How to manage

Soaps and detergents can dry out and irritate the skin and cause itching. Inform the patient to stop using soap.
 

Do not wash too frequently and use cold to lukewarm water.


Wash with an oil or cream based cleanser.


You can also add glycerin to the wash water, if available. This soothes the skin and protects it from drying out. Or use emulsifying ointment as a soap.


Apply moisturizers to the skin at least 3-4 times per day. Examples are Vaseline® (petroleum jelly), oils, seeds or vegetable oil (e.g. sunflower seed oil, coconut oil, olive oil), glycerin, lanolin (wool wax), mineral oils, paraffin, emulsifying ointment.


Steroid creams may be used to reduce inflammation and itch and may be applied once daily to itchy red dry skin areas:

 

  • Face and body folds (armpits, groin): use mild topical steroids, such as hydrocortisone 1% moisturizer or ointment.

  • Rest of skin: stronger topical steroids, such as betamethasone 0.05% cream or ointment."


Never use steroids alone, always combine with moisturizers.

 

Stop steroid treatment and refer if no improvement is seen after two weeks.


Encourage the patient to stop scratching.

Cracks/Ulcers or Erosions


Note: Follow national guidelines or international wound care management principles (WAWLC, EWMA)

 

  1. Identify and manage the cause of the crack/wound/erosion.

  2. Wash (clean water fit for drinking), cover and protect wound from chemical or physical injury

  3. If the wound is visibly dirty, use simple soaps to wash the wound or add glycerin to the wash water.

  4. Apply moisturizers for example Vaseline® (petroleum jelly) to the surrounding skin.

  5. Keep the wound moist (not too wet or too dry). Use a dressing that does not stick to the wound or apply clean greasy moisturizers such as Vaseline® (petroleum jelly) to the wound or onto the dry dressing before application. This stimulates healing and protects from physical damage when removing a dressing which sticks to the wound. 

  6. Remove any dead skin and tissue from wound and surrounding skin.

  7. Treat infection, if needed in accordance with the national guidelines.

  8. Control or reduce swelling to decrease pain and to stimulate healing. Apply clean dressing with light compression that does not restrict movements. This reduces discomfort, protects against infection and stimulates movement which further reduces oedema/swelling.

  9. If the ulcer or erosion is on a limb, elevate the limb and move it frequently to prevent or reduce oedema/swelling. During rest and sleeping, elevate the limb (e.g. raising the foot of the sleeping area or putting an arm on a pillow).

  10. Encourage frequent and careful stretching/movement to avoid contractures and to stimulate healing. This is especially important when a wound is near a joint.

 

Wound care information: https://leprosy.org/wp-content/uploads/2022/02/ALM-10Steps-Step6-021816.pdf