The Skin Why Protect It Associate Professor Geoff Sussman

Functions of Human Skin Protects Transmits sensations: touch, pressure, pain Regulates body temperature Excretes wastes Prevents excessive loss of body fluids Synthesizes vitamin D The main functions of the skin are: protection transmission of sensation regulation of body temperature excretion of wastes prevention of excessive loss of body fluids synthesize vitamin D in the presence of ultraviolet rays

1 Square Cm of Skin Contains 15 sebaceous glands 0.9 metres of blood vessels 100 sweat glands 3,000 sensory nerve cells 3.7 metre of nerves 25 pressure apparatus for touch 2 receptors for cold 12 receptors for heat 300,000 epidermal cells 10 hairs

Changes in the Skin with Ageing Dermis loses 80% of its original thickness 40% less collagen Sebum and sweat production is reduced Epidermal layer separates more easily from the dermis Elastin fibres decrease in number but increase in size, thus making the skin stiff Decrease in Langerhan cells - thus the immune system functions Small blood vessels diminish by 40%  vitamin D, collagen and moisture  migration of capillary epithelial cells  epidermal turnover fragility of capillaries Age changes the structure and ultimately several functions of the skin. Elderly skin is fragile and the elderly patient is at greater risk of suffering skin damage from the effects of frequent washing, shearing and friction than patients with young healthy skin. There is a decrease in the number of sudoriferous and sebaceous glands. Sebaceous gland activity is regulated by hormones and as hormonal activity decreases with age so does the production of sebum. As a result there is reduction in the water holding ability of the stratum corneum resulting in dryness, wrinkling and skin laxity. The epidermal layer is more easily separated from the dermis in the aged patient. The papillae and rete ridges flatten which decrease the stability of the dermis to the epidermis. This predisposes the elderly patient to the effects of shearing for example, through sliding down the bed and dragging the patient back up the bed, and to skin tears. Elastin fibres decrease in number but increase in size ( 2-3times) resulting in a loss of elasticity and an increased in stiffness in elderly skin. The tensile strength is reduced and the ability of the skin to recover from stress, for example from a minor knock, is diminished. A decrease in Langerhans cells may increase the risk of infection and a reduction in melanocytes, which account for 10% of the epidermal cells, increase the skins susceptibility to sun damage. The number of small blood vessels of the dermal papillae decrease by 40% as a person ages altering the elderly patients ability to adjust body temperature in extreme environmental temperature changes and increasing the risk of adequate perfusion to a healing wound. Blood vessels feeding hair follicles and sebaceous glands is also reduced. Body fat decreases and the elderly has less protection and reduced energy stores. There are fewer sensory nerve endings increasing the elderly patient’s susceptibility to mechanical trauma.

MEASURES TO ENSURE SKIN TONE SKIN Ph SKIN MOISTURE SUN DAMAGE USE OF SKIN ADHESIVES

MEASURES TO ENSURE SKIN TONE It is essential to ensure as the skin ages that appropriate measures are taken such as not using soap or other alkaline pH products that will increase the drying and therefore cracking of the skin

The pH of the Skin Surface and its Impact on the Barrier Function The ‘acid mantle’ of the stratum corneum seems to be important for both permeability barrier formation and skin antimicrobial defense. Changes in the pH are reported to play a role in the cause of skin diseases like irritant contact dermatitis, atopic dermatitis, acne vulgaris and fungal infections. Repeated washings with soap may reduce the normal skin flora, leading to an increased colonization of the skin with coagulase- negative staphylococci.

How is Soap Made The basic fat usually animal fat but may include vegetable fat is mixed with Caustic Soda to saponify the mixture and form the base soap mill. This is then mixed with additives, perfume, and other ingredients and then pressed into moulds to form the bar of soap. The issue is that the Caustic Soda is not neutralized so the final product is alkaline.

Soap and the Skin Most soaps and detergents are alkaline and induce an increase in cutaneous pH, which affects the physiologic protective “acid mantle” of the skin by decreasing the fat content. Disruption of stratum corneum and changes in pH are key elements in the induction of irritant contact dermatitis and pruritus by soaps. These conditions are exacerbated in the winter months in people with dry, sensitive skin.

pH of Popular Soaps Brand pH Neutrogena 9.5 Cussons Baby Soap 10.8 Cussons Imperial Leather 10.9 J & J Baby Soap 11.0 Palmolive Regular 11.0 Pears 10.8 Velvet 11.0 Simple Soap 11.2

Soap and the Skin The neutral bar soaps available Cetaphil Bar QV Bar Dove Wash wounds with a pH 5-6 wash if basically clean

MEASURES TO ENSURE SKIN TONE Using appropriate moisturising agents to ensure suppleness and to minimise the drying effects of the ageing process on the skin including. Skin creams e.g. Sorbolene {little value} Skin ointments e.g. Wool Alcohols ointment Bath oils Barrier films

The Use of Moisturizers Sorbolene and other aqueous creams are of little value as Moisturizers. Recent published studies in the British Journal of Dermatology have reported a significant increase in transepidermal water loss. Another study reported Impacts on cellular and molecular level of the skin. Increased desquamatory and inflammatory protease activity. Changes in corneocyte maturity and size indicate an accelerated skin turnover induced by chronic application of this Emollient. Danby ey al The effects of aqueous cream on the skin barrier in patients withy a previous history of atopic dermatitis BJ Derm 201165,329-334 Mohammed D et al Influence of aqueous cream on corneocyte size, maturity, skin protease activity, protein content and transepidermal water loss. B J Dermat 2011 1643,1304-1310

Types of Moisturizers Products from Ego Products from Hamilton Products from Dermatech Products from Nivea Simple products with few preservatives and few ingredients.

Types of Moisturizers Simple products with few preservatives and few ingredients.

MEASURES TO ENSURE SKIN TONE Use of a Lactic Acid Foot Heel Cream

WOUND MANAGEMENT TRADITIONAL THEORY 1. WOUNDS SHOULD BE KEPT CLEAN AND DRY SO THAT A SCAB FORMS OVER THE WOUND 2. WOUNDS SHOULD BE EXPOSED TO AIR AND SUNLIGHT AS MUCH AS POSSIBLE 3. WHERE TISSUE LOSS IS PRESENT THE WOUND SHOULD BE PACKED TO PREVENT SURFACE CLOSURE BEFORE THE CAVITY IS FILLED 4. WOUNDS SHOULD BE COVERED WITH A DRY DRESSING

TRADITIONAL THEORY DISADVANTAGES 1.THE SCAB (DEHYDRATED EXUDATE AND DYING DERMIS) IS A PHYSICAL BARRIER TO HEALING THE DELAY BECAUSE EPIDERMAL CELLS CANNOT MOVE EASILY UNDER THE SCAB THERE MAY BE POOR COSMETIC RESULTS AND SCARRING. 2. EXPOSURE TO AIR REDUCES SURFACE TEMPERATURE OF THE WOUND AND DRIES THE WOUND CAUSING FURTHER DELAYS HEALING 3. GAUZE PACKING IMPAIRES THE QUALITY OF HEALING 4. THE DRESSING MAY ADHERE TO THE WOUND AND CAUSE TRAUMA WHEN IT IS REMOVED.

What factors effects wound healing Extrinsic - mechanical stress - debris - temperature - drying/maceration - infection - chemical stress - other factors (e.g. smoking, drugs) Intrinsic - health status - immune function - age factors - body build - diabetes - nutritional status

WOUND MANAGEMENT Antisepsis Acute injuries will often be contaminated by the surroundings where the injury occurred e.g. dirt, gravel, grass, clothing or other foreign material. The risk of infection developing in these wounds is high due to the inflammatory nature of the wound as the tissue commences the healing process.

WOUND MANAGEMENT Antisepsis The thorough decontaminating of the wound with a good surfactant product will help to remove most of the foreign material and reduce the risk of infection. It is also appropriate to apply a topical antiseptic before dressing the wound. This is usually left in place for 3-5 minutes and then washed off with clean water.

Hand Antisepsis The use of alcoholic hand gels is superior to washing.

Out with the Old and in with the New

What should a home First Aid kit contain Hydrogel for burns Simple waterproof dressing Simple non-waterproof dressing Haemostatic for bleeding Cohesive bandage (support) Simple antiseptic (Betadine) Swabs for cleaning Steri-strips closure Foam dressing (older people to cover skin tears)

Simple non-waterproof dressing Strips Simple waterproof dressing Antiseptic solution

Foam dressings Haemostatic dressing Hydrogel dressings

Bandages Cleaning swabs

Looking after your skin is very important. Conclusion Looking after your skin is very important. The skin plays a vital role in protecting the body. Good hydration, moisturizers and protection from damage are simple ways to ensure good skin health.