As Plain as the Skin on Your Feet: The ABC’s of Skin Care

Michelle Durkin, BSc

The skin is the largest organ of the body and the most visible. Ironically its importance in health promotion can be easily overlooked, especially in elderly patients. Because the skin is the first line of defense against infection, disease, and injury, proper skin care is always important. As the skin ages, however, the importance of its care increases, because structural changes occur which are responsible for compromised skin functioning (see Table 1) and a transformation in appearance (see related article on the aging skin: Wrinkles, Age-spots and Spider Veins Primary Aesthetic Concerns).

Structural Changes

Initially a decrease in the number of collagen and elastic fibers causes the skin to be less supple and wrinkles begin to form. Then layers of skin tend to thin which results in decreased protection from infection and trauma. Shock absorption is reduced and bruising, blistering and tearing of the skin occur more frequently.

The skin also becomes more dry with age. This is because of a decrease in the size of sebaceous glands that normally produce oil to lubricate and moisturize the skin. Eventually dry skin will cause itching which in turn leads to inflammation and possibly infection. Susceptibility to infection is also increased because the number of Langerhan cells will decrease as well. Consequently there is a decrease in the immune responsiveness of older skin.

There are also other fluid changes that occur in the skin. The production of sweat diminishes, which may contribute to the increased incidence of heat stroke in the elderly. Also, blood flow may be disrupted, which could lead to water retention, especially in the lower legs.

The Basics of Skin Care

In order to prolong optimal skin functioning and prevent health conditions such as neurodermatitis and bacterial superinfection of wounds, educating elderly patients about proper skin care is important. During the summer of 1998, two Nurse Clinicians at the Geriatric Day Hospital at Sunnybrook and Women's College Health Sciences Centre in Toronto, Valery Pociluyko and Angela Branscombe, wrote a pamphlet entitled "Summer Sun Sense," which was distributed to the elderly community throughout the hospital. In an interview Ms. Pociluyko emphasized four factors which encompass the basics of skin care in the elderly:

A. Protection--Many of the problems in skin appearance and advanced skin aging is caused by sun damage. Extensive exposure to UV light may cause spots which could eventually lead to skin cancers. Therefore, it is important to wear sunscreen when outside, especially if one is planning to be out for more than fifteen minutes at a stretch. Even on cloudy days the sun's rays can be damaging. Although wearing sunscreen may not reverse damage it can prevent further damage that would otherwise occur.

B. Lubrication--In order to avoid dry skin, lubrication is the key to locking moisture in. Older patients should use non-perfumed, non-drying soaps when cleansing. They should also apply a skin lotion to the whole body after showering or swimming and at bedtime. It may also be beneficial to use a humidifier on cold, dry winter days.

C. Nutrition--Proper nutrition is important for any organ to function properly. It is often harder for the elderly to obtain proper nutrition because they tend to have smaller appetites. Nutrition includes getting the essential vitamins and minerals and most importantly, proper hydration. Drinking lots of water and other fluids helps keep the skin from drying out, which may lead to inflammation and infection.

Feet will often be the first indicator of whether or not a person is properly caring for their skin.

D. Regular Inspection--Inspection is not only important for an individual but the physician as well. If an older person's eyesight or flexibility is failing, they may need assistance. A thorough inspection of the skin, feet and ankles should always be done. Any changes in skin should be identified, especially sores or moles. Both physicians and patients should be aware of changes in colour, size or shape of any visible lesion. Patients should also have any scaly spots that itch or sting examined by an expert, as they could be precancerous or malignant.

When inspecting the feet, physicians should look for calluses and thickened toe nails. Feet will often be the first indicator of whether or not a person is properly caring for their skin. For example, if the toe nails are thickened there may be a fungal infection and this may indicate poor hygiene or peripheral neuropathy.

In conclusion, in order to prevent and/or delay pathological conditions associated with the skin, proper functioning of the skin is needed. For proper functioning protection, lubrication, nutrition, and inspection are the basic necessities.