Good Reasons for Maintaining Healthy Skin...

The First Line of Defense. Despite the many bumps, burns and bruises we've all endured, most people might be surprised to learn just how important the body's skin is. It's the body's largest organ - our first line of protection against the harsh environment, bacterial infection and harmful substances. This flexible, durable barrier insulates the body against cold and heat. It also gives us our sense of touch, allowing us to feel the world around us.

• Epidermis. Visible to the eye, this is the outermost layer of the skin. It has the ability to regenerate and repair itself every four weeks.
• Dermis. The middle layer gives your skin its elasticity. It contains nerve endings, hair follicles, oil and sweat glands and nails, and helps regulate body temperature by controlling evaporation. It also stores water and nutrients the body needs to operate efficiently.
• Subcutaneous tissue. The innermost layer is made up of fat. It acts as an insulator and shock absorber.

Aging Skin Needs Special Care. As our bodies age, our skin becomes thinner, drier, more fragile and more susceptible to injury. It becomes less sensitive to touch and has more places where bacteria can grow. Injuries take longer to heal. For all of these reasons, maintaining healthy skin becomes more important to our overall health as we grow older.

Dry Skin. Skin needs moisture to stay healthy and elastic. Aging, exposure to the sun, wind, cold, indoor heat and frequent washing all cause moisture loss. The use of harsh soaps or excessive washing will make the problem worse. Dry skin can occur if a moisturizer is not used. As dry skin develops, its outer layer thickens, followed by flaking, cracking and itching. Dry cracked skin can also be a source of infection.

Moist Skin. On the other hand, too much moisture also causes problems. Moisture resulting from incontinence, perspiration or drainage from wounds can increase the potential for skin damage caused by even light rubbing. It also encourages the growth of bacteria and infection.

Pressure ulcers . Pressure ulcers (also called bed sores) are caused by unrelieved pressure of body weight against the skin. This pressure cuts off blood carrying oxygen and nutrients to the skin and underlying tissue. Bed sores usually occur on the bony areas of the body, where skin and underlying tissue receive the greatest pressure against an outside surface. They can be very painful and difficult to heal. They can also slow recovery from other health problems. People who are at special risk for this injury include persons who:

• must stay in a bed, chair or wheelchair due to illness or injury
• are unable to change their body position on their own (for example, people who are in a coma, are paralyzed or have a hip fracture)
• have a loss of urine or bowel control
• cannot eat a balanced diet
• have lowered mental awareness from disease, medications or anesthesia.

Daily Skin Inspection. Check the entire body skin surface once a day. Pay special attention to bony areas - they're the most likely points for skin breakdown. You can use a mirror to help in hard-to-see areas. Pressure ulcers range in severity from mild skin reddening to severe open wounds. (Note: Skin reddening that disappears after pressure is removed is normal and not a pressure ulcer.)

Bathing. Use warm water - never hot - and a mild soap to help keep skin clean and dry. Try to establish a routine according to the person's needs for cleanliness and comfort. Use a perineal cleanser (see description below) for the buttocks and genital area. Ask your health care professional about appropriate bathing techniques for a person confined to a bed or wheelchair.

Prevent Overdrying. Dry skin can be prevented with a moisturizing cream or lotion. It's most effective when applied immediately following a bath or shower, while the skin is still damp. In addition, prevent exposure to cold and maintain a humidity level of at least 40%. Drinking plenty of fluids will help keep the skin well hydrated.

Maintain Clean, Dry Skin. Always clean soiled skin immediately. Excessive moisture from incontinence or perspiration can be controlled with products that keep skin dry and aid in comfort and cleanup. Superabsorbent materials found in some underpads and briefs are effective in drawing moisture away from the skin. A cream or ointment may also be effective in protecting the skin from wound drainage or incontinence.

Reposition. Our body's nerves usually tell us when to shift our body to relieve skin pressure. When someone is ill, they may not have the ability to change positions frequently. Pressure sores can develop in two to three hours, so it's important to reposition the body every two hours while in bed. A person in a chair should be repositioned every hour. If they're able, they should shift their weight in the chair every 15 minutes. Your health care professional can show you a variety of desirable positions for persons confined to a bed or chair.

Avoid Friction. Reposition slowly and gently... friction or rubbing can damage the top layer of skin and underlying tissues. Always lift - don't drag - when moving. Ask for assistance from others if necessary. Your health care professional can show you the correct lifting techniques to use when moving or repositioning someone confined to a bed or chair. In addition, avoid seating and bed positions that cause the body to slip down in the bed or chair. If medical conditions allow, the head of the bed should be raised as little and as infrequently as possible. Elevated head positions encourage sliding, which can damage skin and underlying blood vessels.

Bedding. Keep bed linens clean and wrinkle free. Avoid use of harsh laundry detergents.

Avoid Massaging Bony Areas. Massage over these areas can squeeze and damage tissue beneath the skin, leading to pressure ulcers.

Nutrition. Healthy skin is less vulnerable to damage. Encourage a well-balanced diet including protein, calories and adequate fluids. Things that can interfere with good nutrition include tooth decay, gum infection, improperly fitting dentures, certain illnesses and disabilities, depression and certain medications. Discuss special dietary restrictions and concerns with your health care professional. In some cases, a nutritional supplement might be appropriate.

Don't use donut-shaped ring cushions. They can decrease circulation and cause swelling of tissue, which increases the risk of tissue sores. (Note: Those who are confined to a bed, chair or wheelchair may need to use a pressure-reducing mattress or cushion. Ask your health care professional about an appropriate selection.)

Skin Care Products That Clean, Condition and Protect

Perineal Cleanser or Pre-moistened Wipes. The pH level in most bar soap strips natural oils, making skin more susceptible to damage. Soap can also leave a residue that irritates the skin. For urine and bowel incontinence, a perineal cleanser or pre-moistened wipes can help clean and protect the buttocks and genital area. It's formulated to gently clean and condition skin without the friction of washing with soap and water - and without the irritation of rinsing. The skin can be cleaned without rubbing, then blotted dry. (Note: To prevent the spread of infection, always wash hands before and after care.)

Moisturizers. Moisturizing keeps skin supple and healthy, and protects it from drying out and becoming vulnerable to infections. Apply moisturizing lotions or creams immediately following a bath or shower, while the skin is still damp and better able to absorb the moisturizer.

Barrier Products. By providing a barrier against moisture from perspiration, urine and bowel incontinence, these products help prevent infections and contamination. Always remove soiled products before applying fresh barriers.

The information presented in this article is provided as a public service to those who provide personal care for others. It is not medical advice. If you have questions about skin care, always ask a health care professional. If skin is red or swollen, don't take a chance with infection. Call your health care professional immediately.