Skin care is all about restoration of four functions that are easy to remember compared to its several thousand named diseases. There is skin failure due to
1)Failure of barrier function ranging from changes in Transepidermal Water Loss (TWL) to full thickness wounds allowing penetration of infections, irritants and allergens, and activating the repair and remove mode when the epidermis makes and distributes chemicals to stimulate blood supply and to activate recognition and elimination of harmful invaders. This is inflammation and immuno-surveillance.
2)Thermoregulation is being too hot and too cold, controlling sweating and by increasing or decreasing the blood flowing through the skin to maintain optimal body temperature for all functions including wound healing. Inflammation also brings the skin, which is usually cooler than the core, up to body temperature.
3)Sensory loss from injury to nerves in the skin, the spine, and brain, unconsciousness or impairment of awareness. Disturbances of this function underlie both itch and pain. The brain centres that control emotion have a strong influence on the neural pathways involved in inflammation. Amputation is a too common consequence for pain and numbness of the foot.
4)‘The Look Good Feel Good Factor’ – Skin failure includes the unwelcomeness of the disfigured of which leprosy and elephantiasis or the severely burned are well recognized prototypes.
Warning Fear and lack of understanding lead people to taunt, assault, run away or hide from the disfigured. Beliefs surrounding the illness are powerful factors and must be changed.
Action Water loss is relieved by emollients. Thermoregulation is helped by the use and weave of clothing and avoidance of the sun. Sweat spread by body grease and trapped by hair evaporates and cools. Healthy skin is rarely immobile and offloading protects against the effect of pressure. Management should be patient centred, image aware and culturally competent. Chronic illness dominates by far, as does living beyond four score years.