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Wound Care Insights: Skin disease and Long Term Care, Part Two

Welcome to part two of the skin disease installment of our wound care insights series! For the previous installments on skin diseases, click here (Part One).

Xerosis, or severe dry skin, occurs when the moisture content of the epidermis drops below 10%. It is characterized by itchy, dry, cracked, and fissured skin with scaling. It is most commonly found on the lower extremities of elderly patients, likely a result of vascular insufficiency. It is common to encounter xerosis in environments where air is dry. Humidifiers can help create a more skin–friendly environment, and are useful for prevention. Treatment for xerosis is proper dual moisturization with humectants and occlusives.

Miliaria is usually a warm–weather disease. It occurs in skin when the sweat glands become blocked. Patients who are prone to develop miliaria are those with multiple comorbidities, who are generally unable to turn without assistance, or who are immobile in bed. As the patient lies in bed and sweats, the sweat glands are blocked by sheets or clothing. The disease starts as miliaria rubra, a red rash with blisters millimeters in size. If untreated, the disease can advance to miliaria profunda, a flesh colored rash accompanied by a severe burning sensation, and eventually miliaria pustulosa, which is characterized by inflammation and bacteria.

The best way to treat this disease is to turn the patient, to open the skin to ambient air. Environment is also critical; the patient should not be allowed to overheat. Patients should also be well hydrated or rehydrated. Commonly, there will be evidence of a secondary infection with fungal or bacterial organisms, which can be treated with topical agents. A topical steroid regimen, if necessary, should be used to fully eliminate the disease.

Moisture associated skin damage (MASD) is the general term for inflammation or skin erosion caused by prolonged exposure to a source of moisture. MASD can occur anywhere on the body where such moisture is present, and the damage can range in severity from minor to major. The skin can become denuded or infected, and the changes may be difficult to reverse. This condition is not uncommon in patients with wounds, so take care to monitor patients consistently for MASD.

There are some subcategories of MASD, such as incontinence associated dermatitis (IAD), or diaper rash. This is one of the most common forms of MASD, and it is treated by protecting the skin from getting irritated further, providing a proper healing environment, and removing any infection.

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.

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