Skin care is a universal need, as skin health is essential for well-being, and aging skin becomes less able to maintain its metabolic processes, resulting in the barrier breakdown and signs of aging that have a detrimental effect on quality of life and socioeconomic consequences. Factors that contribute to loss of skin integrity include: reduced peripheral sensation, impaired mental health, chronic diseases, medication and inadequate nutrition. Skin conditions are highly prevalent; approximately 70% of elderly people in the U.K. experience skin problems, many of which are preventable,1 with the spectrum of skin conditions ranging from skin redness and slight flairs of eczema or acne to clinical disease.
The skin is an organ of display, and youthful, healthy-looking skin is considered attractive in many societies.2 Therefore, visible skin deterioration can be a significant issue—no age group is immune to the “look good, feel good factor.”3 However, older people are more likely to endure skin deterioration, seeing it as an inevitable part of aging or being fearful that their concerns will be seen as trivial4 or an indication that they are not coping with life.5
Public Face of Skin Care
The purpose of skin care is to maintain skin barrier function and produce a sense of well-being. Skin care practice is often culturally ingrained and guided by ritual. There are numerous professions concerned with the skin: the dermatologist, the dermatology nurse, the esthetician and even the skin care sales assistant. Their expertise, approach, perspective and degree of authority in skin care decision-making is different. Yet, finding common denominators is beneficial, and all of these professionals are skin care consumers themselves. Furthermore, they all benefit from advancements in technology and manufacturing of consumer and therapeutic skin care.
Skin diagnosis is a prime skill in skin care. It is conducted in dermatology with descriptive language to name physical signs (macule, papule) and through recognition of skin function failure. Assessment of skin function can involve skin imaging—which are static, frequently not life-sized and rarely illustrate the dynamics of skin diseases, such as itching.6 Therefore, diagnosis increasingly relies on atlases, algorithms and the laboratory.
Dermatologists emphasize observable criteria of effectiveness, such as clearance of the lesion, while people with skin conditions focus on the subjective concerns, such as softness and alleviation of itch.7 This discrepancy might lead to inadequate use and frequency of skin care application. Clinical skills are being replaced by tests, yet the magic of interaction with people is often missing. Touching the diseased skin, where the patient sees the clinician’s involvement, is an easily understood sign of caring about the patient’s problems.6
Skin care, too, should be one of the cornerstones of nursing. Nurses gather information to assess people’s skin by listening (past medical history, current medication, skin care routine, psychological well-being, reported feelings about body image), looking (skin quality, signs of irritation), touch (texture) as well as smell.
Estheticians also visually assess skin condition, although they are not always recognized as partners to healthcare professionals. And like nurses, estheticians have to be good listeners. Self care is becoming central to U.K. health policy, and estheticians (beauty therapists) are trained to recommend at-home skin care routines. As with other skin care professionals, when estheticians advise people on skin care, it is important to have a holistic approach and to tailor routines to individual needs and lifestyle, using products that are readily available and have a pleasant feel for the people using them to ensure compliance. The information estheticians provide should include teach materials about skin conditions and symptoms, their exacerbating factors and therapeutic options with benefits, risks and realistic expectations.8
Collaboration Between Formulators and Skin Care Professionals
Medical professionals have challenged the research carried out by the skin care industry in the past. In his book Bad Science and in his presentation at the Society of Cosmetic Scientists’ 5th Annual Scientific Symposium, Ben Goldacre, MD, argued that cosmetic scientists purposely mislead the public and forego integrity to sell product. There are skin care manufacturers that have clearly exaggerated product claims; however, there is clinical evidence often attached to skin care benefits measured by unbiased and impartial bioengineering techniques. Goldacre has also argued that clinical work proving the efficacy of cosmetic products has not readily been published in peer-reviewed journals,9 not taking into consideration peer-reviewed cosmetic journals such as Cosmetics & Toiletries and the International Journal of Cosmetic Science. In addition, he also does not consider competitive advantage, patent protection and regulatory issues that are common issues with publishing cosmetic studies.
Regardless, if skin care professionals—doctors, estheticians, manufacturers, etc.—work together in an openly collaborative way, research, products and consumers outcomes can be positively impacted. Innovation often happens at the borders of divergent disciplines. True collaborative effort requires not only sharing of good practice but also respect and recognition among all skin care professionals. Cross-functional scientific meetings, such as the biannual conference of the International Society for Stratum Corneum Research, can provide an environment for the initial discussion.
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1. F Cowdell, Promoting skin health in older people, Nursing Older People, 22(10) (December 2010) http://nursingolderpeople.rcnpublishing.co.uk/archive/article-promoting-skin-health-in-older-people (accessed Apr 8, 2013)
2. PJ Matts and B Fink, Chronic sun damage and the perception of age, health and attractiveness, Photochem Photobiol Sci 9(4) 421-31 (2010) www.ncbi.nlm.nih.gov/pubmed/20354634
3. C-K Ong and T Ryan, Healthy Skin for All: A Multi-Faceted Approach, International League for the Dermatological Sciences, Oxford, UK (1998)
4. N Fanos and R Laird, Management of common skin disorders in the elderly, Family Practice Recertification, 23 10 15-30 (2001)
5. Report on the Enquiry into Skin Diseases in Elderly People, Associate Parliamentary Group on Skin, London (2000). APGS, London
6. D: Diagnosis, http://www.skincareforall.org/a-z/d/ (accessed Apr 8, 2013)
7. SJ Ersser, H Surridge and A Wiles, What criteria do patients use when judging the effectiveness of psoriasis management? J Eval Clin Pract Nov 8(4) 367-76 (2002)
8. NH Nicol and SJ Ersser, The role of the nurse educator in managing atopic dermatitis, Immunol Allergy Clin North Am Aug 30(3) 369-83 (2010)
9. JW Wiechers, Is Cosmetic Science Really “Bad?,” www.cosmeticsandtoiletries.com/research/chemistry/50786997.html (Jul 9, 2009) (accessed Apr 8, 2013)