皮膚的告白
楊惟婷
一、皮膚的生理結構
在進行美容保養之前，必先追本溯源，從了解皮膚的組織開始。簡單的說，皮膚的構造可分表皮、真皮和皮下組織三部份。
（一）表皮
表皮就是我們眼睛看得到的部位。它能維持身體必需的體液，並隔絕可能有害的物質，如碰、撞、細菌、紫外線…等。
在表皮的最上層覆蓋著薄薄的脂肪膜，它是由真皮中皮脂腺分泌出來的油分，透過毛壁擴展到皮膚表面的皮脂，和由汗腺排泄出來汗液，在皮膚表面混合乳化而形成一 層『弱酸性』的薄膜。如果分泌適度的話，皮膚就能夠保持生氣盎然，顯得光滑細緻；如果皮脂分泌不足，角質化細胞則容易自皮膚表面脫落，形成乾燥粗糙的肌膚；若分泌過分旺盛，皮膚看起來就是油膩膩的樣子。因為有層膜，才能使表皮角質層的水分不流失，皮膚才得以滋潤。
正常的脂肪膜應保持在5.6～6.5的酸性程度。如果皮膚表面呈現弱酸性，正可抑制皮膚上的細菌、徽菌的繁殖，防止皮膚生病。皮脂分泌少的人，脂肪膜就會不足，這時必須要使用含油脂脂份較高的乳液來彌補，這時就得藉助保養的工夫了。通常女性一過了25歲，皮膚組織開始由顛峰往下走，製造脂肪膜的機能也逐漸衰弱，因此保養更是不可忽視的一項工作。
表皮內的角質層細胞有新陳代謝的作用，約隔28天脫落一次，其中表皮和真皮之間有一層波浪形的圓柱，圓柱核心含有一整排的黑素（茶色色素）細胞，且排列整齊。這細胞層稱為『基層底』。這些細胞會漸漸改變形狀，並逐漸角化，堆在表皮上。最後它們會變成沒有核心的薄片狀，且又硬又薄的細胞（角質細胞），彼此重疊，形成皮膚最外一層。這角質細胞從表面一片一片剝落，使皮膚不斷新陳代謝而有新細胞。這種現象叫做「角化」。角化順利，皮膚新陳代謝良好，皮膚自然光滑亮麗；萬一角化不順利（這現象稱做角化異常），皮膚表面乾燥又粗糙，時而掉落許多鱗狀薄片（像魚鱗般白色皮膚薄片）。
另外，在表皮的基底細胞之間，有黑素細胞（色素形成細胞），它們是決定膚色的重要細胞。它們呈星形狀且有長長的突起，突起處把黑色色素注入基底細胞中。膚色是白、是黑，由黑色色素的量或顏色深淺決定。
（二）真皮
表皮下面厚厚一層的即是“真皮”，是皮膚原本狀態，故稱做“真皮”。它的厚度是表皮的數倍，皮膚的張力、彈性及厚度全是由真皮來決定。真皮上有許多血管，且併排二種纖維。一種是決定皮膚彈性的彈性纖維，另外一種是膠原蛋白纖維，它們一束長長的且併排在一起。
真皮的突出部分叫毛乳頭，包括毛細血管、淋巴管、神經最後部份。真皮的毛細血管不僅負責皮膚的營養，並將皮膚的廢物排出體外。
皮膚之所以透著紅色光，是由於血管的顏色襯托出來的，一平方公分的皮膚大約分佈著四呎長的血管。
真皮內又含毛囊、皮脂腺、汗線。倘若這些機能一衰退，皮膚就會呈現老化現象；如果彈力纖維萎縮，細小皺紋就會增加。
受傷後皮膚的更生力也是存在於真皮層。燒傷到此層，皮膚並不致留下難看的傷痕；然而，若真皮全部破壞並傷到皮下組織，則會留下永難褪除的疤痕。
另外，當真皮上水分充足時，皮膚就會顯得浮腫難看。真皮上層的水分多寡由全身健康情形而定，皮膚的張力也受身體健康的影響。
至於皮膚的「滋潤」就不是由真皮水分多寡來決定，而是由表皮角質層的水分量來決定。
（三）皮下組織
皮下組織為皮膚的最下層，含豐富的皮下脂肪。全身皮膚含的脂肪量各不相同，其中以眼圈的含量最少，最易鬆弛、老化。例如：在熬夜、過度疲勞或生病的時候，常會感覺「眼睛塌陷」，這是由於眼睛四周的脂肪本來就少，加上身體狀況不佳，脂肪全部耗光的緣故。
但是，如果攝取過多的糖分就會在體內轉換成脂肪，貯存在皮下組織中。所以吃太多甜食會發胖，原因就在這裏。皮下脂肪組織在美容上的問題只是影響皮膚曲線的美醜，和化妝品使用後所產生的種種問題並無關連。如果妳不 想發胖，少吃甜食為妙；同時，糖分會促進皮脂分泌旺盛，易生青春痘，為使自己美眉，就儘量少碰甜食。
二、皮膚的生理功能
一般而言，皮膚具有以下七種功能：
（一）呼吸作用：
從皮膚表面經常散發水氣（肉眼看不見的汗），同時，向真皮輸送氧氣，以促進真皮的功能。
（二）分泌作用：
皮脂腺和汗腺的分泌物可以滋潤皮膚，使皮膚保持健美。但如果皮脂分泌不正常，皮膚也不正常。分泌過多，皮膚呈油性；分泌過少，皮膚就會粗糙。另外，由於激素的作用，有時還會出現粉刺和疙瘩。
（三）吸收作用：
通過毛孔、汗腺以及個人皮膚充分吸收（浸透）溶於脂肪的物質。因而可以有效的浸透化妝品的營養成分。
（四）保護作用：
真皮及皮下組織可以緩衝來自外部的打擊和刺激，同時，可以保護身體不受細菌和強烈陽光等的侵害。
（五）感覺作用：
依靠佈滿皮膚神經纖維，可以產生觸覺、冷熱覺、痛覺等。
（六）調節體溫作用：
要維持身體健康，就要把多餘的熱量散發到體外，這主要靠皮膚來完成。溫度高時，皮膚鬆弛，熱量容易散發；寒冷時，皮膚收縮，可減少散熱。
（七）表現作用：
喜怒哀樂之情，常可以反映在皮膚上，驚恐時蒼白、發怒時漲紅、煩躁時皮膚變得粗糙。
三、留意皮膚釋出的警訊
皮膚是人體最大的器官，當我們身體內部出現問題時，通常會有明顯的警訊出現在皮膚上，皮膚上細微的改變可能透露內臟疾病正默默侵襲著人體，皮膚可以說是疾病的警報區，從頭到腳的皮膚，都可以看出健康的問題。
例如膚色突然異常（包括痣的顏色改變），或長出丘疹、斑塊等，如嘴唇、口腔黏膜出現黑點；胸與背部出現很多咖啡色或棕黑色斑塊；不論兒童或成人，頸部、腋下、鼠蹊部等皮膚皺摺處，如果出現黑色大片斑塊。若持續一段時間，甚至三個月以上，這時，皮膚釋出的可能警訊：
1、肥胖者，很可能是「黑色棘皮症」，默默預告未來得糖尿病的高風險；尤其是五十～七十歲的人，就要注意腸胃是否有息肉病變，甚至癌症。這是因為身體分泌過多的胰島素，刺激局部皮膚的黑色素沉積而造成。
2、另外，黑色棘皮症如果出現在手掌、口腔黏膜，有可能是胃癌、肺癌等引起的表現。
3、但有些藥物也會引起黑色棘皮症，建議要找專科醫師進一步檢查確認。此時，要到醫院做檢查，不能輕忽。
又如，皮膚會發癢。
每個人偶而都會覺得皮膚癢，抓一抓就沒事了，但如果長期發癢就要留意了。北市立聯合醫院家醫科醫師顏正中提到，若長期全身發癢，要小心是否有肝腎功能異常，少數久病不癒的癢，也可能與甲狀腺、自體免疫問題甚至淋巴癌有關。身體其他器官病變，也可以導致皮膚出現癢感，如B、C型肝炎、愛滋病患者以及缺鐵性貧血的人。長期皮膚癢一定要找出原因，生活習慣、職業、藥物史、過敏史、病史都要仔細檢視、對症下藥，千萬不可輕忽。
又如，黃疸。
凡肝功能不好者，會讓身體累積超標的「膽紅素」，過多的膽紅素會進一步讓皮膚和眼白泛黃，我們稱作「黃疸」。而且黃疸患者的皮膚特別容易搔癢，尿液顏色也容易變成紅棕色（或茶色）。
又如，身上有不明的黑痣。
一般的痣是良性的，大多長到一定程度就會停止，0.6公分以下的痣，觀察即可。但病灶若不斷長大超過0.6公分，伴隨形狀不規則、突出，加上破皮、出血、傷口難癒合，可能就是皮膚癌的症狀，建議到皮膚科就醫。其中，「黑色素細胞癌」常出現在手腳或指甲下方，因為極易轉移、惡性程度大、致死率較高，只能藉由早期發現早期治療來提升治癒率。
又如，身上出現蜘蛛痣。
肝硬化病人每三人就有一人，身上有蜘蛛痣；酒精引起的肝硬化，更是每兩人就有一人有蜘蛛痣。
不過，健康的人，例如孕婦、服用避孕藥的婦女、或青春期的孩子，可能因為體內荷爾蒙變化，有時也會短暫出現蜘蛛痣。
總之，只耍多關照身體的變化，必要時尋求醫師診治，但請別恐慌。
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