What Should My Skin Look Like?

Posted by Nurse Linda in Life After Paralysis on November 24, 2021 # Health

Skin is a fabulous body part. It is a body organ but the only one that meets the outside world. In fact, your skin is the first line of protection to keep your internal organs safe from harm in protecting your inner body safe from dirt, or other irritants from entering, including bacteria. Skin maintains and regulates body temperature by sweating to cool the body and regulating internal body temperature by opening and constricting blood vessels to cool or keep your body warm. It also serves the important function of feeling sensations and alerts you when you are touching something that is too hot or cold.

Skin has several layers. The innermost layer is the hypodermis or subdermal, which consists of fat and connective tissue. Contained in this layer are nerves and blood vessels and the basis of hair follicle roots, oil glands and sweat glands, which continue through the layers of skin above. The layer above is the dermis. This layer consists of collagen and elastin, the components that give your skin the ability to stretch when needed for movement and comfort.

Healthy Skin-Darkly Pigmented The epidermis is the top layer that you can see. This is the layer that you can assess. That makes it important for you to know how your skin looks. The epidermis is about as thick as a piece of paper, but it contains four layers in most of your body. Since the palms and soles take the brunt of work and force to your body, they are a bit more protected with the fifth layer of skin to make it extra durable.

Healthy Skin-Lightly Pigmented

There are no blood vessels in the epidermis. A human does not have blood vessels that are close to the outer surface of your body, or you would be bleeding if you bumped yourself. Therefore, the epidermis is for protection. Because of the lack of blood, many people think this layer of skin consists of dead skin cells. But it is really full of keratin, a fibrous protein that gives this outer layer of skin hardness, strength, and water resistance. Melanocytes are located in the bottom layer of the epidermis. These cells produce melanin which creates the pigment of your skin.

The outer layer of your skin should have a rather soft feel to it if you gently rub the top of the surface. This is from a moisture barrier that protects your skin as well as assists in keeping any bacteria from slipping into your body. Soft skin is not often thought of as moisture because moisture is considered to be wet like running water. But on the surface of the skin, softness sensation is from an extremely thin wet surface (mucous membrane) and a faint amount of moisture between the skin cells. Here is a visual image of what skin moisture looks like.Mucous Membrane

Dry skin has this moisture barrier reduced or even mostly eliminated. If sweating or creating moisture on your skin surface is an issue as it can be with neurological disease, the skin may feel dry. Since this moisture barrier cannot be seen, there might be dry, cracked, or even flaky skin symptoms on the surface. Keep your skin moist from within your body by drinking fluid, especially water, and outside your body by applying moisturizers to maintain your skin's hydration.

Skin may have freckles, brown spots, various amounts of hair or moles, which are normal. It should feel moist. However, if there is a change in any of these, it is time to have the area assessed by a healthcare professional.

These are some skin irritations. This is a list of common skin issues. It is not complete as there are many.

Rashes can occur on the surface of the skin or from within the body. A rash may have discoloration on the skin ranging from ashy, purplish, pink or red. Some rashes do not have skin color changes but itch. Some have both skin discoloration and itching. Rashes can be flat on the skin or elevated with small bumps, blotches, or large pustules. Surface rashes are generally from direct contact with something that you are allergic to, scratching an area that creates an opening in the epidermis where bacteria can enter, something rubbing against your skin, or from too much moisture in a crease or fold of the skin. Rashes from within the body are generally from something you drank or ate, inhaled, or a metabolism disruption within the body. Rashes can also develop from bug bites.

Rashes in folds and creases of the body can develop from too much moisture on the skin. Not drying effectively after bathing, frequent use of soap without careful rinsing, caustic substances on the skin such as urine and fecal material are all culprits. The use of incontinence containment devices serves the job of containing moisture that can induce rashes. Areas that are mostly affected are the groin, gluteal fold (butt), the area where your thighs meet your belly, back of the knee, underarms and under breasts.

Some things to reduce rashes include bathing with a mild soap, rinsing completely and drying skin thoroughly. Let your skin folds open to the air occasionally. Sitting all day with your thighs against extra skin in the abdomen or any skin folds create an environment that keeps the area moist. A folded washcloth placed between skin folds can allow air to circulate. Be alert for autonomic dysreflexia (AD) as the skin position change can also trigger symptoms. Gas is passed from the rectum by everyone. Containment equipment does not allow air to circulate to dry the area. Dark, moist skin folds are at risk for bacteria development, rashes, and skin injury. Avoid harsh chemicals in laundry soaps and lotions. Ensure your equipment is not rubbing against your body.

A more advanced type of rash is dermatitis, and inflammation of the skin. These can also be from skin medical issues such as eczema, which results from an overactive immune system that produces an itchy rash. Psoriasis is an autoimmune skin issue that looks like a red patch of skin with silvery scales. Rosacea is an inflammatory rash that appears mostly on the nose and cheeks of the face but also occurs on the forehead and chin. It can develop into bumps, enlarged blood vessels, thickening of the skin and eye irritation.

Acne is the most common skin issue. It is most often seen in teens but can affect anyone at any age. Acne is a clogged pore on your skin. Use a mild cleanser or product developed to control acne. Medications are available for severe cases. Some spine stabilizations surgeries are delayed due to acne on the back because of the risk of infection when opening the skin.

As protective as your skin is, bacteria can still make invasions into your body. Cellulitis is an inflammation of the skin due to infection. There are usually pigment changes in the skin; the area is warm and painful. An abscess is a localized skin infection. There may be pus visible under the skin. Infections of the skin should have a medical evaluation and treatment.

Neurogenic Skin: Sometimes, with neurological disease or injury, the skin may look waxy, especially in the areas of the body affected by the neurological issue. The epidermis has many sensory nerve endings which can be affected, leading to chronic inflammation within the skin. When the skin detects a sensation, the nerves release neuropeptides (nerve signaling molecules). The cells of the skin release neuropeptides and neurotrophins (proteins that help nerves) which create a feedback loop. This can be disrupted by the autonomic nervous system (ANS), the part of the nervous system that controls automatic functions. Neurogenic skin can be the result of disease or injury such as spinal cord injury, stroke, or other neurological issues or directly from some skin conditions such as atopic dermatitis, psoriasis, and rosacea. The connection between nerves and the inflammatory process is still under study.

Growths on the skin can range from normal to severely dangerous to your health. Skin cancer is an abnormal growth of cells. New, changed growths or any sore that should not be checked by a healthcare professional. Issues such as skin tags, moles, or warts should always be examined as there is no way that you can be certain if it is cancerous or not. Changes in areas of skin are a reminder to have a complete body check as all spots should be assessed. Do not lull yourself into complacency. Have the area examined by a healthcare professional.

These are the ABCs of melanoma, but they can be used for the assessment of many skin cancers.

"A" stands for asymmetrical. Does the mole or spot have an irregular shape with two parts that look very different?

"B" stands for border. Is the border irregular or jagged?

"C" is for color. Is the color uneven?

"D" is for diameter. Is the mole or spot larger than the size of a pea?

"E" is for evolving. Has the mole or spot changed during the past few weeks or months?

CDC Guidelines

Pressure Injury individuals with decreased sensation for any reason need to monitor their skin for pressure injury. This is first seen by a change in skin pigmentation, most often over a place where the bone is prominent. If you see a change in pigmentation, stay off the area entirely until the pigment change resolves. This means entirely, not just sitting or lying on the area for just a few minutes. That negates all the time spent trying to resolve the issue.

Scars are places where the skin has been damaged and repaired. They are not elastic like your natural skin. Therefore, the breakdown is easier in a scared area since it does not give your original skin as it moves or flexes. Scars can be softened and even reduced with products such as scar tape, but the area will always be fragile.

A keloid is an overgrowth of scar tissue. It is a scar that keeps forming even when the open area is covered. It generally looks like a scar area with a raised area on the top. Individuals of all skin pigments can develop a keloid.

Take an inventory of your basic skin to see what yours looks like without any issues. Keep a record of how your skin looks so you can tell if there are changes. You can document this on paper or use your personal and confidential cell phone to photograph your normal skin and any concerns.

This is just a brief composite of the most common skin issues. Your healthcare provider will direct you to the treatment of your skin concerns. If you have skin issues, you may want to consult a dermatologist who has extensive knowledge in the treatment of rashes and cancers. A rehabilitation specialist is experienced in the treatment of pressure injury. Nurse Linda

Pediatric Consideration:

Needless to say, diaper rash is the most common issue for infants and small children. This is because the containment diaper is not letting air circulate, holds urine and fecal material next to the skin, and creates an environment for bacteria to grow. There has been extensive development in disposable diapers to wick moisture away from the skin, but this cannot be achieved with 100% certainty. Frequent cleaning with a mild soap, changing when the diaper is soiled, and even airing the area helps reduce diaper rash.

There are many products that can serve as barriers to the skin. Often there is a trial-and-error process to find the right product for the particular diaper rash. You may find a product that works only to discover it does not work for the next rash. Each diaper rash is a bit different. Prescription ointments are also available for severe cases.

Often adults think of young skin as being healthier than adult skin. This is not necessarily the case. Infant, young children and teens have issues with skin with or without neurological and sensation issues. Monitoring your child's skin is critical to their overall health. Nurse Linda

Linda Schultz is a leader, teacher, and provider of rehabilitation nursing for over 30 years. In fact, Nurse Linda worked closely with Christopher Reeve on his recovery and has been advocating for the Reeve Foundation ever since.

In our community, Nurse Linda is a blogger where she focuses on contributing functional advice, providing the "how-to" on integrating various healthcare improvements into daily life, and answering your specific questions. Read her blogs here.

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The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $8,700,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.