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Skin Care: From Skin Health to Ulcer Prevention
Skin performs a variety of functions. It is the body’s the first defense against not only infection from a variety of pathogens (eg, bacteria, viruses, fungi and yeast), but also chemicals, the sun, and other toxic substances. It regulates temperature, controls vitamin D production, and plays critical role in physical attraction and self image.1 In economic terms, more time was missed in the Vietnam war from skin disease than any other cause; in civilian life, persons with skin disease often make less money than their healthy skin equals. In short, understanding skin care is critical.2
Wound care professionals are in a unique position. Because they focus on the damage that affects the skin, they have an opportunity to develop a true expertise in skin physiology and skin care. Unfortunately, other healthcare professionals frequently trivialize skin care. Opportunities to train in and learn about the skin often are not provided by professional schools3; even in dermatology programs, time spent on skin care is minimal. Most internists, for example, enter practice with less than 1 month of dermatologic education and less than 1 month post graduate education.4 The problem is that the majority of patients seeking care for their skin problems see a non-dermatologist: 7% of all office visits to all physicians are for a primary skin complaint5 and more than half of all patients who see their primary care provider over a 2-year period have a skin ailment.6 Not surprisingly, then, non-dermatologists have limited diagnostic capabilities in skin disease, are uncomfortable seeing patients with skin problems, and often render incorrect diagnoses and inappropriate treatment.7
Because part of a wound care professional’s job is to deal with skin problems, understanding the skin and common skin issues is paramount. Regarding feet in people with diabetes, Professor Lindsay from Ireland said, “For every one mistake not knowing, there are 10 mistakes of not looking.”8 For wound care clinicians who evaluate the skin, not knowing may make not looking a desirable alternative.
Recently, the government and other oversight entities have upped the ante. New regulatory guidelines have made skin care and skin evaluation quality indicators for institutions. Litigation and financial liability forebode problems for those who neglect the skin. Most importantly, lack of understanding and knowledge of the skin cause patients to suffer, the clinician not knowing the cause, the treatment, or how to alleviate the discomfort. Clinicians must make the most of the opportunities that exist to improve patient outcomes and quality of life.
Understanding the skin and skin health has a practical importance as well. For example, chronic wounds often are associated with skin changes such as venous dermatitis with venous ulcers, contact dermatitis or Candida infection with pressure ulcers, and dermatophyte infection with diabetic foot ulcers.9 Additionally, maintaining skin moisture is critical because excessively dry skin (termed xerosis) and excessively moist skin are risk factors for pressure ulcer development.10-12 Understanding xerosis, including risk factors for development and prevention and treatment options, is paramount. Xerosis requires appropriate moisturization for its prevention and treatment and to maintain skin health. A validated xerosis scale exists and can be used in conjunction with other skin evaluations. Among the risk factors for xerosis is age; elderly patients with xerosis are at additional risk for pressure ulcer development. With the graying of the population, these issues will continue to grow in importance.
Because skin health is so important, OWM, with the support of the Skin Health Division of Coloplast Corporation, has created this new column, “Skin Matters,” to dedicate focus on the care of the body’s precious commodity and its subsequent relation to wound care and pressure ulcer prevention. Over the course of the next year, OWM will present a series of monthly articles aimed at increasing understanding of the skin, skin disease, skin health, and wound prevention. Each month’s article will examine a different aspect of skin health, skin health maintenance, and skin disease. Various clinicians renowned for their progressive skin and wound care ideas and practices will lend their expertise to topics such as skin assessment, skin physiology, dermatologic vocabulary, xerosis, and other common skin diseases and their treatment. Additionally, the Symposium on Advanced Wound Care (SAWC) to be held in San Antonio, Tex, April 30 to May 4, 2006, also will highlight important skin topics, including a session on geriatric skin health and skin diseases. OWM and the Skin Health Division of Coloplast Corp. continue to be resources for skin care and skin disease information, linking readers to a network of vital, ever-evolving skin care information.
1. Beltrani VS. Occupational dermatoses: current opinion. Allergy Clin Immunol. 2003;3:115–123.
2. Federman DG, Kirsner RS. The patient with skin disease: an approach for the non-dermatologist. Ostomy Wound Manage. 2002;48:22–28.
3. Federman DG, Kirsner RS. The abilities of primary care physicians in dermatology: implications for quality of care. Amer J Managed Care. 1997;3:1487–1492.
4. Kirsner RS, Federman DG. Lack of correlation between internists’ ability in dermatology and their patterns of treating patients with skin disease. Arch Dermatol. 1996;132:1043–1046.
5. Kirsner RS, Federman DG. Managed care: the dermatologist as a primary care provider. J Am Acad Dermatol. 1995;33:535–537.
6. Lowell BA, Froelich CW, Federman DG, Kirsner RS. Dermatology in primary care: prevalence and patient disposition. J Am Acad Dermatol. 2001;45:250–255.
7. Federman DG, Concato J, Kirsner RS. Comparison of dermatologic diagnoses by primary care practitioners and dermatologists: a review of the literature. Arch Fam Med. 1999;8:170–172.
8. Boulton AJ, Vileikyte L, Ragnarsa-Tennvall G, Applegist J. The global burden of diabetic foot disease. Lancet. 2005;366:1719–1724.
9. Valencia IC, Falabella A, Kirsner RS, Eaglstein WH. Chronic venous insufficiency and venous leg ulceration. JAAD. 2001;44:401–421.
10. Gosnell DJ. An assessment tool to identify pressure sores. Nurs Res. 1973;22:55–59.
11. Allman RM, Goode DS, Patrick MM, Burst N, Bartolucci AA. Pressure ulcer risk factors among patients with activity limitation. JAMA. 1995;273:865–870.
12. Guralnik JM, Harris TB, White LR, Cornoni-Huntley JC. Occurrence and predictors of pressure sores. The National Health and Nutrition Examination Survey. J Am Ger Soc. 1988;36:807–812.
