title: Skin response to sustained loading: A clinical explorative study.
abstract: BACKGROUND
  Severe illness, disability and immobility increase the risk of pressure ulcer development. Pressure ulcers are localized injuries to the skin and/or underlying tissue as a result of long enduring pressure and shear. Little is known about the role of the stratum corneum and the upper skin layers in superficial pressure ulcer development.
  
  
  OBJECTIVE
  To investigate possible effects of long enduring loading on the skin barrier function under clinical conditions at two pressure ulcer predilection sites.
  
  
  METHODS
  Under controlled conditions 20 healthy females (mean age 69.9 (3.4) years) followed a standardized immobilization protocol of 90 and 150 min in supine position wearing hospital nightshirts on a standard hospital mattress. Before and immediately after the loading periods skin surface temperature, stratum corneum hydration, transepidermal water loss and erythema were measured at the sacral and heel skin.
  
  
  RESULTS
  Prolonged loading caused increases of skin surface temperature and erythema at the sacral and heel skin. Stratum corneum hydration remained stable. Transepidermal water loss increased substantially after loading at the heel but not at the sacral skin.
  
  
  CONCLUSIONS
  Skin functions change during prolonged loading at the sacral and heel skin in aged individuals. Accumulation of heat and hyperaemia seem to be primarily responsible for increasing skin temperature and erythema which are associated with pressure ulcer development. Increased transepidermal water loss at the heels indicate subclinical damages of the stratum corneum at the heel but not at the sacral skin during loading indicating distinct pathways of pressure ulcer development at both skin areas.
authors.affiliation: Charité-Universitätsmedizin Berlin, Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charitéplatz 1, 10117 Berlin, Germany. Electronic address: jan.kottner@charite.de.
authors.forename: J
authors.initials: J
authors.lastname: Kottner
authors.affiliation: Charité-Universitätsmedizin Berlin, Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charitéplatz 1, 10117 Berlin, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Dobos
authors.affiliation: Charité-Universitätsmedizin Berlin, Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charitéplatz 1, 10117 Berlin, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Andruck
authors.affiliation: Charité-Universitätsmedizin Berlin, Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charitéplatz 1, 10117 Berlin, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Trojahn
authors.affiliation: Charité-Universitätsmedizin Berlin, Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charitéplatz 1, 10117 Berlin, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Apelt
authors.affiliation: Charité-Universitätsmedizin Berlin, Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charitéplatz 1, 10117 Berlin, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Wehrmeyer
authors.affiliation: Charité-Universitätsmedizin Berlin, Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charitéplatz 1, 10117 Berlin, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Richter
authors.affiliation: Charité-Universitätsmedizin Berlin, Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charitéplatz 1, 10117 Berlin, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Blume-Peytavi
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D003668:Pressure Ulcer / Q000209:etiology; D012879:Skin Physiological Phenomena
keywords: Pressure ulcer; Skin barrier; Stratum corneum hydration; TEWL