Skin cleansing and emolliating for older people with xerosis of the lower legs: a quasi-experimental pilot study

Aims. To undertake a quasi-experimental study to : i) assess the effect of low cost hygiene and emollient regimes on the SBF of people aged >65 year with xerosis (dry skin) on their lower legs; ii) assess the utility of portable measures of skin barrier function (SBF) in terms of stratum corneum hydration (SCH) and trans-epidermal water loss (TEWL) in community settings iii) provide evidence for a randomised controlled trial (RCT) on the treatment of adults in a resource-poor country with dry skin on their lower legs which causes and exacerbates the skin disease podoconiosis (non-filarial elephantiasis). Background. Age increases the risk of impaired SBF which can precipitate skin breakdown. Older skin is frequently characterised by troublesome xerosis and pruritus (itching). Hygiene and emollient practices are central to maintaining skin integrity but are currently underresearched. Method. Five combinations of cleansing and emollient interventions were applied to the xerotic lower legs of ten participants with no skin disease for five consecutive days. SCH and TEWL were measured at baseline and day six. Products were chosen because of effectiveness, low cost, and availability in a poor-resource country. Results. The greatest difference in TEWL prepost intervention was indicated by the regimen of soapy water, 2% glycerine soak and VaselineTM (mean 1.14, SD 1.27). This regimen also indicated the greatest difference in SCH (mean 7.92, SD 3.93). The improvement in SCH was significantly greater than for the control (p=0.011), soap (p=0.050), or water soak (p=0.011). Conclusion. A regimen of washing skin with soapy water, soaking in 2% glycerine for 30 minutes and applying VaselineTM has a beneficial effect on the SBF in older people. The study supports previous findings on the positive effects of glycerine on SBF. Implications for practice and research. SBF in older people can be improved using a regimen of washing, soaking in 2% glycerine and applying VaselineTM.