Intense Pruritis Following Extensive Skin Grafting

This poster will describe the successful use of a long-acting, once-a-day moisturizer in reducing pruritis in a 41 year old female who sustained second and third degree burns over 95% of her body at age five.  Having survived this horrible situation, she was left with hypertrophic scar tissue and skin grafts covering her entire torso, both arms circumferentially and her neck. The extent of grafted skin in this compelling and unique case caused severe life-altering pruritis that led to scratching which resulted in non-healing ulcerations.

In normal skin, sebaceous glands are located in the dermis and secrete essential oils that lubricate the skin. The sebaceous glands are absent in a partial thickness skin grafted area, leading to dryness and pruritis. The literature providing evidence-based interventions for the care of skin grafts after the acute care period is sparse.

The patient was referred to a nurse-run outpatient wound clinic for treatment of the non-healing ulcerations.  Interventions were aimed at the pruritis – the root cause of the ulcerations. The patient was given a tube of a long-acting, once-a-day skin moisturizer and instructed to apply it liberally twice daily.  The care plan also included:  a multivitamin daily, showering with a moisturizing gel or foam, increased protein intake and fingernail debridement.

The patient returned to the clinic in one week with reports of no pruritis, no scratching, sleeping through the night and increased range of motion in both of her upper extremities. The ulcerations on her arms and torso were healing and she had no new ulcerations. These outcomes have been sustained for over 2 months with continued adherence to the care plan. This case provides a framework to establish a standardized skin care approach with other patients after extensive partial thickness skin grafting.