“Paint the back”: A simple tool for geriatric patients to self-apply topical medications on their back

Problem

Pruritus is a common, disabling problem in geriatric patients with profound impact on their quality of life. Xerotic and neurogenic itch are the common variants, frequently affecting the trunk.^1,2 Dermatologists often prescribe moisturizers and topical corticosteroids as adjuvant therapy, however treatment compliance remains limited as most elderly patients have physical inabilities in reaching the skin of their dorsal trunk. This situation is worsened in patients living alone (more pertinent recently due to Covid-19 pandemic).³

Solution

We describe a simple method for applying topical formulations on the back by using a foam paint roller [Figure 1 and video 1]. It is a low-cost, widely available and washable tool which may be used for applying topical products in hard-to-reach areas. Furthermore, commercially available extensors can be adapted to the foam paint roller handle to reach inaccessible areas e.g., central portion of back, if necessary.

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Figure 1a:

Hard-to-reach central area of the back

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Figure 1b:

Preparing foam paint roller with an illustrative topical medication

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Figure 1c:

Product application

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Figure 1d:

Good coverage of the back

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Our strategy is safe to apply products, such as emollients, in liberal quantities. However, cautious use is recommended for topical application of certain medications over large surface areas, to avoid risk of systemic toxicity. Thus, one must strictly adhere to the maximum permissible quantity of each product. The proposed technique can assist patients, particularly the elderly, to apply adequate amount of topical medications over restricted areas, to ensure a favorable treatment outcome.