Open AccessCase Report

A Daily Cleansing–Moisturizing Routine for Maintaining Skin Integrity in Aged-Care Residents: A Case Report

Dalibor Mijaljica

^1,*

Joshua P. Townley

¹,

Fabrizio Spada

Maria Nguyen

²,

Yenny Cheung

²,

Wendy Chow

²,

Sandra Brown

¹,

Sharon Meere

¹ and

Mikayla Lai

^1,*

Department of Scientific Affairs, Ego Pharmaceuticals Pty Ltd., 21–31 Malcolm Road, Braeside, VIC 3195, Australia

OLC Care, Rocky Point Residence, 151–157 Rocky Point Road, Beverley Park, NSW 2217, Australia

Authors to whom correspondence should be addressed.

Dermato 2025, 5(1), 5; https://doi.org/10.3390/dermato5010005

Submission received: 9 October 2024 / Revised: 17 February 2025 / Accepted: 4 March 2025 / Published: 6 March 2025

(This article belongs to the Special Issue What Is Your Diagnosis?—Case Report Collection)

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Abstract

Background and Objective: Age-related skin changes affect the skin’s structural and functional integrity and reduce the ability of the skin to perform its key barrier functions. Skin breakdown associated with dryness and itch becomes very common and older individuals are at an increasing risk. We aimed to evaluate a daily cleansing–moisturizing routine and conduct a skin assessment for the presence of five underlying skin integrity parameters among aged-care residents. Methods: This small, 6-week evaluation study included four participants over 80 years of age, all of whom were residents at OLC Care, Rocky Point Residence, Beverley Park, NSW, Australia. Skin assessment for the presence of five underlying clinical parameters including itchy skin, dry skin, bruising, skin tears and pressure injuries was conducted for all four participants at baseline and during the evaluation period. Clinical notes were also taken at baseline, during the evaluation and at the post-evaluation. Furthermore, clinical photographs were taken at baseline and after 2–3 weeks of the cleansing–moisturizing routine. Results: Of the four aged-care residents who participated in this evaluation study, all four showed overall improvement in the appearance of the skin with a reduction in severity of the five underlying skin integrity parameters, including itchy skin, dry skin, bruising, skin tears and pressure injuries, where present. Discussion and Conclusions: This case study has produced basic evidence to support a daily cleansing–moisturizing routine (comprising QV cleansers and moisturizers, and/or a protective barrier cream) as it provides moisturizing and protective benefits to the delicate and fragile skin of aged-care residents, where the aim is to reduce skin integrity associated issues.

Keywords:

cleansing; dry skin; itchy skin; moisturizing; pressure injuries; skin integrity; skin tears

1. Introduction

One of the primary functions of healthy, intact skin is to act as a protective and defensive barrier [1,2,3] from daily wear and tear [4], and against external insults such as foreign pathogens, ultraviolet (UV) radiation, and chemical and allergenic irritants [5]. At its optimum, intact skin is strong, resilient and has a remarkable capacity to preserve its structural and functional barrier integrity [1,6] as well as having an ability to rapidly repair and restore the barrier following the damage [4]. As people age, the skin experiences many structural and functional changes [7]. It becomes thinner, drier and more fragile, and is usually associated with impaired barrier integrity and becomes unable to maintain adequate hydration [8]. Cooperatively, these age-related changes can make skin more susceptible to injury, trauma and infections [8,9]. Therefore, with age, it becomes more critical to implement a daily cleansing–moisturizing routine in order to promote general skin health and reduce the risk of skin damage [10].

Daily skin cleansing and the application of moisturizers can help to maintain skin integrity [9,11]. Harsh skin cleansers and alkaline soaps should be avoided because of the dehydrating and pH-disturbing effect they can have on skin [12,13]. pH-balanced soap alternatives (also known as syndets) reflecting the pH range of the acid mantle (pH 4.0–6.0) of healthy skin in the form of milder in nature, gentler, skin-friendly cleansers should be used instead [12]. Daily use of moisturizers can help ensure a moisture balance in the skin by not just restoring any lost moisture, but also preventing further moisture loss and helping to maintain the skin’s elasticity, flexibility and barrier function [9]. Furthermore, daily application of protective barrier creams can help maintain the skin’s barrier, providing protection against irritants (e.g., particularly where the skin is regularly exposed to irritant fluids, such as wound exudate, urine or feces from incontinence) and preventing the skin from drying out [11,14].

2. Materials and Methods

2.1. Study Design, and Aged-Care Residents’ Key Characteristics and Recruitment

In order to improve overall skin integrity in aged-care residents/older adults, Ego Pharmaceuticals partnered with OLC Care, Rocky Point Residence to evaluate a daily cleansing–moisturizing routine. This 6-week evaluation study was conducted between 15 September 2023 and 27 October 2023 and included four (n = 4) aged-care residents (R1–R4) at OLC Care, Rocky Point Residence, Beverley Park, NSW, Australia. Three of these aged-care residents were women (R1, R3 and R4) aged 96, 87 and 85, respectively, and one man (R2), aged 89 (Figure 1).

The four aged-care residents (R1–R4) residing at OLC Care Rocky Point Residence were chosen for this case study as they had long-term skin integrity associated issues including itchy skin, dry skin, bruising, skin tears and pressure injuries. These four residents were not responding to the standard skincare protocol used at this site and they were inclined to try a new skincare routine that could help them with their skin integrity associated issues. The participants were closely monitored by staff, had the opportunity to withdraw at any time, and were not required to halt any prescribed medications or treatments in order to take part. The QV range and Silic 15 Protective Barrier Cream were initiated (Section 2.2.) and the respective outcomes were documented (Section 2.3.). These are well-established, low risk (cosmetic) products with a very good safety profile. The four aged-care residents (R1–R4) and their relatives were informed of the use of the QV range and Silic 15 Protective Barrier Cream to support the skin integrity issues experienced.

2.2. Staff Education

The two Clinical Care Coordinators (CCCs) with extensive clinical expertise were involved in the evaluation study. Both CCCs were educated by an Ego Pharmaceuticals representative in two separate educational sessions covering a range of QV cleansers and moisturizers, and/or Silic 15 Protective Barrier Cream. These educational sessions also covered CCCs’ responsibilities in the implementation and evaluation process. The first educational session took place when commencing the use of the QV range cleansers (QV Gentle Wash or QV Intensive Moisturizing Cleanser) and moisturizers (QV Skin Lotion, QV Cream or QV Intensive Body Moisturizer) and Silic 15 Protective Barrier Cream. The aim of the first session was to inform the two CCCs about the clinical rationale behind the product selection as well as to discuss the products’ skin benefits. Also, the two CCCs were provided with the instructions on the application of each product. They were instructed to use 1–2 pumps of the selected cleanser (QV Gentle Wash or QV Intensive Moisturizing Cleanser) and moisturizer (QV Skin Lotion, QV Cream or QV Intensive Body Moisturizer) on the upper and/or lower body. For Silic 15 Protective Barrier Cream, the CCCs were instructed to apply a 10 cent coin sized (approximately 2.5 cm diameter) amount of cream over the affected area with a light touch.

The two CCCs informed aged-care residents of the evaluation study and conducted a baseline skin assessment for each of the aged-care residents taking part in the evaluation study. As the incumbent products used in the skin cleansing–moisturizing routines were not helping the residents (R1–R4) with their skin integrity associated issues, those products were removed from the single rooms that the residents resided in. A specific range of QV cleansers and moisturizers, and/or Silic 15 Protective Barrier Cream were labelled so that they were only used by the aged-care residents included in the evaluation study. The CCCs were instructed to use QV Gentle Wash (for R1, R3 and R4) and QV Intensive Moisturizing Cleanser (for R2) when the resident showered and to moisturize the resident’s affected areas—depending on the skin integrity issue—twice-daily either with QV Cream (for R1, R3 and R4), QV Intensive Body Moisturizer (for R2), QV Skin Lotion (for R3) or Silic 15 Protective Barrier Cream (for R1, R3 and R4) over a period of 6 weeks.

2.3. Data Collection and Analysis

As per the Care Plan and Wound Management Program routine practice at OLC Care Rocky Point Residence and the skincare routine implemented in the evaluation study, any data collected and photos taken, corresponding to each resident (R1–R4), were stored on the standard electronic system used across the residential aged care facility. Skin assessment for the presence of five underlying clinical parameters, including itchy skin, dry skin, bruising, skin tears and pressure injuries, was conducted by the CCCs for all four participants at baseline (Figure 1) and during the evaluation period (Figure 2). Furthermore, the CCCs were responsible for taking clinical photographs (Figure 2) of the affected body regions at the start of the evaluation period and during the evaluation period, usually 2–3 weeks into the cleansing–moisturizing routine.

3. Results

Of the four aged-care residents (R1–R4) who participated in this 6-week evaluation study, all four showed overall improvement in the appearance of the skin, with a reduction in the severity of the underlying skin integrity parameters, including itchy skin, dry skin, bruising, skin tears, pressure injuries and incontinence associated dermatitis (IAD), where present.

3.1. Resident 1 (R1): Skin Integrity Clinical Assessment and Clinical Photographs

Resident 1 (R1) presented with skin tears and bruising on the lower limbs (Figure 1). Itchy skin and pressure injuries were not identified at baseline; therefore, these skin integrity parameters were not assessed (Figure 2). After 2 weeks, the use of QV Gentle Wash, QV Cream and Silic 15 Protective Barrier Cream (Figure 1) helped to reduce dry skin and bruising, and the skin tear had healed (Figure 2—clinical photographs). Resident 1 continued to experience mechanical skin tears but those were managed with the same cleansing–moisturizing routine due to its success during the evaluation period.

3.2. Resident 2 (R2): Skin Integrity Clinical Assessment and Clinical Photographs

Resident 2 (R2) presented with itchy red skin on the back and dry scaly skin on the top of the foot (Figure 1). Bruising, skin tears and pressure injuries were not identified at baseline; therefore, these skin integrity parameters were not assessed (Figure 2). After 3 weeks, the use of QV Intensive Moisturizing Cleanser and QV Intensive Body Moisturizer (Figure 1) led to an improvement in the appearance of the skin on the back—there was no visible skin redness (Figure 2—clinical photographs) and the resident did not complain of itchiness. Furthermore, there was a significant improvement in the appearance of the skin on the top of the foot (after 7 weeks)—visibly diminished dryness and scaliness (Figure 2—clinical photographs).

3.3. Resident 3 (R3): Skin Integrity Clinical Assessment and Clinical Photographs

Resident 3 (R3) presented with a pressure injury on the sacrum with extensive bruising and incontinence associated dermatitis (IAD). Widespread bruising was also present on the upper and lower limbs (Figure 1). Itchy dry skin and skin tears were not identified at baseline; therefore, these skin integrity parameters were not assessed (Figure 2). After 3 weeks, the use of QV Gentle Wash and Silic 15 Protective Barrier Cream led to healing of the sacrum pressure injury; however, there was still skin discoloration due to edema (Figure 2—clinical photographs). Furthermore, after 3 weeks, the use of QV Gentle Wash, QV Skin Lotion and QV Cream resulted in a significant improvement in the appearance of the skin on the upper and lower limbs with a reduction in bruising (Figure 2—clinical photographs).

3.4. Resident 4 (R4): Skin Integrity Clinical Assessment and Clinical Photographs

Resident 4 (R4) presented with a skin tear and pressure injury on the sacrum as well as IAD of the genital area (Figure 1). Itchy skin and bruising were not identified at baseline; therefore, these skin integrity parameters were not assessed (Figure 2). After 3 weeks, the use of QV Gentle Wash and QV Cream led to an overall improvement in skin dryness, including in the genital area (clinical photographs not included). Furthermore, after 3 weeks, the use of QV Gentle Wash and Silic 15 Protective Barrier Cream resulted in healing of the skin tear and pressure injury (Figure 2—clinical photographs).

4. Discussion

A skincare routine comprising gentle, pH-balanced, skin-friendly cleansing (e.g., QV Gentle Wash and/or QV Intensive Moisturizing Cleanser) and twice-daily moisturizing (e.g., QV Skin Lotion, QV Cream, QV Intensive Body Moisturizer and/or Silic 15 Protec-tive Barrier Cream) for four aged-care residents was shown to help improve some key skin integrity associated issues including itchy skin, dry skin, bruising, skin tears, pressure injuries and IAD. This type of skincare routine appears to be a cornerstone to maintaining skin integrity in optimal condition as it has potential in providing moisturizing and protective benefits to the delicate and fragile skin of aged-care residents, where the aim is to reduce skin integrity associated issues. It has been shown that adequate skincare is regarded as a major strategy for maintaining the skin barrier, skin integrity and skin health [15,16]. Keeping skin healthy involves a regimen of cleansing (e.g., gentle and skin-friendly cleansers) and the application of moisturizers (e.g., lotions, creams, barrier creams) [14], ensuring consistency in the prevention and management of skin dryness and damage, and for preventing skin injuries such as skin tears and pressure injuries [17,18]. When cleansing skin that may already be excessively dry, using harsh alkaline soap and water may lead to further drying and disruption to an already impaired skin barrier, particularly in people who need frequent skin cleansing because of incontinence [19]. Thus, it is recommended to use cleansers (e.g., QV Gentle Wash, QV Intensive Moisturizing Cleanser) that contain a combination of gentle surfactants with added moisturizers; are free from unnecessary ingredients such as soap, fragrance, color and common irritants; and have a pH that is slightly acidic to match the skin [20]. Additionally, regular moisturizing (e.g., QV Skin Lotion, QV Cream, QV Intensive Body Moisturizer) should be viewed as a vital part of everyday skincare in individuals with fragile skin. This can help to restore the barrier function of the skin, reduce itching, and increase the level of hydration. For example, twice-daily application of pH-balanced, fragrance-free moisturizers to the extremities of residents in aged-care facilities reduced the skin tear incidence by up to 50% [20,21]. It has been indicated that patients with dry and itchy skin conditions including eczema experience noticeable improvements in their condition when using QV cleansers (e.g., QV Gentle Wash) and QV moisturizers (e.g., QV Cream) [22,23]. Also, a protective barrier cream [24] such as Silic 15 Protective Barrier Cream can help prevent skin from further breakdown, for example, in the appropriate quantity to avoid softening of the skin in individuals where IAD may be an issue [24].

Regarding this study’s key limitations, it is important to indicate that this case study involved only four aged-care participants; however, no two people are alike. All four aged-care residents in this study required an individual assessment to establish an everyday cleansing–moisturizing routine. An additional limitation was that no specific or defined measurement of skin integrity improvements was taken as the CCCs were responsible for reporting changes in the skin integrity based solely on their clinical expertise and judgement, which can be subjective. Nevertheless, this case study provides valuable basic advice on cleansing, moisturizing and protecting the skin—a regimen that is supported by the broad range of products, ensuring that skin integrity related issues can be successfully prevented, or where already present, managed in a timely and appropriate manner.

5. Conclusions

Maintaining good skin integrity is essential for skin health and maintenance, particularly for older adults. Evaluation and implementation of a daily skincare routine comprising cleansing and twice-daily moisturizing in aged-care residents was shown to help improve itchy skin, dry skin, bruising, skin tears and pressure injuries. It has potential in providing moisturizing and protective benefits to the delicate and fragile skin of aged-care residents, where the aim is to reduce skin integrity associated issues.

In future, when investigating prevention and management of skin integrity associated issues in older adults, including dryness and itch, there is a need to agree upon and use a set of core outcome clinical measures and scores. Also, it is recommended to include at least some objective measures of skin barrier function as well, namely skin hydration (specifically Stratum corneum hydration) and transepidermal water loss (TEWL). All these factors will without a doubt support the development of evidence-based consensus recommendations and guidelines for providing cleansing–moisturizing skincare to maintain and promote skin health among older people living in hospital and residential settings.

Author Contributions

Conceptualization, M.N., Y.C., W.C., S.B. and S.M.; investigation, M.N., Y.C. and W.C.; data validation, analysis and interpretation, D.M., J.P.T., M.N., Y.C., W.C., S.B., S.M. and M.L.; writing—original draft preparation, D.M.; writing—review and editing, D.M., J.P.T., F.S., M.N., Y.C., W.C., S.B., S.M. and M.L. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

No ethics approval was required as the evaluation study was conducted under a Continuous Improvement Process (CIP). The institution OLC Care CIP project number is RPR/2023/2033.

Informed Consent Statement

All participants signed written informed consent to participate in the evaluation study and to publish their clinical photographs and case details.

Data Availability Statement

All available data are contained within the article.

Acknowledgments

We would like to thank all four aged-care residents for consenting to the publication of images and data for this report.

Conflicts of Interest

D.M., J.P.T., F.S., S.B., S.M. and M.L. are employed by Ego Pharmaceuticals Pty Ltd., the manufacturer of the QV Skincare including QV Gentle Wash, QV Intensive Moisturizing Cleanser, QV Skin Lotion, QV Cream and QV Intensive Body Moisturizer, and Silic 15 Protective Barrier Cream. The authors have no other conflicts of interest to declare.

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Figure 1. Aged-care residents’ sex, age, baseline skin integrity clinical parameters and cleansing–moisturizing routine (comprising a specific range of QV cleansers and moisturizers, and Silic 15 Protective Barrier Cream) used during the evaluation study.

Figure 2. Skin integrity clinical assessment of five clinical parameters including itchy skin, dry skin, bruising, skin tears and pressure injuries and some examples of clinical photographs taken at baseline and after the use of the cleansing–moisturizing (comprising QV cleansers and moisturizers, and/or Silic 15 Protective Barrier Cream) routine.

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MDPI and ACS Style

Mijaljica, D.; Townley, J.P.; Spada, F.; Nguyen, M.; Cheung, Y.; Chow, W.; Brown, S.; Meere, S.; Lai, M. A Daily Cleansing–Moisturizing Routine for Maintaining Skin Integrity in Aged-Care Residents: A Case Report. Dermato 2025, 5, 5. https://doi.org/10.3390/dermato5010005

AMA Style

Mijaljica D, Townley JP, Spada F, Nguyen M, Cheung Y, Chow W, Brown S, Meere S, Lai M. A Daily Cleansing–Moisturizing Routine for Maintaining Skin Integrity in Aged-Care Residents: A Case Report. Dermato. 2025; 5(1):5. https://doi.org/10.3390/dermato5010005

Chicago/Turabian Style

Mijaljica, Dalibor, Joshua P. Townley, Fabrizio Spada, Maria Nguyen, Yenny Cheung, Wendy Chow, Sandra Brown, Sharon Meere, and Mikayla Lai. 2025. "A Daily Cleansing–Moisturizing Routine for Maintaining Skin Integrity in Aged-Care Residents: A Case Report" Dermato 5, no. 1: 5. https://doi.org/10.3390/dermato5010005

APA Style

Mijaljica, D., Townley, J. P., Spada, F., Nguyen, M., Cheung, Y., Chow, W., Brown, S., Meere, S., & Lai, M. (2025). A Daily Cleansing–Moisturizing Routine for Maintaining Skin Integrity in Aged-Care Residents: A Case Report. Dermato, 5(1), 5. https://doi.org/10.3390/dermato5010005

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