cancer. Nicotine narrows capillaries, damages collagen and elastin.

Long-term (longer than 4 weeks) topical steroid use in the potent, very potent, and extremely potent classes Overexposure to sunlight

Cigarette smoking

Smoking cessation if possible or decreased use with support systems Avoid longer outdoor exposure on days when air quality is listed as unhealthy.

Air pollution

Induces oxidative stress

Cleanup without compromise

How can we keep skin as healthy as possible with gentle cleansing when it is fragile? Traditional soap, such as bars for cleansing, have an alkaline pH that can destroy the natural “acid mantle” function. Healthy skin has a pH of 4.5 to 5.5, which is hostile to pathogens and therefore beneficial to us. Most soaps also contain surfactants, which dissolve the natural lipids that protect the epidermis. Newer cleansers such as synthetic detergents (also called syndets) provide cleansing at a natural skin pH level and avoid harsh surfactants, leaving high-risk skin in better condition. It is also helpful to avoid hot water for showering or bathing and to bathe only as often as necessary for good hygiene.

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Our skin has multiple mechanisms to maintain moisture balance, keeping excess moisture from causing damage and protecting it from excess dryness. However, there is a delicate balance that can be