We see lots of cases on our facebook group which is open to clinicians from around the world. One of the recent queries being a request for advice of what to put on a case with fragile, inflamed skin caused by urine/faecal scald. These aren't classed as wounds as such (not until they deteriorate that is!) but the same rules apply. Preserve cell function and create the optimal environment for healing.
With loads of suggestions for creams (intended for humans) its hard to know what is best. The favourites included Sudocrem, Bepanthen, Kamilosan and many others promoted for nappy rash and cracked nipples caused by breast feeding. These products have to be safe if they are used on babies? Don't they?
Well, you guessed it, we say beware - read the ingredients on these products to check they are REALLY what you need in contact with fragile skin. To quote Emeritus Professor Derek Knottenbelt (aka our guru). "If you wouldn't put it in your own eye, then why would you put it in a wound". Further more, when using creams on pets consider some may be toxic if they are licked off.
Very often skin creams (EVEN if intended for human babies) contain more than is needed including antiseptics, perfumes and preservatives that may be unnecessary or even detrimental to healing.
Antiseptics: Savlon, Bepanthen and Sudocrem all contain cetrimide. Its an antiseptic used widely in topical creams. Toxic to fibroblasts it may inhibit progression through proliferative phase of healing.
Other antiseptics and additives featured in products claim 'natural' benefits which is really a reassuring excuse for us to trust them on hearsay.
Natural doesn't mean safe: Many plant based antiseptic compounds are powerful phenolic compounds of which Tea Tree oil is a perfect example. They can be highly sensitising (causing an unnecessary inflammatory reaction) and toxic if ingested, especially in cats. So yes these things may be natural and antimicrobial, but they can also be cytotoxic and damaging. They could be killing the very cells we need that are crucial to healing. So natural does not mean safe or hypoallergenic and the choice may be between antimicrobial effect OR healing progression. Rarely are there antiseptics that do not inhibit cell proliferation in one way or another. We need to decide what is more important.
Preservatives, parabens and perfumes are also a key ingredient of commercially produced creams used for nappy rash. After all, they have to last on the bathroom shelf for months without being an impromptu agar dish!. That is what parabens do, they are the preservatives will ensure doesn't happen.
Ever said, "Ahhhh.... this product reminds me of my Mum." or "its just like the smell of our bathroom when i was a child!". perfumes will help us favour certain products and may even appeal to our sense of memory. They will help us differentiate from one product to another. Natural essential oils (see above!) will be generally be more expensive than synthetically produced agents..
Both parabens and perfumes (even naturally derived) can cause sensitivities and allergic reactions so we are better off choosing products without them if we can.
Keep it simple and use the products intended for the problem: If your skin is inflammed and damaged ask why. Urine or faecal scald, constant contact with wound exudate or a wet environment will warrant a dedicated barrier film designed for the job. Products available include Cavilon® or Sorbaderm®.
Developed specifically for fragile skin these products create an invisible film barrier that prevents penetration of caustic fluids into epidermis leading to a breakdown of the natural waterproofing and protection of the skin. A light layer of cream, or spray will last 24-48 hours and will break the cycle of cell damage and the inflammation that results.
Prevention is better than cure: The key is to deal with the source of the excoriation and inflammation and plan for its resolution. If in doubt ask for help - that is what we are here for.
Barrier sprays and creams do no harm if used as a preventative and are non toxic if the animal licks the area. Applied every other day, with some brands able to protect for longer periods they can be used infrequently enough to avoid stress for the patient and to compliment longer wear times for bandages and dressings.
The following article is a fascinating insight into some of the ingredients you may find in common creams and potions. You might be surprised to find out what you're putting on your own bits and pieces!
"67 Products to avoid in personal care products"
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