More Than Skin Deep

• By David Natalizia, Alan Braverman
• Oct 01, 2004

Have you ever stopped to realize the workings of human skin? Probably not, and it doesn't surprise me—if we thought about the anatomy and physiology of all our body systems, we would most likely be overwhelmed. The skin takes care of itself for the most part and we really don't have to think about how the skin is working minute by minute, much like we don't think about breathing or our beating heart. However, the skin doesn't require a lot, just the basics. Adding some of the newer skin care and advanced skin care products to your shelves not only covers your customers' needs, but differentiates you from your competition. From a clinician's standpoint, wouldn't you rather refer your patients to a provider who offers the latest in wound prevention and treatment, including skin care?

A and P
How about a quick primer on the anatomy and physiology (A and P) of the skin to get started? The skin is the body's largest organ and probably the source of many of your leads: patients and families dealing with pressure, venous, arterial and neuropathic wounds in need of everything; from wheelchair cushions, to compression hose, to advanced wound care dressings, and to skin care products. The skin provides our sensation, literally putting us in touch with the outside world. It also functions to protect us, to regulate our temperature, to store water and fat, to absorb and excrete, to metabolize, to make vitamin D from sunlight exposure and to provide immunity.

The integument (the skin) is the most readily accessible body system, meaning that it allows clinical personnel to quickly assess its health. It often reflects our overall wellbeing. It is the body's first line of defense and actually has its own immune system! If we were able to take our skin off before we retired to bed each night, it would weigh as little as 6 to 8 pounds, yet it remains the largest of the body's organs.

The skin is made up of two distinct layers, the top layer, or the epidermis, is actually comprised of five separate layers. This is the layer we can see and touch. It has cells called melanocytes which give skin its color. It protects us from dehydration or what is technically termed, transepidermal water loss (TEWL) or literally dehydration via the skin. The epidermis doesn't have a blood supply and constantly renews itself by pushing new cells up where they are shed into the environment. The epidermis protects us from invading bacteria, viruses and fungi. It protects our clients and patients from bodily fluids like urine, feces and wound exudate.

The second layer, or the stratum beneath the epidermis, is the dermis. This layer is much thicker compared to the epidermis. It houses the hair follicles, oil glands and has its own rich blood supply. One of the main functions of this layer is temperature regulation through normal evaporation and sweat production. The technical term is "thermoregulation," and it takes place constantly. Without this function, life could not continue, we would literally overheat. Another key function of this important layer is to produce collagen and elastin, proteins that make up the skin and give it its strength.

The basics
Skin care basics include cleaning, moisturizing and protecting the skin. Historically, this has been done with soap and water and inexpensive, easy to obtain moisturizers or barrier products containing petrolatum or mineral oil. The fact is that soap strips and dries out the skin making it more vulnerable to damage. Liquid cleansers containing surfactants are used more commonly today and are not only gentler to the epidermis, but pH balanced as well. Moisturizers seal in the body's water or hydration and are particularly helpful in areas where temperature and humidity are low, which causes havoc to the skin.

When incontinence or wound exudate is an issue, skin barriers and protectants should be used. These products should be stocked next to your advanced wound care products and incontinence products like adult briefs. They provide a physical barrier between the skin and harmful body fluids and offer protection from breakdown. Zinc oxide is a common ingredient and one that offers good protection since these barriers are thick and stay in contact with the skin. Another option are products that contain karaya gum. These goods protect because they don't dissolve in water but rather absorb water to form viscous colloidal material.

Bath time
Another new item to have on your shelf is the bath-in-a-bag products that offer convenience, comfort and good skin care in an all-in-one product. Gone are the days of bed baths that use bath basins with cold, dirty water—making the patients uncomfortable. This is not only inconvenient and time-consuming, but an infection control issue.

A complete bed or bedside bath can be given safely, inexpensively and comfortably with specially formulated system of moist wipes for each body segment. They are easy for the caregiver and clients love them because they actually get clean, feel refreshed and don't get cold while being bathed. Some of these advanced products also offer additives in their formulas that leave a protective barrier or moisturizer like allantoin on the skin, saving the caregiver an extra step of applying separately. Look for a company that offers a variety of different systems, such as antibacterial formulas, scented and non-scented types and shampoo cap systems. Scout out products with large, soft cloths that are easy to remove from the container and that have pH balanced safe ingredients that do not leave a heavy film on the skin.

Research and development
The ultimate goal of skin and wound care product research is to explore new ways to prevent, treat and cure skin problems. Loss of skin integrity is what drives patients and caregivers to our doors and affects millions of people. Only through the most advanced science can we reverse the suffering from poor skin function. Consider yourself in the skin cell saving business and watch your sales soar!

The latest skin care products have advanced beyond surfactants in their cleansers, rather, the skin is cleansed by high-tech ingredients called phospholipids. These products allow the skin to be cleaned without stripping precious natural oils from vulnerable tissue. Be sure to ask your manufacturers for these key ingredients.

Advanced skin care has arrived and you should be offering its benefits to every customer that walks in your dealership. If a client has skin, they need your products. It's as simple as that. Scout out these products from your manufacturers, choose your product mix and start offering your customers what they need. What to look for?

• Surfactant-free cleansers that use phospholipids technology to clean. All-in-one products that offer four steps in one: cleansing, moisturizing, protecting and nourishing.
• State-of-the-art moisturizers that contain oils such as canola oil, olive oil also known as Olea Europaea, sunflower oil, avocado oil, grape seed oil, corn oil, jojoba oil and borage oil, vitamins, proteins and carbohydrates like aloe vera and hyaluronic acid.
• Moisturizers and protectants that contain laser-treated amino acids like L-cysteine, L-proline, glycine and L-taurine (that make them bio-available and easy to penetrate the skin with out irritation) and antioxidants that protect the skin from damaging breakdown from oxidation or "rusting" of the skin.
• High-tech barriers such as complex silicones like cetyl dimethicone, cyclomethicone, cyclopentasilioxane, dimethicone copolymer, dimethicone copolyol, dimethiconol, divinyldimethicone and FDA active ingredients and OTC drugs.
• Products that contain methylsulfonylthmethane (MSM)—a hot ingredient in the news—that decreases inflammation and helps users who feel pain and stinging sensation on their skin. Topical products decrease the stinging feelings.

Feed the need
Just as we need good nutrition to survive, our skin can now be nourished from the outside in. Products containing specially treated amino acids, antioxidants, MSM and vitamins and co-factors can nourish and strengthen the skin; providing an insurance policy against skin breakdown and wounds. These products not only improve the skin's appearance and texture, but also help to build collagen and help develop the skin?s resistance to damage. Imagine offering these state-of-the-art science products in your business.

Protecting and reducing the damage to the skin is the name of the game! Help win the skin battle by becoming your customers' ally in the skin care and wound prevention war. Since skin is the largest organ and probably a pivotal point of your business, capture all the profits by adding advanced skin care to your product mix. Your clients and the bottom line will thank you!

This article originally appeared in the October 2004 issue of HME Business.