Factors Contributing to Skin Breakdown
- Pressure – Most common among individuals who are immobilized or debilitated on pressure point areas where tissue is squeezed between a bone and a firm surface such as a chair or mattress; Pressure results in tissue hypoxia and cell death from capillary occlusion
- Friction – The result of the skin being moved one way while a surface is stationary, or
moves in the opposite direction - Shear – The result of skin being pulled in one direction, however supporting structures such as muscle and bone do not move, or move in the opposite direction
- Thermal Damage – Frostbite/Burn
- Radiation – Tissue becomes fragile and poorly oxygenated; Fibrosis and vascular scarring will eventually develop
- Iatrogenic – Health care provider activities
- Smoking – Smoking reduces the amount of functional hemoglobin in the blood and therefore decreases tissue oxygenation; Smoking may also increase platelet aggregation and cause coagulability
- Drugs – Corticosteroids reduce inflammatory response and slow collagen synthesis
- Anti-inflammatory drugs suppress protein synthesis, wound contraction, epithelialization, and inflammation
- Prolonged antibiotic use may increase risk of superinfection
- Chemotherapeutic drugs can depress bone marrow function, lower number of leukocytes, and impair inflammatory response - Malnutrition – Deficiencies in any of the nutrients may impair all phases of healing
B. Internal Factors
- Systemic – Coexisting disease; Malignancy
- Aging – Reduces skin ability to produce elastin and collagen making it thinner and less elastic
- Inflammatory response is slowed
- Reduced liver function alters synthesis of clotting factors - Obesity – Tissue lacks adequate blood supply to resist bacterial infection and deliver nutrients
- Infection – Prolongs the inflammatory phase thereby delaying collagen synthesis, preventing epithelialization and may result in further tissue destruction
C. Internal/External Factors
- Body Fluids – Skin damage can occur because of urine, feces, perspiration, and fistula damage
- Allergic Reactions – Contact dermatitis can occur when the skin is exposed to a substance that irritates or triggers the allergic response
