 While proper nutrition is the best way to ensure good skin health, proper moisturization is vital in order to optimize high risk skin.
My personal philosophy is that "any cream is better than no cream". Sometimes in my practice I recommend a specific cream to my patients only to find that even though they purchased it, it was expensive and they didn't really want to use too much of it. So it sat on their nightstand! In general clinical practice I just encourage my patients to get whatever creams they like as long as they use it every single day. But in dealing with patients at high risk of skin breakdown and ulceration, I definitely have my favorites and more or less insist that they use them daily.
Let's look at the classifications of ingredients in moisturizers and see what that actually do!!
Humectants
When choosing a moisturizer for high risk skin, I look for a number of factors. I want the product to be pH balanced and contain powerful humectants, I'm sure you've heard the word "humectant". But let's look at the impact of this category of ingredient.
Attracting water from the dermis
into the epidermis,
increasing the water content in the epidermis;
When humidity is higher than 70 percent, humectants can also
attract water from the atmosphere into the epidermis;
Increasing the pliability and flexibility of the skin,
preventing it from cracking;
Promoting consistent desquamation
(shedding of the outer layer of skin).
Some examples of Humectants are: Ammonium Lactate, Glyerin, Sorbitol,
Hylauronic acid.
Emollients
Emollients are ingredients that remain in the stratum
corneum to act as lubricants. They help maintain the soft, smooth,
and pliable appearance of the skin. Some of the more common emollients include methicone, lanolin, isopropyl palmitate and glyceryl stearates.
Occlusives
Occlusives increase the water content of the skin by slowing the
evaporation of water from the surface of the skin. These ingredients are
often greasy and are most effective when applied to damp skin. Some examples are Propylene glycol, caprylic triglyceride, parffin and mineral oil.
There are many other ingredients added to all products. They vary in purpose from stabilizing the mixture, preventing separation of ingredients, and adding color and fragrance. These are often the ingredients that cause problems. Most negative reaction to moisturizers come from these additives, not the basic ingredients. Therefore, any product you consider using should have been tested to make sure that it is: · Non-Cytotoxic
· Non-Sensitizing
· Non-Allergenic
· Non-Irritating
My Choices
Shown below are three of the products that I use most often. I have no financial ties to any of the manufacturers so I feel free to give you my recommendations here.Both the 3M "Cavilon Foot & Dry Skin Cream" and the Medline company's "Remedy Skin Repair Cream" are excellent! They both have a massive amount of testing behind them. And they have been shown in clinical trials to have what I consider to be amazing results with damaged skin. I have used them both for many years on all of my high risk patients. I have had special success with my lymphedema patients. Good skin care is critical in preventing episodes of cellulitis in those patients. Each of those two product lines have slightly different ingredient mixes and you should get more information from your local 3M and Medline representatives. Then you will be able to make your own decision as to which cream to use for which specific clinical presentation. The other cream that is shown below is a generic. The active ingredient is urea. It is over-the-counter in both 20% urea and 40% urea. I find urea a far superior product to other ex-foliants such as AmLactin. Am-Lactin relies on lactic acid or a combination of similar ingredients. I have never found that to be nearly as effective for dry cracked skin as the urea compounds. Especially for problems like those deep heel fissures. I will sand (debride) the calluses/fissures initially. I will then have the patient use the urea cream daily on the area. It is a powerful ex-foliant that will dramatically reduce the buildup of the hyperkeratotic skin. Any generic cream with the 20% urea is fine. Move up to the 40% if you find the 20% is not strong enough to maintain good condition of the heels.   Urea 20% or 40%. (OTC)
 | 3M - "Cavilon" Medline - "Remedy" The important thing is to have your patients use the cream! They need to moisturize their skin daily! The best time is always after a bath or shower since the occlusive ingredients in the cream will hold some of that moisture in and allow it to penetrate. But if the most reliable time for them to use the cream is at bedtime... that's great. As long as they use it! | 
