Skin: Your Face to the World

Is your skin the largest organ in your body?

That is a trick question that every medical student answers wrong at least once. The answer is “yes.” (Med students think of the heart and liver etc, and don’t realize the skin is an organ.) Given your skin is your interface with the world, it takes a fair amount of abuse. Yet despite this, it is a miracle of design and mostly stays intact.

The skin has much in common with a leather armchair at home. It is pretty hard to cut, rip or tear. It lasts almost forever, but looks pretty worn, even when it’s new.

The skin is covered with layers of dead epidermal cells. This is the body’s version of GORE-TEX® breathable shell. It is waterproof but allows sweat to escape. The waterproof part is absolutely essential to life. Your blood needs to be kept in a narrow range of sodium concentration (and other elements).

If your skin was freely permeable to water vapor it would dry up like a raisin. Skin is important for maintaining body temperature by controlling your sweat glands. Your body is fussy about staying at 98.6.

Going deeper into the skin we find the dermis. This is the strength layer of the skin. It has collagen and elastin elements. The collagen is what ligaments are made of and is very strong stuff. Its job is to keep the insides where they belong. Most of us are more concerned about the elastin. The elastin puts the tone in our skin, much like the waistband on your underwear. When the elastic/elastin breaks down, your shorts sag. Ah, but if only Fruit of the Loom made faces.

Sun and time inevitably break down elastin, keeping several industries busy.

Think of yourself as a rainforest. The skin has a unique ecology with tens of thousands of different bacteria, fungi and viruses. We mostly live in peace with this community, a quiet day in the rainforest. We have various relationships with these organisms from commensal to parasitic. Mostly they take up space on our skin and prevent something worse from growing. Kind of similar to “a healthy lawn grows few weeds” sort of thing.

Now the surface of skin looks more like a Thomas’® English Muffin than porcelain when magnified. There is oil on the skin surface secreted by sebaceous glands. Most of the bacteria live in this oil layer. That’s why we wipe you off with an alcohol pad before giving an injection. The alcohol acts like a solvent to remove the oil.

When you cut or chafe the skin, your own bacteria contaminates the wound and starts to grow. If you wait 12 to 24 hours there will be enough bacteria growing in the wound to cause an infection if the wound is closed (sutured). That is why it is important to close wounds promptly. Most wounds do best if closed within 12 hours. Some doctors don’t like to suture after even eight hours.

So if you think you might need sutures, get it checked out; right away. Until we get re-upholstery shops for bodies, we’d do well to keep the skin we have in good shape.

There are several things working against our desire to remain youthful — oxygen and age. Good luck avoiding either one of these. Oxygen is absolutely essential for life, but oxidizes pigments (free radicals and all that). Sun and oxygen combine to oxidize your house paint, making the color fade and develop cracks, not unlike sun-damaged skin.

Oxygen and sun (UV radiation) also cause breakdown of the elastin fibrils as we said before. Staying out of the sun, or using sunblock, is probably the single most important thing you can do for your skin.

Skin also likes moisture. Your skin will never feel softer than after a week in the tropics (rainforest). You might be bug bitten, grow mold, and have interesting hair, but your skin will feel great. Having said that, moisture from the inside is actually much more important than moisture from the outside. Remember the dead epithelial cells layers don’t let much into the skin from the outside.

What about the cosmetic industry? All the creams in the world will only work like a good leather conditioner. They might soften up the feel and prevent some cracking but they won’t create new skin. I hate to think of how many billions is spent on magic creams; my wife must have a dozen of them.

So if magic creams don’t do much, how about more radical approaches? You can sand down some of the outer dead skin layers-dermabrasion (or facial road rash). That will soften it up, and because it is so traumatic, the skin will be swollen for a while. The swelling stretches out the wrinkles. Kind of the healthy glow of road rash.

As a last resort, simply remove loose extra skin, thus tightening up the rest. Your neighborhood plastic surgeon can help you with that. Think of your underwear again, that stretched out old elastic waistband will stay on your backside if you take out a couple of inches, with a safety pin for instance.

You will still have crackly old elastic, but it will fit better — for a while.
So be mindful of the care and feeding of your skin. It’s the only part of you the world gets to see.

Take care of yourself (really).

Dr. B

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