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Wound Care Insights: Dermis and Epidermis

As Brian DeCastro mentioned in our interview a few months ago, people die of organ failure. Since the skin is the largest organ of the body, this week’s installment of our wound care insights series is the dermis and epidermis, and the structures therein.

Understanding the skin and skin pathology plays a vital role in the assessment and treatment of both wounds and lesions throughout the body. As patients age, certain changes occur to the skin which make it susceptible to a variety of disorders.

Although we see the skin as a simple organ, it is actually quite complex. If the skin is not properly cared for, it can become vulnerable to diseases and reactions, which manifest rapidly and are difficult to treat.

The skin is composed of two primary layers: the epidermis and the dermis. The epidermis is the outer section, composed of a stratified squamous layer. Five epidermal layers make up the epidermis and act as a biological conveyor belt, bringing new cells to the surface. These layers are:

STRATUM CORNEUM: the outermost layer and thickest layer of the epidermis, which is composed of dead keratinocytes.

STRATUM LUCIDUM: the second deepest layer, consisting also of dead keratinocytes.

STRATUM GRANULOSUM: the next deepest layer is a three to five cell layer with increasing concentrations of keratin.

STRATUM SPINOSUM: the penultimate layer, containing mature living keratinocytes.

STRATUM BASALE: the deepest layer, which consists mostly of keratin producing keratinocytes.

Through the process of mitosis, cell division occurs at the stratum basale, pushing new cells up to the surface. Within these various layers, the epidermis consists mostly of living and dead keratinocytes, the cells which make keratin, a protective protein. Keratin is important in creating barriers from environmental factors and toxins, maintaining skin integrity, and preventing water loss.

The epidermis is an avascular structure which lacks its own blood supply. The lack of blood in the epidermis becomes important as we try to ascertain how to best moisturize the skin.

The epidermis contains appendages rooted within the dermis, and these include:

HAIR FOLLICLES: composed of a sebaceous gland at the base, which secrete sebum.

GLANDS: an opening that originates within the dermis and secretes substances into the surroundings.

NAILS: consists of hard keratin.

HAIR: mainly composed of soft keratin; its main purpose is to regulate body temperature.

The dermis is the second section of the skin. It is found under the epidermis, separated from it by a basement membrane.It has two layers, called the papillary and reticular dermis, and these contain the important glands for the skin, including sebaceous and sweat glands.

The dermis is highly vascular with a red appearance. It is composed mainly of collagen and elastin, which give it strength and elasticity.

As skin ages, the thickness and hydration of the dermis and epidermis decreases, while the cell turn-over rate increases. This results in cells that have not properly matured, and the skin thus becomes thinner and more fragile. Many of the appendages, such as sweat glands, decrease in number through the aging process as well, leaving elderly patients more vulnerable to disease.

In order to counter the natural aging process of the skin, and keep our patients in the best health possible, it is important to monitor their skin for lesions and other potential breakdowns. Monitoring nutrition is also a good way to make sure that patients have the nutrients they need to keep their skin healthy.

Baths, while necessary, shouldn’t be too hot or too long. In order to keep the skin from drying out, bathing should be done with lukewarm water, and only for a few minutes. Directly afterwards, use a topical moisturizer to rehydrate the skin.

Skilled Wound Care is a mobile surgical practice committed to transforming the chronic wound care model in nursing facilities. Wound care experts make weekly bedside visits to patients in long-term care facilities, avoiding transfers to hospitals or clinics. Our expert physicians give patients the most up-to-date and effective wound treatments, and educate facility staff on how to help patients continue to heal quickly and effectively between visits. This model of collaborative care allows SWC’s physicians to improve patients’ lives and health outcomes, to empower nursing staff, and to raise public awareness. Skilled Wound Care, along with its nurse and nursing home partners, is working every day to positively transform traditional nursing home wound care.

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