|James T. Highsmith|
ATLANTA — Gentle skin cleansing and moisturizing is the foundation for treating simple skin conditions that plague amputees, according to a dermatologist from New York, here.
James T. Highsmith, MD, MS, of the department of dermatology at New York Metropolitan Hospital Center, spoke at the American Academy of Orthotists and Prosthetists Annual Meeting here along with brother M. Jason Highsmith DPT, CP, FAAOP.
Xerois, or dry skin, is the most common skin irritant, affecting 75% of people older than 64 years. Treatment includes using lukewarm water for bath or showers, avoiding harsh and deodorant soaps and moisturizing skin while damp. Using liners with aloe or other emollients or lubricants can help relieve symptoms.
“Ensure they rinse thoroughly because soap residue can cause xerosis,” James Highsmith said. Petroleum jelly can be a good, inexpensive option for moisturizing; he said he routinely uses petroleum jelly for low-income populations because it is affordable.
|M. Jason Highsmith|
“Anything that we can offer them that’s a low cost and low maintenance thing that they can get over the counter is an added value for patient care,” said M. Jason Highsmith, assistant professor at University of South Florida.
General treatment for eczema dermatitis, which can include contact dermatitis, includes removing the eliciting or exacerbating agent, skin hydration and antihistamines to control itching, in addition to gentle care.
“If they don’t itch, they probably don’t have contact dermatitis,” James Highsmith said.
Using refrigerated camphor or menthol as a topical agent is a cooling and effective tool for patients who itch. It also may be necessary to cut the liner to a lower level, if skin irritation is local. If global, switching the liner type or manufacturer or using another suspension system may curb irritation. Materials in the liner itself, such as plastic, preservatives or the silicone itself, may actually be causing the dermatitis. A patch test can help determine if the liner is causing the problem.
Intertrigo is a cumulative term encompassing nonspecific rashes of opposing skin surfaces, such as skin folds. This is often seen in the distal residual limb. A barrier cream such as zinc oxide may be useful, as well as removing the irritating factors. Spreading the skin or pulling the skin together with a physical spacer, or using a custom liner with a spacer built in, can relieve this condition.
“All barrier creams are not created equal,” James Highsmith said. Sometimes an ingredient may cause irritation. As well, if using both a hydrocortisone and barrier preparation, make sure both are either cream or ointment. Do not mix a hydrocortisone cream with a barrier ointment, he said.
Most natural products are fine “as long as you don’t get any irritation from it,” he said. Additionally, if a patient presents with fever or chills, the practitioner should not hesitate to refer the patient to a doctor.
Highsmith J, Highsmith MJ. Skin issues in O&P. Presented at the American Academy of Orthotists and Prosthetists Annual Meeting and Scientific Symposium. March 21-24. Atlanta.