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

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

MEASURES TO ENSURE SKIN TONE

SKIN Ph

SKIN MOISTURE

SUN DAMAGE

USE OF SKIN ADHESIVES

MEASURES TO ENSURE SKIN TONEIt 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 andits Impact on the Barrier Function

The ‘acid mantle’ of the stratum corneum seems to be important for both permeability barrier formation andskin antimicrobial defense. Changes in the pH are reported to play a role in the cause of skin diseaseslike irritant contact dermatitis, atopic dermatitis, acnevulgaris 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 SkinMost 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 SoapsBrand 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 availableDove QV Bar

Wash wounds with a pH 5-6 wash if basically clean

Cetaphil Bar

MEASURES TO ENSURE SKIN TONEUsing 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 201165,329-334Mohammed 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 MANAGEMENTTRADITIONAL THEORY1. WOUNDS SHOULD BE KEPT CLEAN AND DRYSO THAT A SCAB FORMS OVER THE WOUND

2. WOUNDS SHOULD BE EXPOSED TO AIR ANDSUNLIGHT AS MUCH AS POSSIBLE

3. WHERE TISSUE LOSS IS PRESENT THE WOUND SHOULDBE PACKED TO PREVENT SURFACE CLOSURE BEFORETHE CAVITY IS FILLED

4. WOUNDS SHOULD BE COVERED WITH A DRY DRESSING

TRADITIONAL THEORYDISADVANTAGES

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 Intrinsic

- health status- immune function- age factors- body build- diabetes- nutritional status

Extrinsic- mechanical stress- debris- temperature- drying/maceration- infection- chemical stress- other factors (e.g.

smoking, drugs)

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

1. Hydrogel for burns2. Simple waterproof dressing3. Simple non-waterproof dressing4. Haemostatic for bleeding5. Cohesive bandage (support)6. Simple antiseptic (Betadine)7. Swabs for cleaning8. Steri-strips closure9. Foam dressing (older people to cover skin

tears)

What should a home First Aid kit contain

Simple non-waterproof dressing

Simple waterproof dressingAntiseptic solution

Strips

Foam dressings

Haemostatic dressing

Hydrogel dressings

Bandages

Cleaning swabs

Conclusion

Looking after your skin is very important.The skin plays a vital role in protectingthe body. Good hydration, moisturizers andprotection from damage are simple waysto ensure good skin health.