Principles of Skin Care: A Guide for Nurses and Other Health Care Professionals

284 Pages·2010·18.85 MB·English

by  Rebecca Penzer

Principles of Skin Care
Principles of Skin Care: A Guide for Nurses and Other Health Care Professionals Rebecca Penzer and Steven J. Ersser
© 2010 Rebecca Penzer and Steven J. Ersser. ISBN: 978-1-405-17087-1
Principles of Skin Care
A Guide for Nurses and Other
Health Care Professionals
Rebecca Penzer
RN, BSc(Hons), PGDipEd, MSc
Community Dermatology Nurse Specialist, Norfolk Community Health and Care
Dermatology Nurse Specialist, Queen Elizabeth Hospital, King’s Lynn
Deputy Chair, International Skin Care Nursing Group
Steven J. Ersser
RGN, BSc (Hons), PhD (Lond), CertTHEd
Professor of Nursing Development & Skin Care Research
Director, Centre for Wellbeing & Quality of Life
School of Health & Social Care
Bournemouth University, UK
Chair, International Skin Care Nursing Advisory Board
With contributions from:
Julie Van Onselen
BA(Hons), DipN, DipMar, RGN, RSCN, ENB 998, N25(DermN)
JVO Consultancy-education in dermatology and Dermatology Nurse, Oxon PCT
Rachel Duncan
MPhil, BN (Hons), PGCE, ENB 237, RGN
Macmillan Clinical Nurse Specialist – Skin Cancer
St Helens and Knowsley Teaching Hospitals NHS Trust
Jean Robinson
RGN, RSCN, MA
Clinical Nurse Specialist Children’s Dermatology
Barts and The London NHS Trust
This edition first published 2010
© 2010 Rebecca Penzer and Steven J. Ersser
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Library of Congress Cataloging-in-Publication Data
Penzer, Rebecca.
Principles of skin care : a guide for nurses and other health care professionals / Rebecca Penzer, Steven J.
Ersser ; with contributions from Julie Van Onselen, Rachel Duncan, Jean Robinson.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-4051-7087-1 (pbk. : alk. paper)
1. Dermatologic nursing. 2. Skin—Care and hygiene. I. Ersser, Steven. II. Title.
[DNLM: 1. Skin Diseases—nursing. 2. Skin Care—nursing. WY 154.5 P419p 2010]
RL125.P46 2010
616.50231—dc22
2009033608
A catalogue record for this book is available from the British Library.
Set in 10/12 pt Sabon by MPS Limited, A Macmillan Company
Printed in Malaysia
1 2010
Contents
Acknowledgements ix Chapter 4 P rotecting the skin and
preventing breakdown 49
Chapter 1 Introduction 1
Introduction 49
What is skin? 1 The concept of skin vulnerability 49
Skin health 2 What causes skin breakdown? 50
What is in this book 7 Preventative practices 55
Conclusion 8 Nursing intervention to support
References 8 behavioural change (prevention) in
relation to sun exposure 60
Part 1 Fundamental principles of Nutrition to support skin
managing the skin 9 integrity 61
Preventing skin damage by
Chapter 2 Biology of the skin 11
scratching 63
Introduction 11 Conclusion 64
Skin structure 11 References 64
Functions of the skin 20
Skin and ageing 24 Chapter 5 Emollients 71
Conclusion 28
Introduction 71
References 28
Definition 71
Constituents of emollients 72
Chapter 3 Assessment and planning care 29
Potential side effects 73
Introduction 29 Emollient formulations 75
Assessment 30 How emollients work? 80
Planning care 42 Considerations that will
Intervention 44 effect how patients use
Evaluation 45 emollients 82
Conclusion 46 Conclusion 83
References 46 References 83
vi Contents
Chapter 6 Psychological and social Caring for children with eczema 159
aspects of skin care 85 Other forms of eczema in
Introduction 85 adulthood 160
Social impacts 85 Contact dermatitis 161
Psychological impact 88 Treatment options for eczema 163
Nursing interventions 92 Conclusion 173
Conclusion 100 References 173
References 100
Chapter 10 Acne 179
Chapter 7 H elping patients make the Introduction 179
most of their treatment 103 What is acne? 179
Introduction 103 Who gets acne and distribution 184
Self-management and patient Treatments 185
support 103 Psychological impact 192
The challenge of promoting Conclusion 193
treatment adherence 109 References 193
Prescribing skin-related products
and opportunities for medicines Chapter 11 S kin cancer and its
education 112 prevention 195
Conclusion 115 Introduction 195
References 115 Skin cancer epidemiology: the
scale of the problem 195
Pre-malignant skin lesions 196
Part 2 Principles of illness
Non-melanoma skin lesions 198
management 119
Introduction to melanoma 202
Chapter 8 Psoriasis 121 Surgery 207
Introduction 121 Causation, risk prevention and early
History of psoriasis 121 detection 208
Who gets psoriasis? 122 Nursing intervention and
Biology of psoriasis 122 promoting self-examination 209
Comorbidities associated with Conclusion 213
psoriasis 123 References 214
Clinical variants of psoriasis 124
Physical symptoms that accompany Chapter 12 I nfective skin conditions and
psoriasis 128 infestations 221
Trigger factors in psoriasis 130 Introduction 221
Treatments for psoriasis 131 Bacterial skin infections 222
Measuring quality of life 145 Viral infections 226
Conclusion 145 Fungal infections 233
References 147 Infestations 240
Conclusion 242
Chapter 9 Eczema 151 References 243
Introduction 151
What is eczema? 151 Chapter 13 L ess common skin
Atopic eczema 154 conditions 247
What is eczema commonly Introduction 247
mistaken for? 157 Blistering conditions 247
Eczema severity assessment 158 Connective tissue disorders 251
Contents vii
Drug reactions 252 Appendices 269
Lichen planus 255 Appendix 1 – The psoriasis area
Pityriasis rosea 257 severity index (PASI) 269
Primary cutaneous T-cell Appendix 2 – The SCORAD index 271
lymphomas 258 Appendix 3 – Examples of emollients
Rosacea 260 with excipients 272
Urticaria 262
Vitiligo 265 Index 273
Conclusion 266
References 266
Acknowledgements
We would like to thank the following people for their help and support in
writing this book: Dr David Paige, Dr Mike Cork, Professor Eugene Healy,
Professor Terence Ryan, Dave Roberts, Dr Elizabeth Norton, Andrew Kerr and
Alison Jackson. Thanks also to the Wessex Cancer Trust.
1
Introduction
Rebecca Penzer
Perhaps more than any other organ of the body, experience of skin, through a cultural lens. The
the skin is multidimensional; in the totality of multifaceted concept of skin health is introduced
human experience the skin is key. It is a physical and will be revisited as a key topic throughout
presence and Chapter 2 of this book considers the book. Finally a summary of the contents of
in some depth the biology of the skin. But the the book will be given.
skin goes way beyond this. It has emotional and
psychological importance, it can affect whether
we are discriminated against, or not, it is a
What is skin?
sexual organ, it is a work of art (and a canvass
for works of art), it is used to determine social
acceptability, it is a tool to market everything The basic definition of skin both in a medical and
from the obvious (make-up) to the less obvious English dictionary describes it as the external
(sanitary towels) and we use and abuse it in the layer of the body. But this description is really
pursuit of youth and beauty. wholly inadequate. It infers that the skin is an
This introductory chapter to ‘Principles of Skin inert envelope that contains the bones, muscles,
Care: A Guide for Nurses and Other Health Care organs and blood that allow us to exist. Whilst
Professionals’ is a light hearted look at the skin the skin is our external covering that holds us
and what it means to us as humans. It is how- together, it is far from inert. To express it crea-
ever, a significant chapter. To be able to care for tively, the skin is a combination of a lunar land-
patients who have dysfunctional skin, it is key scape, a zoological and botanical haven in which
to understand what is meant by skin health. there is the potential for an immunological party.
Whilst much of the rest of this book is dedicated Expressed more traditionally, the surface of the
to describing what happens when the skin is skin is a rough, undulating environment with skin
no longer healthy, there is a recurrent theme of cells desquamating all the time. It is covered with
using nursing skills to promote skin health and bacteria and fungus that live in harmony with us
prevent disease. and protect us from invading pathogens. In a
Thus, this chapter looks to answer the ques- normal state the immune system within the skin
tions about what is skin and what is the human is quiet and relatively inactive, but if the skin is
Principles of Skin Care: A Guide for Nurses and Other Health Care Professionals Rebecca Penzer and Steven J. Ersser
© 2010 Rebecca Penzer and Steven J. Ersser. ISBN: 978-1-405-17087-1
2 Principles of Skin Care: A Guide for Nurses and Other Health Care Professionals
challenged in any way, a range of immunological how humans respond to treatment. But to truly
cascades are set in motion. In some conditions understand ‘What is skin’ we must gain insights
such as psoriasis these immunological changes are that go beyond comprehending physical func-
not within a normal range and cause severe tion. Research can also help to uncover some
inflammation and hyperproliferation of skin cells. of the psychological and social impacts of expe-
Defining the skin as our external surface is riencing skin disease. For example what affects
also limited because it does not include our how people cope with a chronic condition and
internal skin surfaces such as the mouth or the how quality of life might be affected?
vagina. And of course the scope of the term What is skin for the lay person? The way the
dermatology goes beyond what is traditionally skin looks plays an important role and the aes-
described as skin to an interest in both hair and thetics of the skin are considered shortly, but
nails, commonly thought of as skin appendages the skin has also influenced our language in all
which are constructed of the same basic building sorts of colourful ways. Skin can probably win
blocks as skin itself. the prize for the organ most used in common
Understanding of the science of skin is con- parlance and slang! Table 1.1 gives some exam-
stantly expanding. Of key importance in improv- ples. This reflects the cultural and symbolic
ing understanding of skin and how it functions, importance of skin as an integral part of our
is research. Important areas of biological scien- language.
tific research include how the immune system
within the skin functions and how genetic make-
up influences the expression of skin disease and
Skin health
Table 1.1 The use of the skin concept in common
parlance. Introduction
Simply put, healthy skin is skin that is not
Saying Meaning
diseased. However, this might be thought of as a
somewhat limited interpretation of the concept.
By the skin of one’s teeth By a narrow margin An alternative view is that healthy skin is skin
Get under someone’s skin To irritate or provoke which fulfils all its physical, psychological and
someone social functions. This view incorporates a wider
No skin off someone’s nose No disadvantage to conception of skin health which goes beyond the
someone physical and embraces psychological, social and
Skin and bone Very thin quality of life issues. This book aims to embrace
this wider concept of skin health and to empha-
Skin-up Roll a joint
sise how nursing skills can be used to meet all
Skin deep Superficial
those patient needs. This section will specifically
Skin-flick A film of adult nature look at areas relating to skin health which do
involving nudity
not ‘belong’ in any other part of this book, but
Skinful A large amount to drink none-the-less warrant attention.
Skin game A swindling game or
trick
Display, decoration and adornment
Skin and blister Sister (Cockney rhyming
slang)
The way the skin is displayed (used as an organ
Have a thick skin To be unbothered by
things of display) is significantly affected by social and
cultural influences. Throughout history humans
Save ones skin To avoid harm especially
escaping death have felt compelled to change their skin in ways
that are rarely good for its physical health.
Introduction 3
However, adornment, decoration and display camps was designed to dehumanise and deper-
have other important sociological implications sonalise people. Individuals became a number
indicating belonging to group and tribes or con- rather than a name. Female genital mutilation
versely to show rebellion and individuality. is another example of a practice which is abu-
Signals given through the skin can indicate a sive. Whilst some people within cultural groups
wide range of social norms and values. The obvi- accept the practice as part of becoming a woman,
ous ones include religious observance reflected it is widely condemned as an abusive, dangerous
by the amount of skin and hair covered and and unnecessary practice.
by what types of garments are worn. Clothing The course of human history is littered with
and adornments vitally allow humans to fit into tragedies of discriminatory behaviour brought
their own social system and indicate a sense on by false judgements made because of the
of belonging. The social norms in relation to colour of the skin. Discriminatory behaviour
displaying the skin are time dependent. Thus a due to skin colour is now illegal in many parts
British woman living in Victorian times might of the world and the last 20 years have wit-
have felt it disgraceful to expose her ankles, nessed massively significant events in the quest
whereas in the 21st century this is not gen- for racial equality. The ending of apartheid in
erally considered scandalous behaviour! Piercing South Africa and the election of an African
and tattooing give a wide range of social sig- American as President of the United States of
nals including membership of certain groups. America are two examples of this. But discrim-
However, once again, in the 21st century these inatory behaviour because of skin colour does
rules too are becoming more blurred and less still exist. A recent Health Care Commission
strictly adhered to with a wide cross section of highlighted that many Trust institutions within
society choosing to have tattoos and various the British National Health Service were still
body piercings. not meeting their obligations as equal oppor-
As with other organs of the body, humans are tunities employers. It states that although
prone to abuse their skin. Fair skinned people ethnic minority groups make up 16% of the
aim for the perfect sun-tan and in the process of workforce only 10% are in senior management
getting to this point put themselves at risk of positions and 1% in a chief executive posi-
both malignant and non-malignant skin cancers. tion (Commission for Healthcare Audit and
It is becoming an increasingly common practice Inspection, 2009).
for people with darker skins to want to lighten For one group of people racism, ignorance
them. This is done through a number of unregu- and misunderstanding because of the colour of
lated mechanisms including the use of potent their skin, remains life threatening. There are a
topical steroids, which cause a range of other significant number of people living with albi-
health problems, as well as the desired skin nism in East Africa. Albinism is a genetically
lightening. Depending on the extent and time inherited condition where the pigment of the
frame of steroid use, these effects may also skin, hair and eyes is either reduced or miss-
become systemic. ing altogether. Whilst albinism does occur in
the Caucasian population, it is more prevalent
and more noticeable in black Americans. Some
Abuse and discrimination estimates put the number of those with albi-
nism at 1 in 4000 in Tanzania, whilst the figures
Whatever the context of skin decoration and for the European population is more like 1 in
skin adornment, it is usually done in order to 20,000 (Smith, 2008). Life for an African with
make a personal statement. However there are albinism is curtailed due to hugely increased risk
instances when skin marking and/or skin alter- of skin cancer; however recent urbanisation of
ation is abusive and detrimental to personal the population has led to an increase in murder
health. For example, the tattooing of num- and mutilation. It is thought that possessing a
bers onto the arms of prisoners in concentration body part of someone who has albinism acts as