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Posted: January 31, 2008

Protecting the Skin We’re In

Keeping Sores, Infection Away with Loving Care

Our skin can be our friend or our foe. It’s our largest organ, which if laid flat from an average adult, would cover about two square yards and weigh about nine pounds. That’s a lot to protect us – and a lot to get damaged, all too often at the hands of a harsh winter or a confined environment such as a hospital bed.

To keep skin as our friend instead of foe, we must be alert to the signs of trouble and constantly be aware of the care required both for aging, sensitive-skinned loved ones as well as our caregiving selves.

Remember that skin acts as a barrier, protecting the network of bones, muscles, nerves, blood vessels, and everything else inside. The outer layer of skin is called the epidermis. The next layer of skin is called the dermis, a layer made up of blood vessels, nerve endings, and connective tissue. There are two types of fibers in the dermis, collagen and elastin. Collagen is tough and hard to stretch and helps skin hold its shape, while elastin, as the name suggests, is elastic.

Breaking Down with Age

As we age, some of the elastin fibers degenerate, and this leads to wrinkles. The dermis also contains sebaceous glands, which are glands that produce an oily substance that lubricates the skin and hair. And again, as we age, these glands produce less oil, causing skin to dry out.

Because our skin becomes drier and less elastic with age, it tears more easily. Especially in dry winter weather, we are at risk for cracked skin on our hands and feet. When the skin barrier is broken, we are at risk for infection. This is especially a concern for the elderly, whose immune systems may be compromised by these ruptures, even small ones.

When I worked as a home health caregiver in Cincinnati, Ohio, I saw many clients with skin problems. The worst problems occurred when clients were confined to bed. When a person is unable to get out of bed, or when they sit in a wheelchair all day, they are at risk of developing decubitis ulcers, which are better known as pressure sores or bed sores. These sores are most likely to occur on the buttocks and/or the heels, where there is constant pressure on the skin.

Lee Brooks was one such client. He was terminally ill, and his mother Elaine had been caring for him at home. She was an older woman and had difficulty turning him in bed. The resulting pressure of his buttocks against the mattress all day and night caused bed sores, which soon became infected. Once bed sores develop, it is very difficult to cure them. It is far better to prevent them.

Alma Davis was lucky. Her husband cared for her. She was also terminally ill and confined to bed, but her husband repositioned her every few hours. He took care to make sure her skin stayed clean and dry, and applied a moisturizing lotion. Her skin looked beautiful.

What to Look For

Signs that bed sores may be developing include dark red spots on the skin that don’t fade right away when a person is repositioned. If your loved one is confined to bed or a wheelchair, you should check daily for signs of bed sores. Repositioning them every few hours, keeping their skin clean and dry, and using a moisturizing lotion can help prevent pressure sores.

There are special mattresses and seat cushions that can help prevent bed sores or help sores heal if they have already occurred. A special air mattress was ordered for my client Lee Brooks, and that, along with antibiotics to treat the infection, helped his sores heal. I had another client, Stan Corvey, who was quadriplegic. He spent all day sitting in a wheelchair. He used a special cushion to help prevent pressure sores. This was very important, because if he started to develop a sore, he would have to stay in bed until the sore went away -- and he hated to be confined to bed. Ask your loved one’s doctor about special mattresses or seat cushions, or check with your local medical supply store.

When I worked as a home health caregiver, I had skin problems of my own. In the course of my day, I had to wash my hands dozens of times. As a result, my hands became dry and the skin cracked. This put me at risk for getting some sort of infection, which was not good since I worked with sick people. I could easily pick up an infection from a client, and if I got an infection, I could easily pass it on to another client. Ideally, I would have applied a moisturizing lotion after each hand washing, but that would have been time consuming and simply wasn’t realistic. Instead, I found a water-resistant hand cream. Look for one at your local pharmacy.

While we’re talking about hand washing, wash your hands with a mild soap and water. Avoid using those hand sanitizer products that don’t require rinsing. They have high alcohol content and will dry out your hands quickly.

Remember, the older you are, the more likely you are to have skin problems, because your skin makes less oil and is drier. Your skin is also drier in the winter, because there is less humidity.

Tips for Treating Skin

Lynn Starner is the founder of Beauty Bliss Mineral Cosmetics, a company that makes all-natural cosmetics that are healthy for the skin. She offers the following tips for treating dry skin:

Lynn also advises keeping an eye on the feet, especially for people with diabetes. Dry skin can cause the skin to crack and lead to infection, which can cause serious problems for diabetics.

The National Skin Center adds that the elderly are at particular risk for skin infection because their skin becomes thinner than that of younger people, making it more likely to tear. Therefore, preventing dry skin becomes even more important.

Visit your local pharmacy to find skin care products. Look for moisturizing lotions that contain sun block if you or your loved one spend much time outdoors. Look for lotions that are water resistant if you must wash your hands frequently. Stock up on the supplies you need to keep your skin healthy this winter. And don’t forget to talk to your loved one’s doctor about particular any skin problems you may notice.


Kelly Morris is a former social worker and home health and hospice worker whose writing has appeared in a number of health-related journals. She lives in Mansfield, Ohio, and can be reached at

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