Skin Care

About the Skin You're In

Did you know that the skin is the largest organ of the body? Despite only being a few millimeters thick, skin can weigh between 7.5 and 22 pounds and cover a surface area of 16 to 22 square feet. Taking care of this vital organ is important for your overall health, because the skin serves as more than a cover for our muscles and bones. Skin protects internal organs from harmful external factors (bacteria, ultraviolet rays, moisture) as well as regulates body temperature, stores essential nutrients, and gives us the sense of touch. Changes in the skin, such as color or texture, can be a sign of other medical conditions and should be monitored by a health care professional.

Skin Care at Home

• Keep skin clean and dry. Be sure to immediately treat any episodes of incontinence. Practice good hygiene, including washing hands with a mild soap.
• Moisturize daily. Standard lotions help prevent drying. Be careful not to place any lotion between the toes.
• Properly care for minor cuts, scrapes, and burns. Note any changes in appearance of a wound and the surrounding skin. Let your physician know of any changes.
• Take short, lukewarm showers or baths. Hot water can cause skin to dry out and crack.
• Protect vulnerable areas with proper offloading. This may include using total contact casts, removable cast walkers, wheelchairs, specialty pads, and repositioning.
• Maintain a well-rounded diet as advised by a health care professional. 
• Hydrate with water. Fluids help prevent dry skin and/or mouth and are essential for a healthy body.
• Avoid tobacco products. Begin a smoking cessation program if necessary. Smoking damages collagen and elastin, which give skin strength and elasticity.
• Use sunscreen and wear protective clothing outside. This may seem like a no brainer—but it bears repeating!
• Regularly perform a full-body skin check. Inform your clinician of any areas with discoloration, odd texture, swelling, or discharge.

The Skin's Layers

EPIDERMIS

The epidermis is the outermost layer of the skin. The cells that we see on the top are dead cells (known as keratinocytes) tightly stuck together to form the skin’s well-known protective barrier. This layer constantly renews itself; the lowest level of the epidermis makes new keratinocytes, pushing them up to replace the top-most layer every 4 weeks.

This layer contains additional specialized cells. Melanocytes produce and store melanin, which protects the skin from sun damage. Lymphocytes and Langerhans cells keep infection at bay by fighting germs as part of the immune system. Merkel cells recognize outside pressure and help with touch sensations.

DERMIS

As the middle layer, the dermis is comprised of strong yet elastic collagen fibers that give the skin its durable and flexible characteristics. Though it is tough, the dermis is not immune to injury; tears to this layer can be seen as stretch marks. It houses a network of capillaries, tiny blood vessels that carry oxygen and nutrients from the heart throughout the body. Capillaries work with the dermis’s sweat glands to regulate body temperature. Also in the dermis is many of the body’s sensory nerves. These help the brain know when something hurts, such as a hot stove, or feels nice, such as silk.

HYPODERMIS

Underneath the dermis is hypodermis, which is also known as subcutaneous tissue. It has several functions: attaching skin to the underlying muscles and bones with special connective tissue, serving as insulation and cushioning, and storing fats. Fat (or adipose tissue) store energy and plays an important role in releasing hormones to the body.

Basic Wound Care Tips

• After injury, wash the wound thoroughly with clean water and mild soap. Apply a gentle pressure to stop any bleeding.
• Keep your wound moist with a layer of petroleum jelly and cover with a bandage.
• Keep your wound and the surrounding skin clean and free of irritants.
• Monitor surgical sites for signs of infection. Follow doctor’s orders regarding dressing changes and when to get stitches removed.
• Inform your wound care clinician if a wound does not heal within 4 weeks or increases in size.

Skin Infection

Common signs of skin infection include:

• Rash
• Swelling 
• Redness
• Pain
• Pus or odorous drainage
• Itching

Your risk of skin infection increases if you:

• Have poor circulation
• Are older
• Have diabetes
• Have a weakened immune system due to disease (e.g., AIDS) or medicine (e.g., chemotherapy)
• Are malnourished
• Have difficulty ambulating (e.g., stay in bed a long time or are paralyzed)
• Are obese

Skin infections are diagnosed by:

• Physical examination and conversation about your symptoms with your doctor
• Skin culture, which can identify what bacteria are behind the infection, by swabbing or scraping your skin
• Biopsy, or removing a small piece of skin for further lab tests

Common Conditions

VENOUS LEG ULCERS

These leg ulcers are the most common reason patients see a wound care specialist. When the veins in the legs are not effective in carrying blood back up to the heart, pressure develops in the limbs when standing. The high pressure damages the skin, making it more fragile and susceptible to injury. You can help prevent venous leg ulcers from developing by following your doctor’s recommendations for compression therapy.

DIABETIC FOOT ULCERS

Foot ulcers are a serious complication of diabetes and commonly occur on the bottom of the foot. A number of factors can contribute to the development of these ulcers, including diabetic skin complications and trauma (such as from ill-fitting shoes or an incorrect gait). Often, neuropathy exacerbates a problem because you cannot feel certain symptoms due to damage to the nerves in your skin. Be sure to check your feet daily for any changes in the skin’s appearance.

DEHISCENCE

When a surgical site fails to close, dehiscence occurs. It can be partial, where only superficial layers (i.e., the epidermis) are affected, or complete, where all layers of an incision are separated from the underlying tissue and organs may be exposed. To help prevent dehiscence from developing, carefully follow postoperative instructions from your physician, which likely include good hygiene and avoiding unnecessary strain on the surgical site while you continue to heal.

CELLULITIS

As a bacterial infection, cellulitis affects the skin and its underlying tissues. Bacteria (most commonly streptococci and staphylococci, which live naturally on the skin’s surface) enter the body through an injury like a bruise, burn, surgical site, or wound. If you have any symptoms such as fever, nausea and vomiting, or muscle aches and pains, consult your doctor immediately for treatment.

CANDIDIASIS

Candidiasis is a catch-all term for infections caused by fungi from the genus Candida, which normally colonize in the mouth, gastrointestinal tract, and vagina. You may have previously heard of it as a yeast infection. Changes in the skin’s native bacteria (due to antibiotics) or acidity/chemistry (due to excess moisture) can allow Candida to become invasive. It causes patches of red, moist, weepy skin. Use antifungals as directed by your doctor and keep skin, including under skin folds, clean and dry to help prevent candidiasis. 

To assist in the education of wound care patients, Today’s Wound Clinic offers clinicians and program directors this special resource. Patients: Please consult your health care provider. This document is not meant to serve as complete medical guidance and is intended for general information purposes only.

1. InformedHealth.org. How does skin work? Institute for Quality and Efficiency in Health Care. https://www.ncbi.nlm.nih.gov/books/NBK279255/. Updated July 28, 2016. Accessed April 30, 2019. 

2. The layers of your skin. American Academy of Dermatology. https://www.aad.org/public/kids/skin/the-layers-of-your-skin. Accessed April 30, 2019. 

3. Skin Infections. MedlinePlus. https://medlineplus.gov/skininfections.html. Updated April 3, 2019. Accessed April 30, 2019. 

4. Basic wound care. University Health Services of UW-Madison. https://www.uhs.wisc.edu/medical/common-student-concerns/basic-wound-care/. Accessed April 30, 2019. 

5. Foot Ulcer Symptoms and Diagnosis. UPMS Orthopaedic Care. https://www.upmc.com/services/orthopaedics/conditions-treatments/foot-ulcer#symptomsdiagnosis. Accessed April 30, 2019. 

6. Overview: Venous leg ulcers. NHS. https://www.nhs.uk/conditions/leg-ulcer/. Reviewed January 11, 2019. Accessed April 30, 2019. 

7. Surgical wounds. WoundSource. https://www.woundsource.com/patientcondition/surgical-wounds. Accessed April 30, 2019. 

8. Cellulitis. MedlinePlus. https://medlineplus.gov/cellulitis.html. Updated April 3, 2019. Accessed April 30, 2019. 

9. Candidiasis. Harvard Health Publishing. https://www.health.harvard.edu/a_to_z/candidiasis-a-to-z. Published January 2019. Accessed April 30, 2019.