The smoothness and suppleness of the skin depend largely on the presence of adequate amounts of water in the outer epidermal stratum corneum cells. Water is furnished to the epidermis by plasma that percolates throughout the underlying papillary dermis. This moisture diffuses through the epidermis and is eventually lost to the atmosphere in the form of “insensible perspiration.” The amount of moisture retained in the upper epidermis and stratum corneum is mostly dependent on the presence of a thin lipid layer covering the surface of the skin. These lipids, derived both from sebum and from keratinocytes, restrict evaporative water loss.The two major factors that adversely influence skin lubrication are the presence of epithelial disruption (chapping and eczematous disease) and the exposure to solvents that remove the external lipid layer. Conversely, improvement of lubrication requires treatment of any associated skin disease and reestablishment of the surface lipid layer. Reestablishment of the lipid layer depends on both reduction of the loss of naturally produced lipid and application of additional lipid. Lipid loss can be decreased if the number of exposures to soap and water can be reduced. For example, dishes can be washed once instead of 3 times daily. 
Soap does not need to be used for each hand washing. The wash-water temperature can be reduced, and drying of wet skin can be carried out by “patting,” rather than rubbing, with a towel. Lipid can be added to the skin by repeated application of creams and ointments throughout the day. It is particularly useful to apply these products while the skin is still wet and the stratum corneum is well hydrated.
Many commercial lubricants are available. Most of these are labeled as hand lotions or hand creams. The lotions are very acceptable but, because they contain relatively little lipid, are generally less effective than hand creams. Eucerin cream is widely used by dermatologists, but many patients find it a little hard to spread and somewhat too greasy. Other suitable products include Keri Creme, Moisturel, Lubriderm, and Neutrogena. Hydrophilic substances (humectants) such as urea and lactic acid may be added to lubricants to enhance their water-holding capacity. Commercial preparations of these products include Aquacare/HP, Carmol, Lacticare, and Lac-hydrin. Although these products are extremely effective, they cannot be used without appreciable stinging when applied to fissured or eroded skin.
Oils added to the bath water are minimally useful for lubrication. Perhaps the best use for these bath oils is the direct application to a wet washcloth, in which form they can be used as soap substitutes. Cetaphil, used in the same manner, is another useful soap substitute.
Tags:Diagnostic and Therapeuti Techniques, eucerin cream, keratinocytes, lipid layer, lubrication, papillary dermis, stratum corneum, upper epidermis wet skin
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