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Dermatology videos

Watch our videos about topical steroids, emollients and scalp psoriasis

Dermatology

How to use topical steroids

In this video we describe the different types of topical steroids, how to apply them and use them safely.

  • How to use topical steroids – video transcript

    Hello my name is Tom and I'm a dermatology doctor here at St John's Institute of Dermatology. In this short video I'll describe how to use topical steroids both safely and effectively. This video is not a replacement for the advice given to you by your doctor or specialist nurse. Therefore if you are in doubt please consult your specialist before using any of your prescribed treatments.

    Topical steroids are steroid preparations that are applied directly to the skin. They are used to treat a wide variety of skin conditions and work by reducing inflammation making the skin less red and itchy.

    It is important to remember that topical steroids come in different strengths. Stronger steroids tend to be used on the body whilst weaker steroids are used on the face and skin folds. They come as ointments or creams. Steroid ointments are oilier and are therefore better for treating drier skin.

    Before applying topical steroids wash and dry your hands thoroughly apply a fingertip amount by squeezing the ointment in a line from the last crease of the finger to the tip and this is the amount of steroid needed to treat the area of skin represented by two hands laid flat with the fingers together.

    Topical steroids are usually only applied to affected areas of skin but please do use them as directed by your doctor or nurse. Avoid applying steroids with emollients as this will dilute their effectiveness. Always wash and dry your hands thoroughly after applying topical steroids.

    Steroids have been used by dermatologists for over 50 years and the type of steroids found in these preparations are similar to those produced naturally in the body. Some people worry about skin thinning as a side effect of topical steroids but if you use them correctly and as advised by your doctor or specialist nurse, the risk of this is very low.

    We hope you found this video useful, for more information please download our educational leaflet by following the link below. Thank you.

 

Download our leaflet about topical steroids. (PDF 132Kb)

How to use emollients

In this video we describe the different types of emollients and how to apply them to the skin.

  • How to use emollients – video transcript

    Hello my name is Kim and I am a specialist dermatology nurse at St John's Institute of Dermatology.

    In this short video I will describe how to use emollients. This is a general guide only and should not replace the advice given to you by your doctor or nurse.

    An emollient is a moisturiser which helps to rehydrate the skin. By forming a layer over the skin it prevents water loss and this allows skin to repair itself.

    There are many different types of emollients. Ointments have the highest oil content therefore are most effective for dry skin. Creams have less oil content making them lighter and easier to leave on the skin. For this reason some people prefer to use creams during the day and ointments at night. Lotions have the least oil content and therefore are least effective for dry skin.

    It is very important that you apply your emollients in the correct way for your treatment to be effective. Always wash and dry your hands thoroughly.

    If your treatment comes in a pot or tub you should never use your fingers to decant the emollients. Using your fingers can introduce bacteria which can lead to skin infections. You should always use a spatula or clean spoon to remove the emollient from the tub. Following the direction the hairs lie, apply to the affected area in a stroking motion.

    The amounts of emollient you need depends on the condition of your skin. For adults with very dry skin all over their body we recommend using between 500 grams and 1000 grams per week this is a 500 gram tub.

    We hope you found this video useful for more information please follow the link below to download our education leaflet. Thank you for listening.

 

Download our leaflet about using emollients. (PDF 132Kb)

Treating scalp psoriasis

This video demonstrates techniques to treat scalp psoriasis, including how to apply treatments to the scalp and how to remove hard scale.

  • Treating scalp psoriasis – video transcript

    Hello my name is Karina and I'm a dermatology nurse at St John's Institute of Dermatology. In this short video I'm going to talk about scalp psoriasis and some of the techniques you can use to maximise the effectiveness of your prescribed treatments.

    Psoriasis is a common condition that causes inflammation, scaling and thickening of the skin. It can be harder to treat on the scalp because the hair hides it. The most commonly prescribed treatments for psoriasis are designed to reduce the inflammation in the skin and the overproduction of skin cells. These treatments include topical steroids, coal tar formulations and vitamin D derivatives and these come in different formulations designed to use on the scalp.

    Always wash and dry your hands thoroughly before applying any treatments, apply treatment to the scalp section by section and gently massage the treatment into the affected areas. If you have long hair it may be helpful to part the hair to facilitate this and if you have someone at home to help that might make it easier. Be careful not to let the treatment run off the scalp onto the forehead or neck and remember to always wash your hands thoroughly afterwards. These treatments are normally used once a day but follow the instructions of your doctor or nurse.

    If your psoriasis has thick scale on top it can be helpful to soften this to gently remove it before using your prescribed treatments. One way is to apply emulsifying ointment or oil and leave under a shower cap for a few hours or overnight if possible. The emulsifying ointment should be washed out with a medicated shampoo and a flat comb can be used to help manually remove any loose scale avoid picking though as this can make the psoriasis worse. This procedure can be undertaken before applying your prescribed treatment and as frequently as is required.

    We hope you found this video useful, if you'd like further information please click on the link below for our downloadable leaflet. Thank you.

 

Download our leaflet about treating scalp psoriasis (PDF 68Kb).

How to apply occlusive dressings

This video demonstrates how to apply occlusive dressing over topical steroid creams to help your skin condition.

  • How to apply occlusive dressings – video transcript

    Hello my name is Lucy and I am a specialist nurse at St John's Institute of Dermatology. In this video I will demonstrate how to apply occlusive dressing safely and effectively. Please note that this is a general guide and should not replace the directions given to you by your doctor or nurse.

    Occlusive dressings stick to the skin and are used to enhance the effect of some skin creams. The type of dressings we use are called hydrocolloids and there are many different brands available which come in different sizes. By applying the dressing over your treatment this keeps it on the skin and increases its absorption whilst providing a protective layer to prevent any further damage to the skin.

    Occlusive dressings are often used to make steroid creams more effective, however using steroids in this way increases their strength and therefore should only be used under occlusion for a short period of time. Occlusive dressings are generally safe to use, however they should be avoided when the skin is infected as the infection could worsen.

    We recommend using occlusive dressings on the torso, arms and legs. Do not use on the face or areas prone to rubbing such as the groin, under the breasts or arms or between fingers as they will not stay in place.

    Start by ensuring the area of skin is clean and avoid using moisturising creams on the area where you will be applying the dressing as this will make it difficult to stick to the skin. If the area is hairy you may need to trim the hairs. Wash your hands. Check the expiry date of your dressings. Cut the dressing to size if required ensuring a two centimetre border larger than the affected area. Apply a thin layer of steroid or your prescribed treatment to the affected area. Remove paper backing and centre the dressing over the area being treated, then smooth out the edges. Press the dressing gently onto the skin for one minute to help it to stick. On areas such as the elbows knees and feet you may need to cut slits into the dressing to make it easier to put on. We would advise changing the dressing after 24 to 72 hours but please follow the directions given by your healthcare professional.

    To remove the dressing, support the surrounding skin with one hand and gently remove the dressing with the other hand. On removing the dressing you might notice a slight odour which is likely to be the gelling agent in the dressing.

    Some dressings or tapes come ready impregnated with steroid medication. Tapes can be used on small areas of skin or cracked eczema on the hands. Follow the instruction on the packet for further advice on application. Occlusive dressings are an excellent way to make your prescribed treatments more effective.

    We hope you found this video useful, if you would like more detailed information please download our patient information leaflet.

 

 Download our leaflet about how to apply occlusive dressings (PDF 114Kb).

How to apply paste bandages

This video demonstrates how to apply paste bandages to help treat your skin condition.

  • How to apply paste bandages – video transcript

    Hello, my name is Maria and I am a specialist nurse at St John's Institute of Dermatology. In this short video I will be explaining why we use paste bandages and I will show you how to apply them safely. Please note that this is a general guide and should not replace the advice given to you by your doctor or nurse.

    Paste bandages are cotton bandages that are impregnated with medicated pastes which provide relief from itchy skin conditions such as eczema.

    Your doctor or nurse may suggest using paste bandages in addition to other prescribed skin creams such as moisturisers or steroids, as placing a bandage over these treatments can make them work better.

    Paste bandages are non-elastic. The methods of applying the bandages, which I'm about to demonstrate, allow the bandages to expand if there is any limb swelling. Paste bandages can easily stain fabric materials so it is recommended to use a surface that is easy to clean. You would need to have all the following equipment ready before starting. Paste bandages, which are single-use only. Scissors, ideally scissors that have a blunt end. Outer tubular bandage that is measured to cover each limb, this keeps the paste bandage in place and prevents staining to clothing. Emollient, which is pre-poured out, and topical steroids if you have been instructed to use them.

    Before starting, wash your hands. Clean the area to be bandaged by washing with a soap substitute or as per the advice of your doctor or nurse. Pat the area dry. If you have been directed to use topical steroids under the bandages, apply this to the area affected.

    There are two common methods used to apply paste bandages. This method will be used to cover one of the upper limbs starting from the wrists to the shoulder. Start by wrapping the bandage around the front of the wrist and right around the back of the wrist, carefully smoothing the bandage down as you go. The bandage should then be brought back up to the front of the wrist, and once you reach half the width of the first wrap fold the bandage to create a pleat and continue in the opposite direction, wrapping under the arm, across the top and folding to create the pleat. Each pleat will change the direction that the bandage is being applied in. It is important that the folds are created at different places to prevent a single pressure point. Secure the paste bandage in place with a dry tubular bandage. It is important that this fits snug to keep the under layer in place, but is not too tight.

    You may find this method more suitable if the bandages are applied to smaller areas, such as the wrists, ankles or individual fingers and toes. You should start at the base of the toes. Take the bandage around the foot for one and a half turns, then cut the bandage. Continue doing this until you reach the knee joint, ensuring the overlap is half the width of the previous wrap.

    If you find the paste bandages drying out and becoming less comfortable you can apply a thin layer of an emollient on the outside of the paste bandage. To do this, gently roll the tubular bandage away, apply a thin layer of a spreadable emollient such as white soft paraffin in liquid paraffin (sometimes known as 50/50), in gentle downward strokes, then reapply the outer tubular bandage.

    Paste bandages can stay on for 24 to 48 hours and are not to be reused. To remove the bandage, first roll down the outer tubular layer, unravel the paste bandages starting from the top of the limb i.e. the shoulder if applied on the arms, or the knee if applied to the leg. You will notice the pleats begin unfolding. If you find that the bandages have stuck on the skin this should not be forcefully removed. We advise soaking the bandages to loosen them, which makes them easier to remove.

    Thank you for watching. We hope you found this video useful. If you'd like further information please click on the link below for our downloadable information leaflet.

 

Download our leaflet about how to apply paste bandages (PDF 193Kb).

How to apply wet wraps

This video demonstrates how to use wet wrap garments in the treatment of eczema.

  • How to apply wet wraps – video transcript

    Hello, my name is Heather, and I'm a specialist nurse at St John's Institute of Dermatology. In this short video we will explain and demonstrate how to apply wet wraps to a child as a treatment for eczema. Please note that this is a general guide and should not replace the advice given to you by your doctor or nurse.

    Wet wraps are made of elasticated material that are used with moisturising creams and other prescribed treatments to calm the skin during eczema flares. They also form a protective layer over the skin and prevent further damage from scratching. Wraps are most commonly used with emollient creams underneath, although they can be used with topical steroids for a short time.

    You will need the following equipment to wet wrap a large area of skin: two tops, two leggings, emollient cream, clean warm water in a bowl or sink, and something to distract your child such as toys or a book. Start by bathing according to the advice you've been given. After a bath or shower, apply a thick layer of emollient to the skin from head to toe. Apply the emollient in downward strokes in the direction of hair growth.

    While the emollient is absorbing into the skin, prepare the wraps. Put one of the leggings and one of the tops into a bowl of warm water. Once they are fully soaked, remove them and squeeze the garments to remove excess water. The material should feel damp but not be dripping. Make sure that the labels and seams on the garments are worn on the outside of the garment. Roll the sleeves and body sections up. Put the top onto the child by gently stretching the head hole and pulling it over their head. Gradually roll the sleeves and body section down gently. Avoid overstretching the material as it can tear more easily when wet. Then do the same with the leggings. Gather up each leg of the garment and ask the child to step in. Gradually and gently pull each side up until the material is smooth on the legs. Try to do this as quickly as possible so that your child does not get too cold.

    Once the damp top and leggings are on put a dry top and leggings over the top. The garment should be close to the skin but not too tight. You can leave the garments on for up to 24 hours. Most people find that they use wet wraps overnight and remove them in the morning and use them more during flare-ups.

    If you think your child has a skin infection, wet wraps should not be used at the same time as it can make the infection worse. They should also be avoided if the child has a fever or is generally unwell. If steroid creams are applied under wet wraps this can make them stronger, therefore please ensure you carefully follow the advice given by your doctor or specialist nurse. The garments can be washed in the washing machine and reused. The instructions on how to do this come with the garment box.

    To cover a smaller area of eczema on the arm or leg, tubular bandages may be used instead of full garments. There are different sizes of tubular bandage for the size of area you wish to cover. To use a tubular bandage to wrap a smaller area follow the same steps as applying a garment but instead of using a garment, cut two pieces the same size from a roll of tubular bandage. Apply emollient to the skin with a steroid cream if you have been advised to do this by your doctor or nurse. Wet the first tubular bandage in the same way you would wet the garment. Apply this to the area being treated then apply the second dry layer. The tubular bandages are slightly elasticated so should stay in place but if they fall down, an additional elasticated bandage or close fitting clothing may be used to hold it in place.

    We hope you have found this video helpful. If you would like some further written information, please click on the link below to download a leaflet on how to apply wet wraps.

 

 Download our leaflet about how to apply wet wraps (PDF 117Kb).