Product REVIEW A review of Debrisoft in the management of a variety of dermatological conditions Debbie Lorenzelli, Alberto Barea, Clare Morris This product review examines Debrisoft utilising Monofilament Fibre Technology. Debrisoft is known for its ability to remove dry skin and for the removal debris and barriers to healing from acute and chronic wounds during a process known as wound bed preparation. Debrisoft has recently had its clinical indication extended to include dermatological conditions such as eczema and psoriasis. Lorenzelli D, Barea A, Morris C. A review of Debrisoft in the management of a variety of dermatological conditions. Dermatological Nursing 2018. 17(2): 33-38 Skin problems represent a big slice of Product focus – Debrisoft of the skin or wound bed (Figure 2) and NHS activity. Indeed, in 2006, it was Debrisoft utilises Monofilament Fibre will not damage new granulating tissue reported that in England and Wales Technology (Figure 1) in the form of or epithelial cells. around 24% of the population (12.9 a debridement pad and debridement million) seek medical advice about a device or lolly. The pad comprises of 18 Debrisoft has a unique technology skin condition each year, with the most million special monofilament fibres that and mode of action for wounds and common reasons being skin infection have angled tips to reach uneven areas skin, lifting debris, including biofilm, and eczema.1 In the UK, it is estimated that 70% of older people have a skin condition and eczema is one of the most common conditions.2 In more recent publications³ it has been suggested that 23-33% of the population have a skin problem, and in surveys3 around 54% of the UK population experience a skin condition in a given twelve month period. Skin conditions cause physical discomfort, psychological distress and generally are long-term chronic conditions. Skin diseases remain a major cause of disability worldwide.4 Debbie Lorenzelli is a Dermatology Nurse Specialist at St Helens and Knowsley Teaching Hospital NHS Trust. Alberto Barea is Lead Clinical Nurse Specialist at Plastic Surgery and Dermatology, Kingston Hospital NHS Figure 1. Figure 2. Foundation Trust. Clare Morris is Senior Monofilament Fibre TechnologyTM 18 million special monofilament fibres which have angled Clinical Services Manager, L&R Medical UK Ltd. tips to reach uneven areas of the skin or wound bedTM www.bdng.org.uk Dermatological Nursing, 2018, Vol 17, No 2 33 Product REVIEW superficial slough and exudate quickly, After examining clinical evidence, Following the products launch in binding it within the fibres (Figure 2) NICE concluded: “The likely benefits of 2011, it quickly became established for and removing barriers to healing. using the Debrisoft pad on appropriate use in acute and chronic wound care,6 wounds are that they will be fully and in the management of skin conditions It is soft and conformable and gentle debrided more quickly, with fewer nurse associated with chronic venous disease7 on patients. It is also safe and easy to visits needed, compared with other and lymphedema.8 In recent years, use and can also be used by patients for debridement methods. In addition, the Debrisoft has also been used more in the self-care. Debrisoft pad is convenient and easy to field of dermatology. use, and is well tolerated by patients”.5 How to use Debrisoft 34 Dermatological Nursing, 2018, Vol 17, No 2 www.bdng.org.uk Product REVIEW Review of the dermatology related evidence Weindorf and Dissemond10 discuss The authors concluded that whilst Flinton7 describes the use of Debrisoft the challenges of debridement of painful acknowledging limitations of the study, in varicose eczema following 3 years of chronic wounds in dermatological patients they believed that the evidence indicates unsuccessful management associated such as pyoderma gangrenous and that the use of Debrisoft on psoriasis or with high costs. Five Debrisoft treatments epidermolysis bullosa. Debrisoft proved dry, scaly skin would not cause harm and over a two week period resulted in the to be a useful, non-invasive and therefore may, in longer term testing, show benefits. wounds and varicose eczema healing at safe alternative, especially for chronic the end of the two week period (Figures wounds covered in fibrin and slough. A multicenter case series evaluating 3-5). Debrisoft was continued to prevent Debrisoft in the management of the build-up of hyperkeratosis. Girip and McLoughlin11 report in a childhood atopic eczema and psoriasis case study the management of a lady was undertaken.13 Denyer9 reports on the use of with a three year history of venous leg Debrisoft in the management of children ulcer, recurrent cellulitis and chronic The primary aim of this clinical with severe epidermolysis bullosa. eczema that was successfully managed evaluation was to investigate if Debrisoft This condition is extremely challenging, with debridement of the wound and skin would benefit the skin care regime of with wound management often being with Debrisoft in her own home. It was children suffering from atopic eczema painful and time consuming. Denyer important for this patient that a hospital and psoriasis compared with their recommends that Debrisoft is introduced admission was prevented, not only to current regime and if that benefit led to from infancy as it can be difficult to prevent the distress a hospital admission preservation of the epidermal barrier introduce new products later in life. would have caused her, but to prevent the by improving penetration of creams and Denyer states that Debrisoft will hopefully costs associated with admission. emollients. help in early detection of squamous cell carcinoma, as these tumours are often An interim report12 described the The intervention was offered to the concealed beneath crusts and debris. use of Debrisoft in the management of parents and was compared with their psoriasis and dry, scaly skin on two healthy current regime of gauze, flannel and volunteers. The basis of the study was to sponge. examine if it is possible to use Debrisoft in the management of skin conditions such Key results with Debrisoft were that as psoriasis and dry, scaly skin without in all 33 cases the condition was not adverse effect on the skin, and to establish made worse and in 31/33 cases no pain whether there was sufficient basis for a or discomfort was experienced. This more extensive study. was compared with 23/33 cases with their previous regime causing pain and Two volunteer subjects participated 22/33 cases where the condition was in this short study. Measurements were made worse due to increased itching and made using different measurement bleeding. In 31/33 cases dry skin came techniques including the Tissue Viability away more easily with the Debrisoft than Imager, Visioscan, Corneometer, with standard practice. There were many Tewameter, Mexameter, Colorimeter and positive comments received from parents, Skin Thermometer. Following baseline children and clinicians during the study. measurements Debrisoft was moistened and applied using a wiping motion to Key results with Debrisoft affected areas of skin. Twenty minutes after were that in all 33 cases the treatment a further set of measurements condition was not made were made. worse and in 31/33 cases In most cases the erythema no pain or discomfort was measurements were increased, which experienced may indicate an increased blood flow to the area. This is most likely due to In all parameters Debrisoft led to the massaging effect of Debrisoft. The an improved skin care regime when hydration figures were mostly increased. compared to their usual practice. Parents If the Debrisoft was causing damage to found it easier to apply creams and the skin the hydration figures would be emollients, and the affected area felt decreased. Initial TEWL results would smoother. It was pain and trauma free, and indicate that the monofilament pad does they would continue to use the product not impair the barrier function of the skin. as part of the daily management of their Figures 3,4 and 5. child’s skin condition. www.bdng.org.uk Dermatological Nursing, 2018, Vol 17, No 2 35 Product REVIEW In 2014, the first national guidance mainstay of treatment in these situations confidence.25 Debrisoft is outlined as a document was produced,14 outlining the are based on four main components; wound and skin debridement technique management of hyperkeratosis of the skin care, exercise, lymphatic drainage which requires minimal training and being lower limb. This was followed in 2015 and external compression and support. convenient and easy to use in patient’s by a UK consensus document.15 Both Greaves20 and Harding21 both report on home, GP surgery or an inpatient setting.5 documents acknowledge the role of the devastating psychological and social Debrisoft in the management of lower impact of these conditions and how the Debrisoft is outlined limb hyperkeratosis and how it can be management of the skin changes with as a wound and skin used by all health care professionals Debrisoft along with management of debridement technique working in hospital or community and by the other mainstay components led to patients and carers. Its ease of use may considerable improvements in quality of which requires minimal encourage patients to take an active role life, organisational cost savings. training in their care and undertake exfoliation of their own hyperkeratosis and dry skin.15 Whiteside and McIntyre22 describe Young26 describes the introduction of how they utilised the role of the band a skin care regimen in an elderly inpatient It is very important that hyperkeratosis 3 health care assistant in providing skin population. The elderly often suffer from is removed in a safe, atraumatic, way as care for lymphoedema patients in a dry skin when in hospital due to the any disruption of the skin integrity, for clinic setting under the direction of the aging process, frequent cleansing and the example by using forceps, increases the lymphoedema specialist.