The skin is the external covering of the body. It is tough and, at the same time, pliable. Its major function is to protect the underlying cells. Just like the heart or the liver, the skin is an organ. In fact, it is considered the largest organ and is every bit as complex, if not more complex, than any of the other organ systems of the body.

     The skin serves several protective functions:

• Its unbroken surface presents a barrier against air, water, most foreign substances, and germs.
• The skin has the ability to repair its own minor wounds, such as scratches and bruises.
• Regulation of heat loss is another important function of the skin. The body is cooled by the evaporation of sweat and the radiation of heat through the skin.
• The skin is well supplied with nerves, and, because it is, the skin gives us the sensations of pressure, touch, pain, and temperature.
• The skin has the ability to eliminate water, salts, and oils.
• Beneath the skin is a layer of tissue containing fatty materials which have both insulating and cushioning properties. Both the skin and the fatty tissue cover and protect the muscles.

     Skin management is an important aspect of care for individuals with brain injury. For patients in coma or for those with muscle paralysis or weakness, skin must be monitored carefully to prevent the development of skin sores, also called pressure sores, decubiti, decubitus ulcers, or bedsores. Bladder incontinence, common in many brain injury patients, is also a significant risk for developing skin problems. Because of changes in cognitive (thinking) skills, many patients need instruction and reminders about monitoring skin condition and assisting in the management of skin breakdown.

     The social impact of skin problems far outweighs almost all other problems you may encounter. A skin sore can mean several weeks of hospitalization or bed rest in order for the sore to heal. This can mean valuable time away from your job or school.

     The most important point, however, is that skin problems are preventable. By eliminating the causes of skin sores and with routine inspection of your skin, skin sores need not happen. You must be responsible for your skin care. You must know the condition of your skin and the early warning signs of skin sores. Skin management cannot be neglected. Skin management is of vital importance to you and your continued ability to function.