In Part 1, we talked about why moisturization is so important, and what the big categories of healing agents are (read Part 1 here). In this installment of Wound Care Insights, we’ll break down humectants, occlusives, and emollients, and talk about when to use them in the long-term care setting.
Keeping Water In: Occlusive Agents
Occlusive moisturizers are agents that physically block water loss in the stratum corneum. The most common occlusive moisturizer is petrolatum (commonly known as petroleum jelly) in a minimum concentration of 5%, followed by lanolin, mineral oil, and silicones such as dimethicone. Aquaphor, for example, is a petrolatum-based occlusive agent that will keep water in. Petrolatum has also demonstrated many pro-healing effects like protecting scratches, abrasion, and other wounds on the skin. Lanolin (a complex structure of esters, diesters, and hydroxyesters of high molecular weight; lanolin alcohols; and lanolin acids) is also commonly used and as the major product in lantiseptic cream. Drawing Water to the Skin: Humectants
Humectants are what we typically think of when we think of moisturizers. Humectants attract or draw water to the epidermis either from the deeper dermis through diffusion, or from the atmosphere when there is a humidity of 70% or greater. The use of humectants increases the pliability and flexibility of skin, which prevents cracking, as well as promoting desquamation and shedding of old skin cells (thus reducing the irritation caused by dry skin).
Humectants include glycerin, sortbitol, urea, alpha hydroxy acids (i.e., lactic acid), and other sugars. In our practice, we recommend humectants in cases of severely dry skin, followed by an occlusive moisturizer such as petrolatum.
Smoothing and Repairing: Emollients & Lubricants
It’s also critical to repair the skin and improve its ability to retain moisture: this is where emollients and lubricants come in. They do not hydrate - instead, they smooth skin by filling spaces between skin flakes with droplets of oil. They are not usually occlusive unless applied heavily.
In most of the agents we use in medicine, an emollient/lubricant is included with the moisturizing cream we use. Vitamin E, A, and D, mineral oil, fatty acids, cholesterol, squalene, and structural lipids are considered to be emollients.
A & D Cream is a good example of a moisturizer that contains emollients, vitamins A & D; in addition it also includes occlusive moisturizers such as petrolatum and lanolin.
Common Healing Agents in Long-Term Care (And When to Use Them!)
For moderately dry skin, it is best to use an occlusive moisturizer containing emollients, such as:
A&D Ointment: contains Vitamin A, Vitamin D, petrolatum, and lanolin
Lantiseptic: 50% lanolin
Calmoseptine: 0.44% menthol, 20.626% zinc oxide
Aquaphor/Eucerin: petroleum-based occlusive moisturizer (apply 3-4 times daily)
For xerosis, or severe dry skin, it is best to use a humectant followed by an occlusive moisturizer. Apply the humectant first, and once dry, follow with the occlusive moisturizer. For example, one might use:
Ammonium Lactate products (such as Amlactin or Lac Hydrin) followed by an occlusive like Eucerin; and
10% Urea Cream along with an occlusive like Eucerin (apply 3-4 times daily)
Stay tuned for more Wound Insights!
Skilled Wound Care is a mobile surgical practice committed to transforming the chronic wound care model in nursing facilities. Wound care experts make weekly bedside visits to patients in long-term care facilities, avoiding transfers to hospitals or clinics. Our expert physicians give patients the most up-to-date and effective wound treatments, and educate facility staff on how to help patients continue to heal quickly and effectively between visits. This model of collaborative care allows SWC’s physicians to improve patients’ lives and health outcomes, to empower nursing staff, and to raise public awareness. Skilled Wound Care, along with its nurse and nursing home partners, is working every day to positively transform traditional nursing home wound care.