Barrier Creams and Their Role in Skin Protection

Why moisture matters as much as pressure

When families first learn about pressure ulcers, the focus usually lands on movement: turning, repositioning, and the right mattress or cushion. All of that is essential. But there is a quieter culprit that does just as much damage to fragile skin – moisture. Skin that is repeatedly exposed to urine or faeces becomes softened, more alkaline, and far more vulnerable to friction and breakdown. In UK nursing and care settings this is known as incontinence-associated dermatitis, or IAD.

It helps to understand the difference between IAD and pressure damage, because the two often appear together. Moisture damage tends to be diffuse and red, appearing in skin folds, on the buttocks, or under a pad, and the person often describes it as sore or stinging. Pressure damage usually starts over a bony point such as the heel, sacrum or hip. If you are not sure which you are looking at, ask your district nurse rather than guessing – the treatment is different.

What a barrier cream actually does

A barrier cream works by leaving a thin protective layer on the surface of the skin. That layer separates skin from urine, faeces, sweat and wound leakage, and helps to keep the skin's natural slightly acidic pH in balance. Some products rely on zinc oxide, others on dimethicone or petrolatum-type ingredients, and some combine several.

What barrier creams do not do is prevent pressure ulcers on their own. They are one part of a wider plan that includes regular repositioning, checking skin daily, good nutrition and hydration, and appropriate equipment. Think of them as protection against moisture damage, which in turn reduces one of the key risk factors for pressure damage.

Creams, ointments, films and pastes

• Creams are lighter and easy to spread, and suit occasional soiling or mild redness. They may need reapplying more often.
• Ointments are thicker and more water-repellent, so they last longer when someone is being changed frequently. They can feel greasy and may affect how well dressings or pads adhere.
• Barrier films go on as a liquid and dry to a thin, invisible layer. They are useful when soiling is very frequent, because they are not wiped away as easily. Let them dry completely before applying anything else. Ask for an alcohol-free version if skin is broken, as alcohol-based films can sting badly.
• Zinc oxide pastes give strong protection and are often used for severe moisture damage. Apply them thinly – if you cannot see the skin at all, it is too thick. Removing them needs a gentle oil-based cleanser rather than scrubbing.

Before using anything new, patch-test a small area and wait 24 hours. Your pharmacist, district nurse or continence adviser can advise on suitable products, and many are available on prescription.

Cleanse, dry, protect – in that order

Barrier cream complements gentle cleansing; it never replaces it. Applying cream over skin that still has urine or faeces on it simply traps irritants against the skin.

• Cleanse with warm water and a pH-balanced, soap-free cleanser. Ordinary soap and flannels strip the skin and make things worse.
• Pat dry gently. Never rub – fragile skin tears easily.
• Look at the skin every time you change a pad or check a continent relative. Redness, blistering or broken areas should be recorded and reported.
• Apply a thin, even layer of barrier cream, then allow a moment before putting a pad or clothing back in place.
• Reapply after each episode of soiling, and avoid layering fresh cream over old, dried product.

Do not massage reddened bony prominences. Massage over a pressure area can cause further damage to tissue that is already struggling.

Fitting skin protection into the bigger picture

Barrier cream sits alongside the other basics of good pressure care: repositioning at the interval your nurse has advised, using the right mattress or cushion, keeping sheets free of creases and crumbs, encouraging drinks and protein-rich food, and checking heels, the base of the spine and elbows regularly. If someone is on a prescribed plan, follow it and write down what you see, as patterns help nurses adjust care.

Keep an eye out for products that sting, cause a rash, or seem to make skin more moist rather than less – some creams trap too much moisture under a pad. A change of product is usually simple to arrange.

When to ask for help

Contact your GP or district nurse if you notice broken or blistered skin, a spreading rash, skin that is purple, dark or black, a wound that smells unpleasant, or a sudden increase in pain. Fever, confusion or rapidly worsening skin in someone who is unwell needs urgent advice – call 111 or seek same-day help. Ask about a referral to the continence service or a tissue viability nurse if soiling is frequent or damage keeps returning. You are not expected to manage this alone, and asking early is a sign of good care, not a failure.