Factors that exacerbate skin breakdown and ulceration
Skin Breakdown: The Silent Epidemic.
Smith & Nephew Foundation
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Although good skin care is recognised as a key component in the prevention of skin breakdown, in practice this is not always based on clinical evidence. The factors that research has identified as exacerbating skin breakdown are often overlooked. The important factors are age, continence, skin hygiene, mobility, nutrition and pressure. The combination of faecal and urinary continence is particularly damaging to the skin.
These factors interact in a complex and imperfectly understood way.
Washing with conventional soap and water may damage skin by interfering with several of its protective mechanisms. Use of alternative skin cleansers to soap is largely based on clinical experience rather than good quality clinical evidence. There is similarly little evidence on the best way to dry skin after washing, and whether or not using emollients and barrier creams is effective at preventing skin breakdown. This is particularly important given that skin breakdown is more common in neonates and in the elderly. Incontinence has been found to affect 40-70% of patients in nursing homes and long-stay wards.
As well as immobility and age, altered consciousness and nutritional status have also been found to be strongly predictive of skin breakdown.
More research is needed into the mechanisms of skin breakdown, especially in pressure ulcers, and further studies are needed to assess the effectiveness of current interventions designed to prevent skin breakdown.
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