INTRODUCTION
Palliative care patients often develop skin problems as a result of weakened skin barrier by the effects of chronic disease and ageing, performance status, multiple comorbidities, and iatrogenic effects of treatment.
It is therefore important to ensure good skin care, managing skin breakdown and its related symptoms, so as to promote patient comfort and improve quality of life of patients and caregivers.
GOOD SKIN CARE
Aims to maintain skin integrity through cleansing, hydrating, moisturising, and protecting.
1. Skin cleansing
• Use of soap to clean and paper/ cloth towels to dry can strip the skin of natural oils
• This disturbs the balance of normal skin flora which allows bacteria to enter through breaks in the weakened skin
• Use gentle, soap-free skin cleansers instead with lukewarm water for showers
2. Moisturising and hydrating
• Moisturisers smoothen and hydrate skin; it is best applied immediately after showering, and at least 2 times per day
• Occlusive moisturisers form protective layer on top of skin to trap moisture
E.g. White soft paraffin, aqueous cream
• Humectants draw water to skin and delay water from evaporating from skin
E.g. Urea cream, ceramides-containing moisturisers
3. Skin protection
• Barrier products form a thin layer on the skin surface
• This protects the skin against excoriating body fluids and decrease skin breakdown and bleeding
• Barrier products should be reapplied whenever the skin is cleaned
PREVENTING PRESSURE ULCERS AND MOISTURE LESIONS
Pressure ulcers and moisture-related skin breakdowns are two of the most common skin problems experienced by palliative patients at the end-of-life due to reduced mobility and incontinence exposing skin to body fluids (urine, faeces, sweat).
The key to good pressure or moisture-related injuries management is prevention
1. Pressure ulcer prevention
• Frequent repositioning and avoid pressure on areas of redness
• Do not massage or vigourously rub skin at pressure areas
• Use of pressure relieving devices, e.g. alternating air mattress
• Consider prophylactic use of foam dressing to bony prominences
2. Preventing moisture-related skin damage
• Keep skin clean and dry
• Change soiled disposable diapers promptly and apply barrier products to maintain skin integrity
REFERENCES
1. Bergevin RC. Assessing wounds in palliative care. Nursing 2014; 44: 68-9.
2. Dale B, Emmons KR. Palliative wound care: principles of care. Home Healthcare Nurse 2014; 32: 48-53.
3. Maida V, Ennis M, Corban J. Wound outcomes in patients with advanced illness. International Wound Journal 2012; 9: 683-92.
4. Voegeli D. Moisture-associated skin damage: aetiology, prevention and treatment. British Journal of Nursing 2012; 21: 517-18, 520-21.
5. Sebastian P, Georgina G. Skin problems in palliative care. In: Cherny IN, Fallon M, Kaasa S, Portenoy KR, Currow CD, eds. Oxford Textbook of Palliative Medicine. New York, NY: Oxford University Press, 2021: 613-21.
