Skin care Resources

As a stoma care nurse, the author regularly sees people with peristomal skin complications (PSCs), and we know that there are people in the community living with a PSC believing it to be a normal part of having a stoma. However, patients should know that these complications are largely preventable, and often easily treatable.

The almost quarter of a million people living in the UK with a stoma are likely to encounter damage to the skin around their stoma. Community nurses are well placed to assist in skin assessment and planning of interventions to improve skin integrity if damage does occur. As part of that skin assessment process, it is important to understand the terminology used to identify issues being observed as well as the potential causes. Although general wound healing is similar across different areas of the body, wound healing products used on peristomal skin need to be considered in terms of how they might adversely affect adhesion of the stoma appliance. Sometimes simple changes to diet or skin care routine, which community nurses can suggest, is enough to improve the peristomal skin condition.

Changes to skin integrity and damage to the skin can occur at the end of life (EOL), despite appropriate interventions that meet or exceed standards of care. It can also be difficult to determine which wounds can be prevented and which ones are unavoidable (Sibbald et al, 2010; Beldon 2011). It is therefore the role of the nurse and carer to consistently deliver the best end-of-life (EOL) care, support palliation of symptoms, and maintain optimal skin integrity. Best practice for EOL skin care is about maintaining skin integrity for as long as is possible, followed by a goal of a dignified death (Kennedy, 2016) in line with patient/family wishes. This article discusses factors associated with maintaining skin integrity, and how skin damage can be prevented and a skincare regimen managed in EOL patients.

This clinical series aims to demystify and simplify approaches to assessment and
management of chronic oedema in the community, including the promotion of selfcare,
to improve efficiency and the delivery of evidence-based care for patients with
chronic oedema. Part 4 looks at chronic oedema management, beginning with skin
care and exercise (Wound Care People, 2019).

Moisture can affect the normal function and permeability of the skin, leaving our bodies susceptible to infection. The damaging effects of moisture-associated skin damage (MASD) impact a wide range of patient groups, however, wounds caused by moisture are often mistaken for and treated as if they are pressure ulcers. Moisture can come into contact with the skin from a number of sources, but damage can be treated in the same way, despite its cause. In the authors’ clinical opinion, if nursing staff are able to identify and treat skin damage correctly according to its aetiology, faster rates of healing, improved quality of life, and fewer resources used on wound care would be seen. This article looks at the identification of seven aetiologies of MASD following an audit, and the subsequent development and implementation of a protocol to improve and standardise skin care in the authors’ trust, which it was hoped would provide a dynamic and unified approach to the management and education of MASD.

Erosive pustular dermatosis (EPD) of the leg is a rare condition that is challenging and complex to diagnose and treat. This cutaneous inflammatory disease is associated with trophic changes of the lower limb, and while its incidence is unknown, it is believed to be more common than previously thought. Care of leg ulcers poses a considerable burden to the health service, although it is estimated that only half of patients receive the appropriate treatment. This article reflects on the case of a patient with chronic ulcerated and swollen legs who was referred to a wound advisory clinic by his GP. It critically assesses the data from the patient history, physical examination and treatment decisions. It is hoped that describing this case — patient history, findings from physical examination and treatment plan — will help further community nurses’ understanding of the condition.

The 2014 National Institute for Health and Care Excellence (NICE) guidelines for the assessment and management of psoriasis were updated in 2017. There is little of note in relation to the previous articles in this series, however since the development of more biologics and cheaper forms of biosimilars, the guidelines were amended to reflect these readily available treatments (NICE, 2017a). The seventh and final article in this series provides an overview of systemic non-biological and biologic therapies. It looks at how these treatments target and treat psoriasis, as well as side-effects, contraindications and monitoring recommendations of certain drugs.