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keywords
* Emollients
* Skin sensitisers
* Skin structure
These key words are based on subject headings from the British Nursing Index. This article has been subject to double-blind review.
summary
Although the benefits of emollient therapy have been widely acknowledged in dermatology treatments (Cork 1997), emollients have tended to be undervalued and under-used in general care and wound management. Healthy skin is an essential part of patient wellbeing, and emollient therapy is integral to the management of skin problems. The integration of tissue viability and dermatology services in the Plymouth Hospitals NHS Trust provided an opportunity to evaluate how and why emollient therapy is implemented. In practice, the authors have identified that healthcare practitioners need guidance and advice on emollient therapy to improve their care delivery. This article is based on the emollient therapy currently used in the authors' trust.
A SOUND KNOWLEDGE of normal skin function provides the basis for a better understanding of skin conditions and complaints, and enables practitioners to select the most appropriate management strategy for individual patients (Hooper and Goldman 1999).
The skin is the largest organ of the body and has many functions (Box 1). This article focuses on the skin as a barrier and protector. The skin comprises two basic layers:
* Dermis - inner layer.
* Epidermis - outer layer.
The two layers have essential differences in composition and function (Hunter et al 1995). The dermis consists of collagen, which gives the skin its elasticity and strength. It contains blood vessels, lymphatics and nerve endings. The epidermis is avascular (that is, it has no blood supply) and obtains its nutrients from the dermis.
Keratinocytes formed in the stratum basale (basal layer of the epidermis) continually divide by mitosis and move upwards to the stratum corneum (horny layer). As they progress through the epidermis they mature from a columnar shape with a nucleus, to flattened dead cells (corneocytes) cemented together by intercellular lipids (Hunter et al 1995).
In healthy skin, the balance of water and lipid content keep the epidermis intact and the skin soft and supple. The stratum corneum not only protects the skin from the external environment, but is also water-resistant (Gawkrodger 1997). Water resistance is due to lipids that are released from...