Practical tips for looking after your skin
As we get older, our skin becomes more delicate and dry, and skin tears are common. However, the simple step of moisturising twice a day can help prevent skin tears in the first place.
This brochure has tips on how to take care of your skin to prevent skin tears and what you should do if you have a skin tear. It also highlights the importance of using compression therapy for venous leg ulcers and when to seek treatment for a wound.
What you need to know about skin tears
With a skin tear, the outer layer of skin peels back and can look like a loose flap of skin. Skin might be torn in incidents like knocking your leg on a chair, or catching your arm on a plant or stake in the garden.
Skin tears can be bothersome and might stop you from doing the things you enjoy such as gardening or playing golf.
Research has found that men and women who apply an appropriate moisturiser twice a day halve their chance of having a skin tear.1 There are many different types of moisturisers and some of these are better than others. Alpha Keri® lotion is an example of an appropriate moisturiser that DVA gold and white card holders might be eligible to receive on the Repatriation Pharmaceutical Benefits Scheme (RPBS). Ask your doctor or pharmacist which moisturiser might suit you best.
1. Carville K, Leslie G, Osseiran-Moisson R, Newall N, Lewin G. International Wound Journal. 2014; 11: 446-453.
Follow these tips to help prevent skin tears:
Apply moisturiser to your arms and legs twice a day – it only takes a minute or two. Make it part of your daily routine by moisturising at the same time each day, e.g. after showering in the morning and before bedtime at night. Be careful not to get moisturiser on the soles of your feet. It might make them slippery.
Use a soap substitute cleanser when bathing. Soap can make your skin dry out. For example your doctor may prescribe Hamilton® Skin Therapy Wash. Take care as soap substitute cleansers may make surfaces slippery.
Keep limbs protected by wearing long sleeves and pants.
Eat a healthy balanced diet and drink plenty of fluids, unless otherwise instructed by your doctor.
Reduce the chance of falling over; wear good practical footwear, and glasses where prescribed, and keep the house and garden clutter free and well lit.
What should I do if I have a skin tear?
If you do have a skin tear, even a small one, it is a good idea to see your doctor. Your doctor, or a nurse, can check that the wound is clean and give you advice about how to look after it. Your doctor can talk to you about what might have caused the skin tear. For example if you felt dizzy and fell over, your doctor might review your medicines, to make sure one of them isn’t the cause. If you would like to know the basics of how to care for a skin tear, see the insert Looking after a skin tear: know the basics.
Make an appointment to see your doctor if you have a wound and notice any of the following:
- the wound has not healed within two weeks
- increased or new pain
- swelling, or redness around the wound
- the wound is weeping a lot
- the wound becomes black or yellow
- bleeding in or around the wound
- a foul odour is coming from the wound
- you feel unwell or have a temperature.
What you need to know about venous leg ulcers
A venous leg ulcer is a wound between the knee and ankle that is slow to heal because of problems with the veins in the leg. Talk to your doctor if you have any wound below the knee that has not shown signs of healing within two weeks. They might refer you to a specialised wound clinic or district nurse who is trained in applying compression therapy.
Compression therapy is the most important treatment
Compression therapy uses special bandages and hosiery to apply supportive pressure to your leg. It works by squeezing the limb, reducing swelling and helping venous blood to return to the heart. Research has shown that in most cases venous leg ulcers heal much quicker when compression bandages are used. Listen to this patient who regained his independence by using compression therapy http://www.woundaware.com.au/be-wound-aware-for-patients.html
Gold and white card holders might be eligible to receive compression bandages and hosiery as well as aids to help apply hosiery. Talk to your doctor to find out more information.
What should I do if I have a venous leg ulcer?
If you have a venous leg ulcer, the best thing you can do is use compression therapy as directed by your health professional. There are different types of compression bandages and treatment will be tailored to your needs.
Compression therapy should feel firm and supportive without causing pain. The slight discomfort of the first few days will ease as the leg swelling reduces. Compression bandages will need to be kept on until the ulcer has healed. Bandages are usually changed once a week. If your compression therapy is uncomfortable at any stage of your treatment, talk to the doctor or nurse who applied it. The bandage might need to be adjusted.
What should I do once my venous leg ulcer has healed?
Once your venous leg ulcer has healed, the best thing you can do to prevent another one is to use medical-grade compression hosiery. Research has shown that continued use of compression hosiery reduces the chance of it recurring by 70%. Compression hosiery is different to the white anti-embolic stockings used for preventing blood clots. Your leg needs to be measured to ensure you use the correct size. Compression stockings can be removed when you are bathing or have your leg elevated e.g. if you are lying flat in bed.
Things that I can do to help my venous leg ulcer heal
Use compression therapy as directed by your health professional.
Once the venous leg ulcer is healed, wear compression hosiery to prevent the ulcer returning.
Put on compression hosiery first thing in the morning when leg swelling is less. Wait at least 30 minutes after applying moisturiser before putting on the hosiery, otherwise they will be harder to put on and might get damaged.
Wear dishwashing gloves for a good grip when taking hosiery on and off. It makes the process easier and prevents damaging them. If you have trouble taking the stockings on and off, ask your doctor about aids that can help.
Make sure the compression hosiery is evenly applied without ridges as this can cause skin damage.
Replace compression hosiery every three to six months as directed.
Compression bandages and hosiery must be kept dry. Use a waterproof protector while bathing.
When wearing compression bandages or hosiery, seek advice from your doctor if your toes change in colour e.g. they turn white or blue.
Keep your leg elevated to your waist when you are resting or sitting to help reduce the swelling in your legs. The best way to do this is by lying flat in bed. You might also use a recliner chair or high footstool.
Daily exercise, such as walking, can improve healing. If walking is difficult, talk to your doctor about foot and ankle exercises that can help.
Maintain a healthy diet and weight, and take steps to quit smoking.
Looking after a skin tear: know the basics
- In most cases, it is best to see a doctor or health professional for advice.
- Always start by washing your hands thoroughly, and drying with a clean towel.
- Stop any bleeding by gently pressing a clean dry towel against the wound. Talk to your doctor if the bleeding does not stop after 10 minutes.
- After the bleeding has stopped, rinse the wound well with cold running water. Drinkable tap water is fine. Don’t use soap.
- Gently remove any dirt with a soft, clean, moist cloth. See your doctor if you are unable to gently remove all the dirt from the wound.
- After cleaning, gently pat dry with a soft clean cloth.
- If there is a loose flap of skin, carefully place the flap back over the wound without stretching the skin.
- Cover the wound with a non-stick dressing pad (see Diagram 1 for instructions). Ask your doctor or pharmacist for advice on an appropriate dressing as some dressings can make the skin tear worse.
- Keep the bandage on until the wound is completely healed – this is usually five to seven days.
- Change the bandage if it becomes loose, wet, or dirty. Dressings suitable for skin tears are not waterproof and need to be kept dry.
- Remove dressings gently and slowly. To avoid further damage to the skin, take care to remove in the opposite direction to the skin flap (see Diagram 2 for instructions). If the dressing sticks to the skin, try dabbing the edges with damp paper towel.
Diagram 1: Dressing your skin tear
Cover the wound with a non-stick dressing pad. Draw an arrow on the top of the dressing to indicate the direction for removing. The arrow should be pointing in the same direction as the edge of the skin flap.
Diagram 2: Safe removal of the dressing
Remove the dressing slowly and close to the skin, using the arrow to guide you. Never pull against the direction of the skin flap.
If you have any concerns about cleaning and dressing the wound or how to safely remove your dressing, talk to your pharmacist or doctor.
Frequently Asked Questions
(Click on each question to expand)
As we get older, our skin becomes more susceptible to damage in many ways. It becomes drier, flaky and itchy, and we may be more prone to infection. We often have less feeling in our fingers, toes, feet and legs and are less able to control our body temperature, making us more susceptible to skin tears, bruising and wounds that can be slow to heal.
For these reasons it is better to use an emollient liquid soap which is softer, soothing and gentler on the skin than bar soap, which is drying and irritating and can damage the skin. If you are unsure of which soap is best for you to use, talk with your doctor, pharmacist or practice nurse.
Yes, it does matter. It is very important that you don’t get your compression bandages wet. If they get wet, it can increase your risk of an infection in your ulcer. When you have a shower or a bath, you can cover your bandaged leg with a plastic protector to keep it dry. It is a simple, comfortable and re-useable waterproof bag that is self-sealing and can be completely submerged in the bath. One should last the duration of treatment. It might be a good idea to ask your doctor about them.
If you don’t have a plastic protector, after your bandages have been removed and you are having a dressing change, wash your leg with a gentle wash. Dry your leg with a clean cloth and apply an appropriate moisturiser to the leg. Don’t use one that is too greasy because you don’t want the bandages to slip down. Applying a moisturiser at this time is a good way to keep your skin in good condition and help prevent ulcers in the future. Your doctor can recommend an appropriate moisturiser for you, if you are unsure of which one to use.
There are several things you can do to help heal your venous leg ulcer more quickly. You can:
- Wear your compression bandages: The most important thing to do when you have a venous leg ulcer is to keep wearing your compression bandages as directed by your treating practitioner (nurse or doctor). When you first wear compression bandages, you might feel a bit of throbbing or slight discomfort, but as the swelling in your leg goes down, this should disappear and you will feel more comfortable. Compression bandages should feel firm and supportive, but not cause you any pain. Keep wearing your bandages or stockings until your doctor or nurse tells you to stop wearing them. If you have difficulty with wearing them or they become loose or uncomfortable, don’t take them off; talk with your doctor or nurse first.
- Protect your skin: Use an appropriate moisturiser twice a day on your legs and arms. Your doctor or nurse can help you with choosing a good moisturiser. Don’t let your skin get too warm by sitting too close to a fire or having the water too hot when you have a bath or a shower.
- Stop smoking: Smoking can slow the healing process by making it difficult for the blood to flow around your body.
- Be active every day: Exercise helps improve the circulation in your legs and reduces swelling. It also helps to maintain a healthy weight and improves your general feeling of wellbeing. Doing ankle stretches, calf stretches and heel-to-toe walking, even while you have your compression bandages on, will help to strengthen your calf muscles, improve blood flow and reduce swelling. Thirty minutes a day will make a big difference.
- Avoid standing or sitting for long periods of time: Try to change your position at least every 30 minutes or so when you are sitting or standing in one spot. Long periods of standing or sitting will slow the circulation in your legs and can cause your legs to ache or cramp. Standing for long periods will also increase the swelling in your legs.
- Raise your legs to the level of your heart when sitting or lying: When you are sitting, try to support your legs on a pillow so that they are up to the level of your heart or higher than your waist. This will help reduce the swelling in your legs. Don’t sit with your legs crossed.
- Eat a healthy diet and drink plenty of fluids: Try to eat some meat or fish, vegetables and fruit, dairy products and breads each day. A diet high in proteins, calories and vitamins A, E and C is best to help the healing process. Avoid too many fatty or salty foods. Remember to drink plenty of fluids each day unless otherwise instructed by your doctor. Dehydration can cause muscle cramps, fatigue, discomfort and other serious problems. Take a bottle of water with you when you go for a walk. If you are unsure of the type of foods to eat while you have a venous leg ulcer, speak with your doctor or nurse for some advice.
- Take your pain medicines as directed: Take the medicines that have been prescribed for you to help manage your pain as directed. You will be better able to manage and enjoy your everyday activities, including going for a walk, preparing your food and having your dressings changed. Don’t start or stop any medicines without first talking with your doctor.
Maintaining a healthy diet and weight is important to help the healing process. When you do not eat a healthy diet every day, your venous leg ulcer may be slow to heal and it may be more prone to infection. If you’re concerned about your weight or your diet, talk with your doctor and they may arrange a referral to a dietician to help you choose the right foods.
Having a wound puts extra stress on your body, so eating a variety of foods and including more nutritious foods is the key to helping your body heal faster. Here are some tips that you might find helpful:
- Include vegetables and fruits in your diet every day. They will help to provide you with fibre, vitamins, minerals and antioxidants. Choose a variety of types and colours.
- Include a variety of lean meats, fish or poultry, nuts and seeds, legumes and beans. These help provide you with proteins to repair skin and muscle, and important minerals and vitamins.
- Choose good fats such as nuts, seeds, avocado, olives and olive oil.
- Include eggs in at least two meals a week.
- Include dairy foods, such as yoghurt and cheese.
- Include whole grain breads and cereals, potatoes, rice or pasta to help provide your body with the energy you need to heal.
- Drink plenty of water or other fluids you enjoy unless your doctor tells you otherwise. Water replaces fluids lost through your wounds.
- Eat healthy snacks including cheese, sandwiches, peanut butter or nuts, granola or fresh fruit.
- Limit your intake of high fat, sugary or salty foods and alcohol.
The Australian Guide to Healthy Eating provides a food selection guide which visually represents the proportion of the five food groups recommended each day. It can be accessed at: https://www.eatforhealth.gov.au/guidelines/australian-guide-healthy-eating
Maintaining a nutritious diet every day when you have a chronic wound can be complicated. If you are unsure of what foods you should include in your diet, talk with your doctor or nurse and they will be able to give some advice or refer you to a dietician.
Exercises that are designed to strengthen your calf muscles will help to pump the blood back to your heart and help your ulcer heal faster. It is important to continue these exercises when you are having compression therapy. Some good exercises to do include:
- Walking: Avoid shuffling or limping as this does not help blood flow. Make sure when you are walking that your heel strikes the ground first and try to walk for 30 minutes each day, or two or three times a week to start with and build up to every day. If you have difficulty walking, doing seated heal raises or standing heel raises and ankle stretches is useful.
- Seated heel raises: Whilst seated in a chair, raise both heals off the floor ten times. Repeat three times, three times a day or as many times as you can do comfortably.
- Standing heel raises: Stand at a bench or chair with your feet hip distance apart. Rise up on your toes ten times. Repeat three times, three times a day or as many times as you can do comfortably.
- Ankle stretches: Stretch your feet and ankles up and down, in and out and in circles 10 to 20 times.
Talk with your doctor or nurse about which exercises will suit you and for further advice.
Even when venous leg ulcers have healed, they are likely to return unless ongoing prevention is maintained. One way to help prevent them from recurring is to wear compression hosiery. Compression hosiery applies constant pressure to your leg to improve the movement of blood through your veins, which helps prevent the ulcer from recurring.
Put your stockings on first thing in the morning and remove them last thing before going to bed at night. If you find you are having difficulty getting them on and off, speak with your doctor or nurse to obtain a ‘donning aid’ through DVA. Another tip to get them on and off more easily is to wear dishwashing gloves. If you are finding your stocking is too heavy or uncomfortable to wear, talk with your doctor or nurse and you might be able to get one that is ‘made to measure’.
If your compression stockings become loose, torn or worn out, make sure that you talk with your doctor or nurse, to replace the stockings.
Other than wearing the compression hosiery every day, there are a number of other things you can do:
- Wear loose socks and well-fitting, comfortable shoes.
- Keep your legs raised when you are sitting and at night, don’t sleep in a chair.
- Aim to exercise each day, e.g. go for a walk.
- Avoid standing for long periods of time.
- Avoid bumps to the legs which could cause an ulcer to come back, e.g. bumps from furniture or supermarket trolleys.
- Keep your feet warm but avoid overheating, such as sitting too close to a fire or having hot showers or baths.
- Take care when washing your legs - apply a moisturiser twice a day and inspect them daily to make sure the skin is intact, they are not scaly or dry and there is no swelling.
Due to the elasticity of the stocking, it is not possible to roll them up when putting them on, so they can be very difficult to get on and off. Here are some tips that might help you:
- Don’t apply a moisturiser immediately before putting your stocking on.
- Shower in the evening just before you go to bed and put your stocking on first thing in the morning when the swelling is usually less.
- Don’t roll or fold down the top of the stocking as this will reduce the blood flow to your leg.
- Wear dishwashing gloves to put your stocking on, to increase your grip. Don’t pull on the top band as this will stretch the stocking and can tear it.
- When putting your stocking on, place your hand in the foot end, grasp the shaped heel section and partially turn the stocking inside out over the foot section. Slide your foot into the foot section, ensuring your heel is centred in the right place. Then slide the stocking over itself and work it up the leg to just below the knee. Massage out any wrinkles.
- Talk with your doctor about a donning aid to help if you are still having difficulty getting your stocking on.
Yes, you should tell your doctor if you have:
- swelling in your legs or ankles
- broken skin, irritation or redness
- pain, especially if it is getting worse
- compression stockings that are not fitting comfortably.
No they are not suitable. Anti-embolism stockings also known as TED stockings are designed to help prevent deep vein thrombosis. They do not provide enough graduated compression to treat people with a venous leg ulcer. Your doctor or practice nurse will show you the correct hosiery to wear for a venous leg ulcer.
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