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Skin is a specialized boundary tissue which forms the entire external surface of the body and is continuous with mucosa lining the respiratory, gastrointestinal, and urinogenital tracts at their respective openings. Skin is the largest organ in the body but is often overlookedin this respect. Skin has many functions, some of which are not immediately obvious. • It minimizes damage from mechanical, thermal, osmotic, chemical, and sunlight insults. • It forms a barrier against microorganisms. • It has a major function in thermoregulation. • It is a sensory surface equipped with touch, pressure, temperature, and pain receptors. • It has good frictional properties useful in locomotion and handling objects. • It is waterproof. • It is the site of vitamin D synthesis. • It also plays a role in non-verbal communication when we blush, alter our facial expression, or use tactile communication such as touching or kissing.Skin has two distinct parts when seen under a microscope, the superficial epidermis and the deeper dermis. The epidermis is a surface epitheliumin which the outer cells are keratinized. Keratinization is the deposition of tough mats of keratin which are intracellular fibrous proteins that make the cells tough; keratinization also kills the superficial cells so the outer layers of your skin are dead. The epidermis varies in thickness. The thickest and most heavily keratinized areas are on the soles of the feet and palms of the hands whereas the epidermis on the face and back of the hand is much thinner and less heavily keratinized. Habitual activity, such as holding a pen, digging with a shovel or using scissors, may produce localized thickenings of thick skin by increasing the thickness of keratin to produce calluses. Cells below the keratin layer have a special coating that forms a permeability barrier, preventing water moving between cells, thus preventing water loss from the body and water-logging when exposed to water. Epithelium does not contain blood vessels, which is why you do not bleed when you lightly knock your skin. To bleed, you need to expose the blood vessels that lie in the dermis and supply the overlying epidermis by diffusion of nutrients through fenestrated capillaries.

Skin colour is controlled by the level of pigments—coloured substances—produced by some of the cells that make up your skin. This chapter looks at conditions that can cause changes in skin colour by affecting the levels of these pigments. The ways in which skin colour varies, as well as the reasons for these variations, are discussed, along with an explanation of the areas of colour change that occur with freckles, birthmarks, and scars. The chapter then moves on to focus on a condition known as vitiligo, in which skin loses its pigment and therefore colour; the underlying causes, diagnosis, and treatment of this condition are all then explored.

The skin is an organ that serves many functions in maintaining homeostasis in the body (Bryant, 2000). A wide range of diseases manifest in changes in the skin and its appendages, and because the skin is visible and its disorders are often disfiguring, skin disorders can cause emotional and psychological stress for children and their families (Ball & Bindler, 2007). Skin diseases affect 20–33% of the population at any one time, seriously interfering with activities in 10% (Byrant, 2000). Epidemiological evidence suggests that many cases of skin disease do not reach the general practitioner (GP) or even the local pharmacist; nevertheless, each year about 15% of the population consult their GPs about skin complaints (Bryant, 2000). Skin disorders are among the most common health problems in children (Butcher & White, 2005). The infant and child are possibly more vulnerable to the effects of skin disorders and breakdown due to their underdeveloped integumentary system. Understanding the normal condition of the skin can help in the identification of abnormal signs and prompt treatment of skin disorders (Butcher & White, 2005). This chapter will focus on the integumentary system of the child, with reference to the normal structure of the skin together with common alterations and injuries to the skin of the child and the skills required for their nursing management. At the end of this chapter you should be able to do the following: ● Understand the normal child skin anatomy and physiology. ● Understand the fundamentals of a skin assessment in a child. ● Develop an awareness of the management of common skin alterations. ● Understand the nature and treatment of a child with a skin injury. The skin of an infant or child is normally fundamentally the same as that of an adult, although the blood and nerve supplies are immature and the dermis thinner, with less collagen and fewer elastic fibres. This means that the skin is fragile and can be more easily damaged through physical and mechanical trauma (Turnball, 2007). The skin of a newborn is found to have lanugo, which is a very fine, soft, and unpigmented coat of hairs covering its body until it is shed about 14 days after birth.