This new manuscript reviews barrier functions of skin and defines specific pathophysiologic factors that lead to its disruption including hypoperfusion, hypoxia, increased vascular permeability, and edema – all of which act synergistically. The article further defines acute and chronic conditions leading to these pathophysiologic aberrations including Multiple Organ Dysfunction Syndrome (MODS), protein-calorie malnutrition, and immunocompromised states. Also addressed are critical contr...