Skin is the boundary between who we are as we present ourselves to the world while acting as the barrier to the insults that we experience in our day-to-day existence. Skin is the largest organ in the body and as such it is critical to the maintenance of our bodies. If we suﬀer damage to our skin, we can suﬀer a loss of function.
To describe our skin as our boundary between ourselves and our environment underestimates how truly dynamic the skin function is. The barrier function of the skin is both dynamic and complex. We have learned that we live, for the most part, in harmony with a large number of bacteria in the environment. Current estimates are such that we believe that we have more bacteria on the parts of our bodies exposed to the environment than we have cells in our bodies. We also have learned that bacteria do not live in isolation. Historically, science has examined bacteria a single organism at a time. We are familiar with some of the names of these organisms precisely because they can lead to disease. Large numbers of bacteria reside on the skin and, as a result, a balance between the skin and the bacteria is required for normal function of the skin. We also have learned that these bacteria form communities that themselves are in a delicate balance. The awareness that bacteria exist in communities has led to new ways to study these groups and we refer to the collective grouping of bacteria as the “microbiome” or “microbiota”. The skin has its own “skin microbiome” where a balance in the skin’s environment allows for us to peacefully coexist with these bacteria bodies.
Detailed knowledge of the members of the skin microbiome has allowed us to develop and to continue to develop technologies that can be used to help reduce the risk of infection when the skin barrier is breached as part of current medical therapy. Reducing the number of bacteria on the skin is known to reduce the risk of infection following any type of disruption of the skin barrier: surgery or the placement of vascular catheters or direct therapy of an underlying disease become possible with a high degree of clinical comfort.
Our genetics and our lifestyles help to determine the health of our skin. We are more familiar today with genetics and our genetic makeup than ever before. The skin reﬂects genetic changes, although genetic change in the skin is more often associated with disease than with function. Genetic changes can be subtle or dramatic and complex as well, requiring years before they are expressed clinically and become apparent both to the patient and to the caregivers.
Our unique genetic composition may take years to express the dynamic nature of the skin over long timeframes. There can be changes in skin function that we can observe over a matter of minutes, over hours, over days, over weeks or over years. The skin is a dynamic organ over all of these timeframes and it varies over all these time frames in a continuous fashion. The ability to understand the interplay of who we are as given by our genetic makeup and the dynamic responses of our skin to the world around us constitutes the science of skin. Reducing the number of bacteria on the skin prior to surgery or over the entire time course of treatment with a vascular or other invasive device that engages the skin as part of therapy requires a dynamic understanding of the skin’s responses. The understanding of the science of skin is critical in order to allow for the successful development of technologies that require the successful interaction of the technology with the living skin.
Clearly, the skin is a dynamic organ, reﬂecting who we are in the presence or absence of a disease. Our ability to have our skin maintain its integrity and ability to act as a barrier against damage and infection depends on our age, genetics, environment exposures and underlying clinical condition. It may be the case that as we look for medical care in the near future we may be able to state not only our age but we may develop the capacity to describe the “functional” age of our skin since so much of modern therapy depends on the ability to adhere to skin.
For more information, download the whitepaper, “Science of Skin: Skin Through the Ages”.