The body encompasses all the rest of the skin not previously discussed, except for the skin fold areas. Most notable body areas for discussion are the back, chest, arms, and legs. The skin on the body does not heal as well as the face and neck. The further the skin is away from the face, the poorer the surgical result. This is due to the thicker skin in these locations accompanied by the distance away from the heart and a poorer blood supply.
Anatomy and Physiology
The thickest skin of the body is present on the upper back due to the need to sustain pulling and twisting movements from arm motion. This thick skin does not heal well and is a common site of unsightly scars. The poorest healing parts of the body are the upper chest, upper arms, and upper back where hypertrophic scars (thickened scars) and keloids (scars that extend beyond the boundary of the injury) may form with increased frequency. Oil glands are also reduced in these areas making careful cleanser selection and the use of moisturizers important. One of the itchiest spots on the entire body is at the base of the shoulder blade on the back. It is not quite clear why is this the case; however, this spot is extraordinarily difficult to reach and is a common place where people routinely rub against a doorframe!
The arms and legs form another anatomic area. Both sites possess skin that is designed for movement accompanied by hair growth. The oil glands are more numerous here than on the back and chest, but these are frequent sites of skin dryness in the elderly.
Common Dermatologic Disease Considerations
Most dermatologic diseases affect the body, thus a complete discussion of this topic is beyond the scope of this text. For those who wish additional information, a recommended reading list is presented at the end of the chapter. However, it is worthwhile mentioning that the most common skin disease of the body seen by the dermatologist is dry skin, known as eczema. Why is this the case? The reason can be simply stated as overbathing. Many people feel a need to bathe daily and some twice daily. Bathing the body has become a ritual. Some bathe to relax prior to retiring for the night while others bathe to wake up. Athletically inclined individuals bathe after each exercise session. The elderly, who are otherwise inactive, may bathe frequently as they find the warm water soothing for achy muscles and joints. This excessive amount of cleanser and water contact eventually removes not only the sebum, but also the intercellular lipids, causing dry skin. The skin cracks, exposing tender dermal nerve endings, and itching ensues followed by scratching. This further damages the skin barrier and more itching and more scratching occur. Finally, the skin barrier is in complete disarray and the dermatologic disease of eczema is present. This sequence of events is known as the itch-scratch cycle. Successfully controlling the
eczema depends on stopping the itching, repairing the barrier, and restoring the skin to health.
Hygiene Needs
This means body hygiene is a careful balance between removing enough bacteria to prevent disease and body odor while leaving the skin barrier undamaged. This is indeed quite a challenge. It would be nice to somehow develop a cleanser that could distinguish between sebum and intercellular lipids, removing the former while leaving the later untouched. This should be the goal of all therapeutic body cleansers.
Skin Care Needs
The desire to bathe frequently has created moisturization as the major skin need of the body. Body moisturizers should create an optimal environment for healing and quell itch, leaving the skin smooth and soft. The moisturizer must function in hairy body areas and leave behind a breathable film that does not prevent sweat from evaporating from the body surface. The construction of moisturizers for this purpose is discussed in Chapter 6.