Barrier Creams and Skin Care Under Pads

Why skin breaks down

• Moisture softens and macerates the skin, making it fragile.
• Urine and stool irritants, particularly liquid stool, which contains digestive enzymes that attack the skin.
• Friction from pads, clothing, bedding and vigorous wiping.
• Heat and sweat under plastic-backed products.
• Thin, dry, ageing skin with reduced fat and slower repair.
• Poor nutrition, dehydration, diabetes, poor circulation and some medicines impair healing.
• Immobility and pressure, so that skin is also at risk of pressure sores; see preventing bedsores at home.
• Infrequent changes and harsh soaps.
• Fungal infection, which thrives in warm, moist folds.

The skin damage that arises is called incontinence-associated dermatitis; see incontinence-associated skin damage: prevention and care.

The basic routine: cleanse, protect, check

### 1. Cleanse gently

• Clean promptly after each episode of wetting or soiling, rather than waiting.
• Use warm (not hot) water and a soft cloth, or alcohol-free, fragrance-free wipes, or a no-rinse cleanser designed for skin, ideally with a pH close to that of skin. Avoid ordinary soap, which is alkaline and drying, and avoid harsh antiseptics.
• Pat, do not rub. Clean from front to back, with a fresh cloth or wipe each time. See wipes and perineal hygiene done gently.
• Rinse if needed, then pat dry thoroughly, including skin folds. Moisture left in folds invites rashes and fungus.
• Avoid hot water, which damages sensitive skin; see hot water and scald safety for older skin.
• Do not use talcum powder, which clumps, absorbs moisture unevenly and can irritate.

### 2. Protect

• Apply a thin layer of barrier product to clean, dry skin in the areas exposed to urine or stool: the groin, genital area (outside), buttocks, upper thighs and skin folds, as advised by the nurse.
• Reapply after each cleanse, or as the product instructions say.

### 3. Check

• Look at the skin at every change: colour, shine, blisters, open areas, swelling, pain, rash, smell.
• Record changes in a care diary; see care diary and handover notes.

What barrier creams are

Barrier products form a thin protective film on the skin, to block moisture and irritants. Common types and ingredients include:

• Zinc oxide creams and ointments: protective, mildly soothing, traditional, usually thick and white. They can be sticky and hard to remove (clean off gently with oil-free cleanser, not by scrubbing).
• Petrolatum (petroleum jelly) and similar ointments: strongly occlusive, waterproofing the skin.
• Dimethicone and silicone-based creams: form a breathable, water-repellent layer, less greasy and often more pad-friendly.
• Acrylate or film-forming barrier products: sprays or wipes that leave a thin, transparent polymer film that is not removed by wiping, and lasts for a day or two, used in clinical settings.
• Cream or lotion moisturisers: treat dryness but do not protect from wetness; not a barrier substitute.
• Combination products: zinc plus dimethicone, or others.
• Products with antifungal or antibacterial ingredients, or steroids, are treatments, not barriers; use only if prescribed.

Choose fragrance-free, alcohol-free, dye-free products, particularly for sensitive skin. Check for allergies. A nurse or pharmacist can suggest the right type.

How to apply

1. Wash hands and, if helping someone else, wear gloves. 2. Clean and dry the skin, as above. 3. Take a small amount, about the size of a pea or a fingertip for a hand's area. The aim is a thin, even film, not a thick layer. Heavy layers do not protect better and can block the absorbency of pads, clump, rub off and trap moisture. 4. Smooth gently over the skin with clean fingers or gloved hands, without rubbing hard. Cover the area exposed to moisture, including skin folds. 5. Let it settle for a short while before applying the pad or pants. 6. Do not apply to wet, broken, weeping or infected skin unless a nurse or doctor says to. 7. Do not re-use the same fingers in the pot after touching soiled skin; use a clean spatula or tissue, or a tube. 8. Remove excess at the next cleanse by gentle wiping with a soft cloth, without scraping off every trace if the film is intact; it is acceptable to leave a thin layer if the area is not soiled, and to cleanse around, as advised. Do not scrub zinc products hard. 9. Wash hands afterwards.

Barrier cream and absorbent products

• Thick creams can reduce the absorbency of pads, underpads and pull-ups by coating the surface and blocking fluid from entering, causing leaks and wetting of the skin. Use thin layers, and ask the nurse about a product that is compatible with pads.
• Cream on the product, rubbing off onto sheets and clothes, may stain; wash with detergent.
• Barrier creams do not replace changing: prompt changes remain the most important protective step; see pull-ups or briefs: choosing the right product and how to change an adult diaper in bed.
• Use breathable products and bedding to reduce heat and sweat; see bed linen for sensitive older skin.
• Washable pads: creams can build up in fabric; wash with detergent, no softener; see washable underpads: washing, drying and lifespan.

What to avoid

• Perfumed, alcohol-based or medicated wipes and soaps, and strong antiseptics.
• Rubbing and scrubbing.
• Talcum powder and cornflour, which can feed yeast and clump.
• Thick layers of cream.
• Hot water.
• Plastic sheets in contact with skin.
• Home remedies such as turmeric paste, coconut oil on broken skin, lemon, baking soda paste, herbal powders or mud; they can irritate, sting or infect open skin. Ask the nurse before using any natural product.
• Steroid, antifungal or antibiotic creams without a doctor's prescription: steroids thin skin and can worsen fungal infections.
• Using the same cloth for different areas.
• Waiting for rash to appear before starting skin care.

Oxygen safety note

If your parent uses oxygen, remember that petroleum-based and oily products are fire hazards near the nose and face. Barrier creams in the groin area are not a face concern, but keep oils and greasy products off the face, hands and equipment while oxygen is in use; see using an oxygen concentrator safely at home.

Special areas and conditions

• Skin folds under the abdomen, in the groin and under the breasts need drying and may need a moisture-wicking cloth; ask the nurse.
• Men: care around the foreskin and scrotum.
• Women: keep the creams on the outer skin, not inside the vagina.
• People with catheters: clean around the catheter site gently; see catheter care basics for families.
• People with diarrhoea: protect often and consider a stool-management plan with the nurse; see bowel incontinence and constipation in later life.
• People with diabetes: skin heals slowly and fungal infections are frequent; see diabetes after 60: a home care guide.
• People with dementia: may scratch, pick or resist; keep nails short, and use calm routines; see incontinence and dementia: routines and reassurance.
• Hot, humid weather: frequent changes and breathable products matter more; see summer heat and bedridden care.
• Skin conditions: see skin conditions in older adults.

When skin is already red or broken

• Mild redness that fades when pressed may respond to more frequent changes, gentle cleansing and a barrier.
• Redness with shiny, weeping or open skin, blisters, erosions or pain needs a nurse's or doctor's assessment. It may need a different product.
• Bright red rash with small red spots at the edges (satellite lesions) suggests fungal infection (candida), which needs treatment, not just barrier cream.
• A dark red, purple or maroon patch, a deep sore or tissue loss may be a pressure injury, which needs urgent medical care; see pressure ulcers: stages, wound care and prevention.
• Fever, spreading redness, swelling, pus or foul smell needs urgent medical attention.

When to ask a professional

Ask a nurse or doctor to look at any skin that is red, sore, blistered, weeping or broken, or that does not improve in a few days. Ask a pharmacist for fragrance-free products. Ask for a care plan for a person at high risk, such as someone bedridden or with diarrhoea. Seek urgent help for fever with confusion, spreading redness, pus, deep or dark wounds or no urine for many hours; call 112 for emergencies.