Wound Care Made Incredibly Easy

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External threats to skin integrity

Creams

Creams are preparations of oil and water that are a bit more occlu sive than lotions. They don’t have to be applied as often as lotions. Usually, three or four applications per day should be sufficient. Creams are better for preventing moisture loss due to evaporation than for replenishing skin moisture. Ointments are preparations of water in oil (typically lanolin or petroleum). They’re the most occlusive and longest-lasting form of moisturizer. For dry skin, they are most effective if applied while skin is still moist following a shower or bath. Because they are occlusive, oils are not preferred for areas that are exposed to too much moisture, such as in the skin folds, between toes, and areas often exposed to wetness as with incontinence. If using ointments on the feet, put socks on before walking to avoid slipping. Socks and gloves can prevent the ointment from rubbing off too quickly from feet and hands and make nighttime application very effective. Friction is a physical force that occurs when two surfaces rub against each other. When healthy skin rubs lightly against a surface, like sheets on a bed, this can cause a bit of warmth but will not cause damage. It is a different story when fragile, rough, flaky skin or overly moist skin rubs on a surface, increasing friction that can result in exfoliation of lay ers of epidermis (an abrasion), or even into the dermis, depending on the weight and whether the area being rubbed is a flat surface of skin (forearm) or curved (buttocks and heels). Friction itself cannot cause a pressure injury, but any compromise of the skin increases risk. An abra

Ointments

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sion occurs when skin cells are removed due to friction; depending on the amount of damage and the health of the skin, blisters may form. Fissures, or linear cracks in the skin, and skin tears can occur due to friction or blunt trauma when xerosis is pres ent. This is most common in compromised or very thin skin and in seriously dry skin (xerosis), often found on the heels and lower legs of older adults.

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Craft. N., & Fox, L. P. (2010). VisualDx: Essential adult dermatology . Wolters Kluwer Health/Lippincott Williams & Wilkins.