Helping Prevent Pressure Ulcers

Pressure UlcerAccording to the National Pressure Ulcer Advisory Panel (NPUAP), a pressure ulcer is “localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction”.

Pressure ulcers (also known as bed sores or pressure sores) are a serious issue affecting the quality of life for many individuals with various health complications in different settings including living at home.

Pressure ulcers are a complex healthcare problem with multiple causes.  They are not a new phenomenon since their occurrence was recorded beginning in 2050 BC.  In addition, the early physician, Hippocrates, documented pressure ulcers in 400 BC.  Today, pressure ulcers are a substantial clinical, economic, regulatory and legal problem for healthcare providers and patients.  In fact, it has been estimated that treating pressure ulcers cost the U.S. at least 11 billion dollars per year.

For high-risk populations including critically ill patients, a cumulative incidence of at least 15% has been reported for category 2 or higher pressure ulcers.  There are also many factors that increase the risk for pressure ulcers including advanced age, malnutrition, immobility, loss of consciousness or cognitive abilities, inability to feel pain, decreased blood flow due to diabetes or peripheral arterial disease, as well as dry skin and skin maceration that makes skin more vulnerable to damage.

Increasing Hydration and Protecting Macerated Skin

Senior woman in wheel chairViniferamine® Renewal Moisturizer and Viniferamine® SkinMineralZ contain important skin nutrients including antioxidants, amino acids and vitamins to strengthen vulnerable skin. Renewal Moisturizer increases skin hydration to help keep moisture in skin, as well as ensure proper nourishment of the epidermis.  Each ingredient in Renewal Moisturizer has been perfectly pH balanced.  SkinMineralZ helps nourish macerated, inflamed skin while providing absorption of toxins.  The micronized zinc oxide in SkinMineralZ is ideal for treating delicate skin that cannot tolerate abrasiveness.

Pressure is the amount of force applied perpendicular to a surface area.  In addition, forces known as shear forces may be applied parallel to a skin surface.  Shear forces are commonly applied when patients slide down a surface and they typically affects the sacrum and heel areas of skin.  When pressure is applied to skin, especially over bony prominences, it distorts the skin and underlying soft tissues.  If constant pressure is maintained, soft tissue will change and mold itself to accommodate the external shape, referred to as tissue creep.  Blood vessels within the distorted tissue become compressed, bent or stretched out of their normal shape such that blood cannot flow which results in the tissues supplied by these vessels becoming ischemic.

Changing Positions and Strengthening the Skin Barrier

Normally, reflexive movements relieve tissue distortions, or the central nervous system is stimulated producing pain that causes movement to relieve pressure and distortion before serious damage occurs.  In fact, healthy individuals (that have normal sensation) change positions in their sleep every 11.6 minutes on average.

Young man asleepWhen the circulation is restored, local capillaries dilate and blood flow increases resulting in reactive hyperemia.  This appears as a bright pink blanchable (capable of whitening) patch on the skin.  When the erythema (redness) is unblanchable, that indicates tissue damage characteristic of category 1 pressure ulcers has occurred.

Therefore, there are 3 main causes of pressure ulcers: immobility, failure of reactive hyperemia and loss of sensation.  Pain is an early warning sign for pressure damage and the use of strong pain medicines may delay triggers for movement.  Distortion of soft tissues is particularly dangerous for paraplegic patients.  If ischemia persists, pressure ulcers can occur within 2 hours.  Patients who experience sudden drops in blood pressure due to events such as cardiac arrest may also be at risk for pressure ulcers.  Prolonged pressure can result in skin atrophy and thinning of the protective skin barrier.

Viniferamine® skincare products include ingredients that strengthen skin and improve the skin barrier. Quantitating transepidermal water loss (TEWL) is a way to assess the quality of the skin barrier and how well it functions.  Oleuropein has been shown to reduce TEWL indicating its ability to increase skin barrier function.  Evidence also demonstrates that melatonin has a stimulatory role in building and maintaining the epidermal barrier.

Besides implementing optimal skin care provided by Viniferamine® skin and wound care products, there are other steps that can be taken to reduce the risk of pressure ulcers.  It’s important to reposition patients that are immobilized.  Pressure redistribution support surfaces are also useful.  Patients that cannot move need to be advised to report pain to someone who can help them reposition.  It’s important to be aware of the fact that a source of pain in another location may distract an individual from the pain associated with pressure, reducing the likelihood that the individual will respond to the pain trigger.

It’s good to know that Viniferamine® skincare products include ingredients to decrease inflammation, nourish and strengthen skin, and protect and hydrate skin.  SkinMineralZ helps protect macerated skin to decrease the risk of pressure ulcers and Renewal Moisturizer helps eliminate dry skin, which also decreases the risk of pressure ulcers.

References
1. Dermatol Nurs 2007; 19: 343-349.
2. Am J Critic Care 2008; 17: 328-337.
3. Nursing Times 2002; 98: 41.
4. JAMA 2006: 296: 974-984.
5. Int J Nursing Studies 2015; 52: 1655-1658.
6. Nursing Times 2012: 108: 16-20.
7. Int J Cosmet Sci 2008; 30: 113-120.
8. FASEB J 2013; 27: 2742-2755.

Disclaimer: These statements have not been reviewed by the FDA. The decision to use these products should be discussed with a trusted healthcare provider. The authors and the publisher of this work have made every effort to use sources believed to be reliable to provide information that is accurate and compatible with the standards generally accepted at the time of publication. The authors and the publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or reliance on, the information contained in this article. The publisher has no responsibility for the persistence or accuracy of URLs for external or third party Internet websites referred to in this publication and does not guarantee that any content on such websites is, or will remain, accurate or appropriate.

About the author: Nancy Ray, PhD is the Science Officer at McCord Research. Dr. Ray received her PhD in Biochemistry and Biophysics and was a postdoctoral fellow at NIH, Harvard University and Dana-Farber Cancer Institute, and the University of Iowa. She also earned bachelor of science degrees in Chemistry and Microbiology.

Copyright 2015 McCord Holdings – All Rights Reserved.

Helping Prevent Fragile Skin Bruising

Fragile skin bruising arm image

As the number of individuals living longer rises, the prevalence of certain skin issues experienced by older individuals, such as fragile skin bruising, is increasing.

Fragile skin bruising or senile purpura (sometimes called solar purpura) is a common skin disorder that occurs with at least 10% of individuals over the age of 50, and 29% of elderly individuals.

Although the bruising is typically not painful it can be fairly irritating. Moreover, fragile skin bruising is highly visible and is likely to have a significant psychological impact. Fragile skin bruising appears as red or purple spots or patches in the skin that fade to brown. It is characterized by hemorrhages in the skin due to vascular fragility, trauma, or deficient coagulation. The bruises are commonly associated with skin tears and can result from very minor trauma including bumping into fairly soft objects.

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Reducing Moisture-Associated Skin Damage

Intertrigo-400x300 Moisture-associated skin damage (MASD) involves skin inflammation, irritation and erosion that results from prolonged exposure to moisture from various sources including urine, stool, wound exudate, perspiration, mucus or saliva.

The four main types of MASD are:

  1. Incontinence-associated dermatitis (IAD)
  2. Intertrigo (in skin folds)
  3. Periwound (around a wound) MASD
  4. Peristomal (around a stoma) MASD

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Protecting Peristomal Skin

Ostomy+ body illustrationMore than 1 million Americans have a stoma, and it has been estimated by the United Ostomy Association of America that 130,000 ostomy surgeries are performed every year in the United States.  Unfortunately, up to 80% of people with a stoma experience peristomal skin problems. Prevention, early identification and proper care for peristomal skin complications are critical for individuals with a stoma.

Stomas can be either temporary or permanent.  A stoma is formed during a surgical procedure (ostomy) to divert the flow of urine or feces outside the body for collection in a stoma appliance or ostomy pouch system that consists of a baseplate, washer with flanges and a pouch for collecting effluent.  There are 3 main types of stoma: the colostomy, the ileostomy and the urostomy.  The reasons for ostomies include cancer involving the colon rectum or bladder, inflammatory bowel diseases such as Crohn’s disease, congenital malformations and diverticular disease.

Several studies suggest that stoma complications within the first 2 to 3 weeks following surgery are common.  85% of individuals with a stoma experience stoma leakage.  A pouch system that fits well immediately following surgery may not fit well several weeks later.  Selection of ostomy equipment that is appropriate for the type of stoma, volume and consistency of the effluent as well as self-care skill level of the individual with a stoma is critical.  Proper use of the stoma appliance including proper pouch application, timely emptying and pouch changing all contribute to helping prevent skin problems. Continue reading

The Importance of Skin Lipids

Bricks and mortarThe stratum corneum or uppermost layer of the epidermis has been described of as consisting of bricks and mortar.  Long thought of as an inactive layer of dead skin cells, in contrast, the stratum corneum is highly dynamic.  The bricks are the corneocytes or differentiated keratinocytes that are tightly connected by links called corneodesmosomes and the mortar is the extracellular space composed of highly ordered lamellar lipids that form membranes.  The lipids within the extracellular spaces help provide a barrier to moisture and electrolyte loss from the skin that is absolutely required for survival.  These lipids include ceramides, cholesterol, and fatty acids.

Viniferamine® skin and wound care products contain ingredients that protect skin lipids and enhance the barrier function of skin to help prevent excessive transepidermal water loss (eTEWL).  Oleuropein, an olive polyphenol found in Viniferamine®, has been shown to reduce TEWL indicating it’s ability to increase skin barrier function.  Evidence also indicates that melatonin, another important ingredient in Viniferamine® skin and wound care products, has a stimulatory role in building and maintaining the epidermal barrier.

The lipids that form the extracellular lamellar membranes are secreted from lamellar bodies produced by keratinocytes as they differentiate into corneocytes.  Interestingly, a calcium gradient exists within the epidermis consisting of higher levels of extracellular calcium found in the upper layers of the epidermis.  When the skin barrier is disrupted, increased water movement through the stratum corneum causes decreased calcium in lower levels that stimulates lamellar body synthesis and secretion of lipids.  This normal skin response is in place to assure that impairments in barrier function are corrected.  Continue reading

 Avoiding Hand Dermatitis

Hand dermatitis is one of the most common problems encountered in dermatology with a prevalence possibly as high as 50% hand dermatitisor greater in certain occupations. The dis­comfort associated with hand der­matitis frequently results in a de­creased quality of life. In fact, hand dermatitis can be debilitating for many years.

Dermatitis (or eczema) is inflam­mation of the skin, characterized by itchy (pruritic), red, weeping skin with vesicles and/or crusty patches. The risk factors for hand dermatitis include chemical expo­sures, frequent handwashing, and wet-work environments contribut­ing to a higher prevalence in specif­ic occupations including healthcare professionals, machinists, hair­dressers, and food industry em­ployees. Continue reading

 Reducing Dermal Scarring

Scars are areas of dermal fibrosis that replaces normal tissue after in­jury and during wound healing.

There are several types of dermal scars including:

  1. Atrophic scars that appear as sunken or pitted areas of skin
  2. Hypertophic scars that are charac­terized by raised areas of skin
  3. Keloid scars characterized by growth outside the original wound area
  4. Striae distensae (stretch marks) characterized by linear bands of atrophic-appearing skin.

Dermal ScarringWound healing involves 4 critical phases that overlap: the coagulation phase, the inflammatory phase, the migration-proliferation phase (de­velopment of granulation tissue), and the remodeling-regeneration phase that includes maturation, scar formation and re-epithelialization. The magnitude of the second phase, inflammation, affects the amount of scar tissue that is produced at the conclusion of the healing process. Regeneration is thought of as re­placement of tissue, however, scar formation actually involves a pro­gressive remodeling of granulation tissue. In fact, scars are defined as dermal fibrous replacement tissue that results from a wound that has healed by resolution (rather than re­generation).

Scarring typically occurs following damage to more than 33% of the skin thickness from trauma or surgery. Can skin damaged in this way ever heal without scarring? Actually, com­plete regeneration occurs exclusively in lower vertebrates. Scarless heal­ing in humans only occurs in early embryo development. So, why do we form scars after early development? One theory suggests that wound healing in mammals is optimized for fast healing in a fast-moving, micro­bial-rich environment. Rapid inflam­matory responses may allow quick healing to prevent infections. Continue reading

Protecting Mitochondria for Skin Health

Mitochondria are organelles found in the body’s cells (including skin cells) that generate energy in the form of ATP.  They are known as the powerhouses of cells due to this important function.  Interestingly, they are thought to originate from bacteria-related cells because of their striking similarity to bacteria (including mitochondrial DNA that is very similar to bacterial DNA) and the belief that they appear to have developed a symbiotic relationship with higher order cells, such as mammalian cells.

In addition to generating energy, mitochondria play critical roles in other cellular processes including:

  1. The production of reactive oxygen species (ROS)
  2. The regulation of cellular metabolism
  3. Calcium signaling
  4. Programmed cell death (apoptosis)
  5. Inflammation
  6. Wound healing

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Antioxidants and Skin Health

The skin is the largest organ of the body and is the first line of defense against balancing rocksvarious external threats including temperature
changes, dehydration, invading microbes, harmful chemicals, pollution, and ionizing radiation. These threats are potentially damaging because they can alter biological homeo­stasis (or the maintenance and regulation of stability required for proper functioning).

One very important aspect of skin homeostasis involves maintain­ing the balance between the pro­duction of free radicals, known as reactive oxygen species (ROS), and the skin’s oxidative defense system. Toxic chemicals, pollu­tion (including cigarette smoke), ionizing radiation (including UV), and extreme temperature change can all cause elevated ROS that may disrupt this balance, poten­tially leading to oxidative stress, skin inflammation, increased ag­ing and disease. Continue reading

Relief from Itching

Itching Itch or pruritus has been defined as an unpleasant sensation that elicits the desire or reflex to scratch.  Itch is the most common symptom in dermatology.  It is also the most common skin complaint in people over the age of 65 years and it can have a major impact on an individual’s quality of life.  Itch has many similarities with pain, but the responses to itch and pain differ since pain evokes a withdrawal response and itch evokes a scratch response.  We all know that the itch sensation can be reduced by the painful sensation caused by scratching.  Studies have also shown that various other types of pain stimuli can also reduce itch.  In some ways, itch and pain are regarded as closely related, however, itch and pain are different sensations that are processed by distinct sets of neurons.  Continue reading