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284 Pages·2010·18.85 MB·English
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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 Blackwell Publishing was acquired by John Wiley & Sons in February 2007. Blackwell’s publishing programme has been merged with Wiley’s global Scientific, Technical, and Medical business to form Wiley-Blackwell. Registered office John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, United Kingdom Editorial offices 9600 Garsington Road, Oxford, OX4 2DQ, United Kingdom 2121 State Avenue, Ames, Iowa 50014-8300, USA For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell. The right of the author to be identified as the author of this work has been asserted in accordance with the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher. Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books. Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought. 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

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Principles of Skin Care is a practical, evidence based guide to the principles of skin management and skin health. Broader than a dermatology book, this text focuses on the generic components of helping patients with skin conditions, exploring the underlying evidence base, and provides practitioners
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Most books are stored in the elastic cloud where traffic is expensive. For this reason, we have a limit on daily download.