Introduction
Older skin needs gentle handling. The skin becomes thinner and the structures in the dermis are less well supported and easily damaged. The skin’s immune defences are less active. However as the skin is dry, common agents can upset older skins. These include soap and water, dry air, excessive heat and cold and friction. While not every problem can be avoided, there are some simple measures which can help to reduce the risk of trouble and they may make life more comfortable.
Personal Hygiene
While it is important to keep the older skin clean, over-washing and use of soaps and other washing materials can result in dryness and itching. Water itself has the effect of acting as a drying agent. Therefore in the elderly:
- Avoid soap, bubble bath and shower gels which strip the skin of its natural oils.
- Use soap substitutes. These are moisturising creams and lotions which can be bought over the counter. Many are available on prescription. There is no ideal moisturiser for all – it is worth trying several to see which suits. Large quantities will be required and many come in 500g tubs.
- Apply the soap substitute directly to the skin with a flannel or sponge and wash off with warm water.
- Avoid cold and very hot water
- Use bath oils and moisturising shower gels if desired
- Take care, as all moisturising products may make the bath or shower cubicle slippery
Moisturising
The regular use of moisturisers directly on the skin can greatly reduce the rough feeling and itching which many older people experience. To help avoid the miseries of dry, itchy skin:
- Humidify the air
- Apply a generous amount of moisturiser all over the skin, ideally at least twice a day.
- Put small dabs of the cream or ointment directly on the skin then smooth on, following the direction of hair growth.
- An average person will need about 30g for a single application so make sure enough is available.
- Take this opportunity to examine the skin for signs of treatable conditions such as actinic keratoses, early skin cancers and infections. Seborrhoeic warts are benign, very common and may be a focus for itching.
Foot care
Many elderly feet have been damaged over the years by pressure from footwear and oedema. Callosities and corns can greatly reduce mobility. Use of thicker emollients and keratolytics, such as 10-20% salicylic acid in white soft paraffin, can help.Paring by a podiatrist may be needed to reduce pain on walking. Foot ulcers need medical assessment, especially in diabetics and those with peripheral vascular disease.