University of Washington

Department of Rehabilitation Medicine

Spinal Cord Injury (SCI) & Maintaining Healthy Skin

What is Healthy Skin?

Your skin is much more than an outer surface for the world to see. It protects you from bacteria, dirt and other foreign objects and the ultraviolet rays of the sun, and contains the nerve endings that let you know if something is hot or cold, soft or hard, sharp or dull. Your skin also plays an important role in regulating your body's fluids and temperature.

Below the smooth, hairy outer skin, or epidermis, that we see every day is a thick, strong and elastic layer of tissue known as the dermis. The dermis is richly supplied with blood vessels, sweat and oil glands, and nerve endings.

Healthy skin is smooth, with no breaks in the surface. It is warm (not hot or red) and neither dry and flaky nor moist and wrinkled. Healthy skin is a mirror of a healthy body.

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How to Take Care of Your Skin

Nutrition: To keep your skin healthy, eat a well-balanced diet that includes plenty of protein foods, fruits and vegetables (fresh if possible) and liquids. If you are having a skin problem, such as a pressure sore or a healing surgical incision, you should increase your intake of protein (lean meats, dairy foods and legumes), carbohydrates (breads, cereals), vitamins A, C and E, and zinc. Extra iron may be needed if you are anemic (see "Anemia" paragraph below).

Circulation: The skin is served by a large number of blood vessels, and adequate circulation is needed to maintain skin health. You can help ensure a healthy blood supply by considering the following suggestions:

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Tips for Maintaining Good Skin Care

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Skin Inspection

The only way to know if your skin is healthy and intact is to look at it regularly. In areas where sensation (feeling) is decreased, skin inspection is essential and should become a habit. Plan it as a part of your regular daily routine, during a time when you are undressed anyway — such as after a shower, before dressing in the morning or after undressing in the evening. Daily skin inspection is necessary.

If you are unable to see some parts of your body, use a mirror or teach another person to check your skin for you. Long handled mirrors and other specially designed mirrors are available. Check all of your bony prominences, or areas where the bones protrude slightly below the skin

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What to Look For

Look for any reddened areas, rashes, cuts, bruises, scrapes, or indentations from seams or elastic binding. Check also for blisters, bumps, insect bites, dry flaky skin or pimples. Feel your skin for any thickening or change in texture, especially over bony areas. Check toenails for any redness or pus formation around the end of the nail.

Whenever you notice a problem, try to figure out its cause and make any changes necessary to prevent further problems. The first step in curing any skin problem is to eliminate the cause.

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Preventing Skin Injuries

Pressure Releases: Are you changing your position often enough to relieve pressure over bony prominences?

In both bed and wheelchair, change your position according to your skin tolerance. (For information on establishing skin tolerance, see our “Pressure Sores” pamphlet.) Pressure releases in a wheelchair can be done by pushing straight up, leaning side to side, bending forward over your knees, reclining the seat of your electric wheelchair or having someone tilt you back in your manual chair. Always use your wheelchair cushion.

In bed, body parts can be padded with pillows to keep bony prominences free of pressure. Place a pillow between the knees while sleeping on your side to prevent skin-to-skin contact and increase air circulation between the legs (see illustration above). Get into the habit of checking your body position for correct alignment and pressure-free positioning of bony prominences.

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Are you using the best equipment? Does it fit you properly?

Wheelchair — Does it support your back? Are your footrests the right height? Are you using the best wheelchair cushion?

Bed — Are you using a good mattress?

Leg bags — Are the straps too tight?

External catheters — Is the correct size being used? Is it being changed ­frequently enough?

Splints/Braces — Do they fit ­properly? Do you do skin checks after wearing them?

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Extremes of temperature call for extra caution in protecting your skin:

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Body Weight

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Proper fit is important. Avoid sitting on seams and back pockets, and always check your skin carefully after wearing new shoes or clothing.

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Over-indulgence in alcohol - or any other drug - may interfere with attention to your personal care needs. For example, while under the influence you might forget to turn yourself, or be too weak to transfer yourself properly.

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Stress and depression can have a similar effect by causing you to lose interest in your personal care and pay less attention to your skin and general health.

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Spasticity may cause your arms and/or legs to bump against an object, or to fall off your armrest or footrest, and be injured. Spasms may cause your skin to rub against something (for example, the sheets on your bed), which could produce an open sore.

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