Skin symptoms in palliative care

Pressure ulcers

Pressure ulcers can be caused by prolonged bedrest and immobility, putting the skin under pressure for too long. Having insufficient nutrition also increases the risk of developing pressure ulcers. If pressure is applied to healthy skin, the skin quickly returns to its usual colour once the pressure is removed. A red area that doesn’t go away after 20 minutes from removing the pressure is a sign of pressure damage. Typical sites of pressure ulcers include the sacrum, hips, heels, elbows, and ears. Fissures on feet may be caused by ill-fitting footwear subjecting the skin to constant chafing.

Wounds caused by tumours

Cancerous tumours on the skin may break through the surface of the skin and create wounds. Skin metastases most commonly appear in breast cancer (around the chest) and melanoma, but even other forms of cancer can spread to the skin.

Skin infections

Reduced general condition and poor nutrition lead to lowered skin immunity, making the skin less capable of protecting against various bacteria, fungi, and viruses. In addition, oedema (swelling) makes the skin more susceptible to infections.

Cancer treatments weaken the immune system and therefore increase the risk of infections. In addition, side effects of cancer treatments may include rashes. New targeted therapy drugs are particularly associated with various adverse effects related to the skin, such as infections in the skin around the nails, dry and scaly skin, sores, and hair loss . If you develop skin problems during cancer treatment, make sure to let the attending physician or nurse know.

Itching

The cause of itching may be local, such as dry skin, a rash, or sweating. The cause can also be internal: for example, cancer may cause itching by affecting the metabolism. A bile duct obstruction causes bile to accumulate in the body, leading to jaundice (yellow skin) and itching. Itching can also be caused by advanced kidney failure. In addition, itching can be related to nerve damage: for example, after having shingles, itching may persist in the area where the blisters were. Even though itching is not a life-threatening symptom, it can be extremely irritating, and if left untreated, it may have a highly negative impact on quality of life by causing further problems such as irritability and trouble sleeping.

Sweating

Potential causes of sweating include fever, symptoms of the menopause, long-term illness, and medication. For example, drugs used in cancer treatment include ones with hormonal effects; these may cause menopause-like symptoms, such as sweating and hot flashes.

When treating skin problems, the aim is to always address the root cause and origin, make a plan for the appropriate local treatment, and relieve any associated symptoms, such as pain.

Treatment for dry skin is founded on applying moisturiser (see “Self-management”).

Pressure ulcers

When treating pressure ulcers, prevention is key, as most pressure ulcers can be prevented. It’s important to reduce pressure on the skin. Making sure to change the patient’s position every couple of hours is essential. In addition, special mattresses and cushions can be used to reduce pressure on the skin. The care team assesses the stage of the pressure ulcer and makes a plan for the appropriate local treatment. Sometimes the ulcer needs to be cleaned surgically by removing dead tissue from the wound. If the ulcer is painful, good pain management is a part of the treatment.

Wounds caused by tumours

Wounds caused by cancerous tumours can be prevented and treated with radiation therapy. When treating wounds, it’s important to keep the wound clean and apply appropriate local treatment according to instructions provided by the care team.

If a cancerous skin tumour is bleeding, radiation therapy may be used to control the bleeding. Other ways to reduce bleeding include local treatments, such as dressings (with haemostatic agents, if needed) and ice packs.

If the wound has a bad odour, products that can be used to absorb or conceal the odour in the room include cat litter, charcoal, incense, and various aromatic fragrances. Antimicrobial dressings reduce the odour. In addition, aromatic or antibiotic substances can be applied to the dressings.

If the wound is exuding, foam dressings can be applied to reduce the fluid coming from the wound, also known as exudate.

Skin infections

If possible, the treatment of skin infections begins with taking a culture sample and determining the cause of the infection. Infections can be caused by either bacteria, viruses, or fungi. If needed, the attending physician may prescribe a course of antibiotics; however, treatment with antibiotics isn’t always necessary.

Itching

Itching is managed both with locally applied moisturiser creams and emollients and, if needed, with cortisone creams. For a cooling effect that may relieve itching, menthol can be added to moisturiser creams. When treating itching, the aim is to address the cause – for example, in the case of bile duct obstruction, the aim is to unblock the bile duct. Itching can also be relieved with medication. While regular non-drowsy antihistamines are not very effective, other types of medication can be helpful.

Sweating

If sweating interferes with your life, let the attending physician know. Treatment of excessive sweating aims to identify and target the cause. In addition, there are medications that help reduce sweating. For example, sweating associated with the menopause may be reduced with hormonal medications, but non-hormonal medications are available as well. Sweating caused by a fever can be treated with medications that lower the fever, such as paracetamol or nonsteroidal anti-inflammatory drugs (NSAIDs). However, sweating is often associated with fluctuating rather than steady fever, in which case using medication to lower the fever might actually increase the sweating instead of reducing it.

In palliative care, the primary focus of skin care is on prevention and self-management.

When it comes to skin care, good self-management includes regular examinations. Making sure to moisturise the skin thoroughly, avoiding excessive washing with soap, and using moisturiser instead of soap are ways to protect the skin from dryness and promote the wellbeing of the skin. A short shower doesn’t dry the skin as much as soaking in the water for a long time.

Chafing and wounds can be prevented by choosing appropriate clothing and footwear. Regular visits to a foot care practitioner are recommended, especially for patients with diabetes.

Pressure ulcers

In addition to keeping the skin in good condition, prevention of pressure ulcers involves making sure to change the patient’s position regularly and ensuring that the patient is seated or lying on an appropriate surface.

Itching

Itching leads to an urge to scratch. That’s why it’s recommended to keep the nails short and wear cotton gloves at night, if needed. Sweating should be avoided, along with clothing that itches or irritates the skin. When washing itchy skin, it’s recommended to use lotion and apply fragrance-free moisturiser generously. Moisturiser can be stored in the refrigerator, as applying cream that’s cool may also relieve the itching.

Sweating

Ways to try and reduce sweating include choosing appropriate clothing, keeping the room cool, and cutting down on stimulants that increase sweating, such as coffee, tea, or potent spices.