Skin Care
Skin is your body’s largest organ. It serves as an important protection device for the body. Skin also plays a role in sensation, fluid regulation, and temperature regulation. Your skin is affected in many different ways after a spinal cord injury. You may have decreased or no sensation, you may sweat more or less in different areas, and you may swell because there is no voluntary muscle action below the level of the injury.
General skin care and tips
There are things you can do to help protect and take care of your skin. You may have done many of these things before your spinal cord injury without thinking about them.
Nutrition and weight
What you eat can have a definite effect on your skin. Vitamins A, C, E, and B6 are key vitamins necessary for skin development and maintenance. You can get them from vitamin supplements, but it is also important to eat a healthy and balanced diet.
Staying at an appropriate weight can help lower the risk for skin breakdown. Ask your health care team, which may include a nutritionist, what your appropriate weight is and how you can maintain it.
Hygiene
It is important for patients with spinal cord injuries to practice good hygiene. This involves staying clean, and making sure that you do not let dirt and grime settle on your skin for long periods of time. Although you may not need to bathe every day (doing so can actually make the skin drier and is not always recommended), you should clean your armpits and groin area every day. You also should wash your skin any time it gets dirty.
There are some hygiene points that spinal cord injury patients do need to keep in mind:
- Wash your groin area before going to bed. Thoroughly dry it after washing.
- Air out the groin area at least once a day.
- Dry between your toes and fingers after bathing.
- Be careful not to use too much powder in your groin area if you use powder. Too much powder can lead to irritation, rashes, and cracks in your skin.
- Put lotion on dry skin, except between your toes. Dry skin may crack open.
- Clean your fingernails and toenails daily. Keep them short for your safety.
- Clean your urine collecting equipment every day.
Daily skin care routine
Tips for skin inspection:
- Check your skin twice a day. Check areas that may have had pressure when you were lying down, and that may have had pressure when you were sitting.
- Check all bony places — ankles, elbows, heels, hips, and tailbone — below the level of your injury. Use a mirror if needed.
- Look and check out anything that seems different. Look for reddened areas, scrapes, bruises, blisters, and cuts. Feel for changes like lumps or tender spots.
Specific clothing areas to check
- thick seams, like those found on jeans
- binding in the groin area
- tight shoes
- socks with elastic tops
- straps holding the urine drainage system
Pressure releases
You should do pressure releases every 15 minutes, and hold the position for between 30 and 60 seconds. This will take the pressure off your tailbone and other bones that you sit on. Work with your rehabilitation team to determine the best releases for you. Releases may include:
- Push up out of the seat of your wheelchair with your hands placed slightly forward.
- Lean side to side.
- Bend your chest to your knees.
- Use powered seating systems.
Positions and turning
Changing your body posture and position will take pressure off bony areas. There are different things you can do, depending on whether you are in a bed or a wheelchair.
In bed
- Change your position according to your skin tolerance level. Sleep on your stomach, if possible.
- Use an alarm clock to wake you for turning. Turning in your sleep may become automatic after a while.
- Get someone to turn you if you cannot do it yourself.
- Consider getting a specialized mattress.
In a wheelchair
- Check your posture. Make sure that your ankles, the sides of your knees, and your hip bones are not leaning against the wheelchair.
- Make sure the foot pedals on the wheelchair are adjusted for your height.
- Sit up as straight as possible in the wheelchair.
- Always use a well—maintained cushion.
Tips to try to avoid problems
- Check your skin for redness or chafing after wearing new clothing.
- Buy jeans with low profile seams. Consider removing back pockets.
- Buy jeans and slacks a size larger than what you would normally buy.
- Wear socks that are not too tight or too loose.
- Make sure your shoes fit correctly.
The problem with pressure
You need adequate blood circulation to keep your cells alive. When circulation is cut off — as it is when you sit or lie in one place for a while — the cells cannot get blood and oxygen. They die and sores may develop.
Pressure can come from outside the body. The pressure of your weight pushes your bones onto blood vessels and cuts off circulation. Cells can die in 30 minutes if they do not have proper circulation.
Shearing
Shearing happens when two layers of skin are pulled in opposite directions. It can lead to skin breakdown and skin tears. Shearing can happen any time you slip down — either in a wheelchair or in bed. Shearing increases your risk of getting pressure sores.
Friction
Friction happens when there is constant rubbing or pulling on the skin. This can create blisters. Friction can happen when you drag any part of your body across a surface. Spasms also can cause friction.
Dealing with pressure sores
There may be early warning signs that pressure is causing damage. These signs include redness and firmness. You should check for them when you do your skin checks.
There are four stages of pressure sores, which are also known as decubitus ulcers. The deeper the pressure sore, the more serious the problem. Pressure sores can vary from redness, to wounds deep enough to involve tendons, bone, or muscle.
- Stage 1: an area of redness that does not fade or blanch. The skin is intact.
- Stage 2: the skin is broken. It may look like a scrape, blister, or shallow crater.
- Stage 3: a deeper crater. It goes all the way through to soft tissue.
- Stage 4: to the muscle, bone, or tendon.
Pressure sores can be treated. Successful treatment, however, depends on finding them early and removing the cause. Treatment includes:
- removing all pressure
- staying off the pressure sore
- keeping the area clean and dry
Do not:
- massage the area
- clean the wound with soap, iodine, hydrogen peroxide, alcohol, vinegar, or a bleach solution
- dry the wound with a heat lamp or hair dryer
- put sugar, vitamins, or antacids into the wound
- use antibiotic ointments in the wound unless prescribed
You may need surgery or a specialist to help with treatment. Pressure sores take a long time to heal, and the skin will still have scar tissue.
Preventing Injury
It is important to take steps to help prevent injury:
- Always be aware of how close you are to possible hazards.
- Be careful not to bump into things when you are transferring from one location to another, or when you are moving around.
- Do not try to do new maneuvers in your wheelchair until you have been trained to do them.
- Do not sleep in the wheelchair.
Potential hazards to skin
- Hot and cold extremes: May cause damage to the skin, and you might not notice an immediate reaction because of the loss of skin sensation.
- Alcohol abuse: Alcohol abuse can interfere with proper cell reproduction.
- Moisture: Moist skin is more prone to breakdowns.
- Edema or swelling: When tissues are too swollen, it is hard to get oxygen and nutrients to the skin cells. This increases the chances of having the skin break down.
- Diabetes: High blood sugar slows the healing process.
- Sun: You will still be at risk for sunburn, like any person with or without a spinal cord injury.