Skin care 101
PREVENTION VERSUS TREATMENT
The mix of preventative measures for an elderly patient is specific to each individual; for example, when a person has limited mobility, the major prevention tactic may be to constantly “turn” the patient to ensure pressure redistribution on high risk skin areas, which can prevent pressure ulcers from developing. A patient with extremely dry, flaky skin may need to moisturize the skin with an appropriate product to improve the skin integrity and avoid a range of medical skin problems in the future.
The good news about prevention tactics for skin care in the elderly is that for the most part they are based on common sense, are usually non invasive and require simple vigilance and consistent maintenance.
It is essential to understand the issues of skin care, together with the risk factors and prevention techniques. An awareness of the theory behind your actions often provides that extra motivation to avoid complications in the future.
The following chart reviews the benefits of preventative skin care actions:
| Prevention Method | Treatment Method |
|---|---|
| Little effort needed. | Demanding for both patient and caregiver. |
| Patient comfort assured. | Possible patient stress, discomfort and pain. |
| Patient in control. | Patient dependent upon medical staff. |
| Not expensive. | Costly due to medications, dressings, laundry, medical staff, etc. |
| Medical staff less involved— perhaps in advisory capacity. | Medical staff actively involved. |
| No presciptions necessary. | Prescibed medications sometimes needed. |
| Safe procedures. | Risk of complications. |
| Reduces hospital stay. | Can increase time of hospitalization. |
| Post hospitalization seldom required. | Continued post hospitalization services, medical appointments necessary. |
| No recurrence possible. | Recurrence possible. |
ANATOMY OF THE SKIN
The skin acts as a tough, self repairing, flexible covering without which we would fall apart. It protects us from the harmful rays of sunlight and any physical injury. If we get too hot, the skin enables sweating; our blood vessels dilate, changing our skin colour to red, and this has the regulatory effect of cooling us down. The skin also keeps water out and equally important, keeps our body fluids inside us.
Epidermis
The skin has two distinct layers, the epidermis and the dermis. The epidermis is the layer nearest the surface and is about as thick as a piece of writing paper. There are no blood vessels or nerves in it, so if a pin is pushed sideways through this outer layer of skin, it will not bleed or hurt.
The cells in the deeper layer part of the epidermis (keratinocytes) divide and move outwards so that there is a continuous movement of cells towards the surface. This movement normally takes about 28 days, at which point these skin cells die and flatten out to become part of the outer, horny layer (also called strateum corneum). This outer layer is thin in most areas, but thicker – up to 6 mm – on the palms of the hands or the soles of the feet.
Another type of cell in the epidermis, called a melanocyte, also reproduces; it is this cell that provides the pigment to the skin.
The epidermis also contains hair follicles and sweat glands (also called eccrine glands)
The dead cells from the stratum corneum are continuously shed from the surface, but in such small pieces that the skin does not normally look scaly.
There are also cells in the epidermis that provide an immunity defense against bacteria and other outside elements. These are called langerhans cells.
Dermis
The dermis is the layer that lies under the epidermis and gives it support. It is made of fibers which are interwoven to give the skin its strength (collagen fibers) and elasticity (elastin fibers). In the elderly, the skin loses some of this elasticity and begins to sag and wrinkle. Any deep damage to the dermis disturbs the collagen and elastin fibers and will leave a scar; in contrast, superficial damage to the epidermis heals quickly and without leaving any trace.
Running through the dermis are blood and lymph vessels and nerves; therefore the dermis hurts and bleeds if it is cut. However, it is the dermis that provides nutrition for the epidermis.
Although hairs grow out through holes in the epidermis, the hair follicles (roots) where they are formed lie deep in the dermis. An individual follicle goes through alternating phases of growth and rest, but not in time with its neighbours.
The scalp contains at least 100,000 hairs, each of which will grow for up to five years before being shed. A normal scalp can lose up to 100 hairs a day as a result of this growth/rest cycle.
Opening into the hair follicles are sebaceous (grease) glands which produce oil which lubricates and waterproofs the skin and is mildly antiseptic.
Sweat glands
There are two types of sweat glands:
a) Eccrine glands
There are 2-3 million eccrine sweat glands which produce a watery sweat, creating as much as two to three litres a day in hot climates. This evaporation helps cool us down. It also helps with grip because it is difficult to grip with dry hands. Too much sweat, of course, can be a hindrance, but a little is necessary.
b) Apocrine glands
This type of sweat gland is most numerous in the armpits and in the groin. Skin bacteria act on their secretions to cause body odour.
FUNCTIONS OF THE SKIN
Barrier
The skin acts as a passive barrier, protecting the body from the environment, and preventing damage from water, chemicals, bacteria, irradiation and direct injury from trauma. It also acts as a selective “dynamic” barrier to salts and heat.
Regulates temperature
By way of its sensory components which communicate to the sweat glands, blood vessels and other skin parts, the skin ensures that the body is protected from extremes of temperature, either the intense cold of northern climates or the sweltering heat of the tropics.
Sensory functions
The skin can detect vibrations and temperature and relays this information to the various cells of the body to react accordingly.
Communication functions
The skin has so many ways to communicate socially and sexually that we tend to take them for granted and perhaps not appreciate the innate and complex sophisticated qualities of this body organ.
Water balance
The body needs to be optimally hydrated; the skin through its excretion glands and other functioning aspects ensures that optimum hydrations levels are maintained.
Vitamin production
The skin also carries out some metabolic functions such assisting in the production of vitamin D and acting as a catalyst in conjunction with sunlight.