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Topic Nine: Barrier Films and Creams

Composition and Properties

Commercial skin protectors are products designed to provide an occlusive barrier between the skin and any potential irritants. They are manufactured in different forms, such as creams, sprays or wipes and are meant to provide a ‘breathable’ layer, which lets TEWL (trans-epidermal water loss) out whilst preventing wound fluid, urine and faeces from coming into contact with the skin. They can also be used to protect the skin from dressing adhesives.

A variety of new, synthetic, silicone-based, non-irritant barrier products are available. These products provide a thin, protective polymer film and are available as creams, films, and wipes (Voegeli, 2008). The advantages of silicone products are that they dry without leaving a residue, are not petroleum-based and should not, therefore, interfere with the adhesion of dressings (Cutting, 2006). They also have the added benefit of not stinging on application.

Skin protectors that contain acrylate and silicone are also water-repellent. Zinc oxide, silicone and acrylate skin protectors keep irritants from coming into contact with the skin. However, they also influence the TEWL. Using more than one product can further increase the risk of maceration. Therefore, products containing zinc oxide and acrylate should not be used at the same time (Langoen, 2010).

The ideal barrier product should be suitable for use on both intact and broken skin. It should also be hypoallergenic, transparent, easy to apply, breathable, have protective properties, and be pain-free to the user (Voegeli, 2008; Flynn & Williams, 2011).

Indications for use

Barrier creams are designed for use on intact skin and should not be applied to broken skin unless specified in the manufacturer’s instructions. Barrier films are suitable for use on both broken and unbroken skin (Voegeli, 2007; Beldon, 2008).

Non antimicrobial barrier creams and films are often contraindicated for use on infected areas of the skin (check with the product guidance and instructions for use).

Barrier products should be used as part of a holistic skin care regime designed to protect against excess moisture exposure. A barrier product should be selected following a holistic assessment of the patient.

Evaporation of water from the skin is called trans-epidermal water loss (TEWL). If the barrier product is applied too thickly, moisture cannot escape, and the skin can become macerated. The barrier function of the skin is compromised as a result.

Further assessment of the patient will be required to determine the cause of the excessive moisture and other interventions may be needed to treat the problem. Any skin care regimen, including those that protect the skin, should be effective, readily available, patient-friendly and an integral part of patient care. Strategies to avoid skin damage should be used throughout all episodes of patient care (Woundcare Handbook, 2014/15).

For information on moisture associated skin damage please refer to module 4, section 6.