Practical tips for looking after your skin

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.