In older people, glycerin-based lotion may reduce skin tears more than usual care. Other urea- or glycerin-based creams or lotions may reduce skin dryness.

Lichterfeld-Kottner A, El Genedy M, Lahmann N, et al. Maintaining skin integrity in the aged: A systematic review. Int J Nurs Stud. 2020 Mar;103:103509.

Review question

In older people, do non-drug treatments applied to the surface of the skin (topical treatments) improve or maintain skin health?

Background

Older people often have adverse skin conditions, such as dryness, thinning and tearing, and inflammation and itching. Some skin care strategies may help keep your skin healthy and reduce your risk for getting adverse skin conditions. This review looks at how well non-drug, topical treatments work for maintaining or improving skin health.

How the review was done

The researchers did a systematic review of studies available up to October 2018. They found 67 studies that included more than 8,394 people (average age, 52 to 90 years). About half of the studies were randomized controlled trials.

The key features of the studies were:

• people were 50 years of age or older and had skin with signs of aging;
• most studies looked at treatments to prevent or treat dry skin, improve the skin barrier, or prevent skin tears;
• treatments included washing or bathing procedures (cleansing strategies) or use of creams, lotions, or emollients that you apply and leave on your skin (leave-on products); and
• most treatments were given for 2 to 6 weeks (for as little as 1 day to as many as 9 months).

Studies of drugs or anti-aging treatments to improve the look of sun-damaged skin and those mostly including people with skin diseases (e.g., rosacea or atopic dermatitis) were excluded.

Studies that looked at treatments to prevent incontinence-related dermatitis or pressure ulcers are not reported here.

What the researchers found

Based on small randomized controlled trials of leave-on creams, lotions, or emollients,

• urea-based products reduced skin dryness and improved skin hydration more than placebo;
• urea-based products reduced skin dryness and peeling, but not skin itch, more than glycerin-based products;
• glycerin-based products reduced skin dryness and peeling and improved skin hydration more than placebo;
• glycerin-based products reduced skin tears more than usual care;
• urea, glycerin, and petrolatum products healed cracked skin on the heels of people with diabetes more than placebo at 2 weeks, but not at 4 weeks; and
• plant-based products reduced skin dryness, scratch marks, itch, or peeling, and improved skin hydration more than no treatment.

Based on small randomized controlled trials of cleansing strategies:

• washing with disposable wash gloves improved skin hydration more than usual washing methods; and
• bathing in whirlpool or ultrasound tubs, with or without specialized soap, did not improve skin condition more than bathing in still water with standard soap.

Conclusion

In older people, glycerin-based leave-on products may reduce skin tears more than usual care. Other urea- or glycerin-based leave-on products may reduce skin dryness more than placebo, no treatment, or usual care.

Topical, non-drug treatments for skin care in older people*

*Based on results of randomized controlled trials.