Spinal Cord Injury (SCI) & Maintaining Healthy Skin

• What is Healthy Skin
• How to Take Care of Your Skin
• Tips for Maintaining Good Skin Care
• Skin Inspection
• What to Look For
• Preventing Skin Injuries
• Equipment
• Temperature
• Body Weight
• Clothing
• Alcohol
• Stress
• Spasticity

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:

• Smoking - DON'T! Nicotine in cigarettes causes blood vessels to get small (constrict) and prevents blood, oxygen and nutrients from flowing to the body tissues. Edema , or swelling caused by fluid collecting in the tissues, usually occurs in a part of the body that is not moved frequently and is below the level of the heart (i.e., the feet, legs and hands). Skin over areas of edema becomes thin and pale and injures easily because of poor circulation. Edema can be prevented by elevating your legs and hands frequently, performing regular Range of Motion (ROM) exercises and wearing compressive stockings.
• Anemia (a decrease in red blood cells). Oxygen is essential for skin health, and is carried by red blood cells. A decrease in their number means less oxygen gets to the skin, which means that skin cells may become unhealthy or even die. Anemia should be evaluated and treated by your health care provider.
• Vascular Disease, or a narrowing of the blood vessels, can be caused by diabetes, smoking, high blood pressure or elevated cholesterol. The result is decreased blood flow to the skin. Work closely with your health care provider to manage conditions that can lead to vascular disease and cause skin problems.

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Tips for Maintaining Good Skin Care

• Avoid soaps labeled "antibacterial" or "antimicrobial." These tend to reduce the skin's acidity, which acts as a protection from infection.
• Keep the skin clean and dry. Wash with soap and water daily, then rinse and dry thoroughly.
• Skin folds or creases (as in the groin area and underarms) need washing more frequently - twice a day, morning and bedtime. Rashes can easily form in these areas because of increased moisture and warmth. Increasing the air circulation to these areas to help prevent rashes can be accomplished by positioning the arms and legs so the skin surfaces are separated. For example, use the "frog" position to air the groin area. Air these areas two times a day.
• Rashes can be caused by tapes, soaps, fabrics or other irritants. Total body rashes may result from food or drug allergies. Consult your health care provider for treatment of these and any other rashes you may have.
• Avoid using items that may dry the skin - for example, harsh soaps or alcohol based products such as lotions. (A good non-drying lotion to use is Alpha Keri.)
• Lubricate dry skin with moisturizing creams or ointments (such as Eucerin or Aquaphor). Use care in applying creams over bony areas, since they may soften the skin and promote skin breakdown.
• Soiled skin can break down easily. Urine and stool have irritants in them and should be cleaned up immediately to prevent weakening and breakdown of the skin surface.
• Avoid using talc powders, as they may support yeast growth. They can also "cake up" and keep moisture in, causing skin breakdown.
• Calluses may form on your feet and hands. These can be removed by soaking frequently in warm water and toweling briskly to remove dead skin. You can use moisturizing creams to help soften calluses. Note that calluses may indicate an area of excess friction or pressure.
• Finger and toe nails require special care. Soak them and rub gently with a towel to remove dead skin and decrease the chance of hangnails forming. Nails are easier to cut after soaking; be sure to cut them straight across to avoid ingrown nails, and keep them short for safety. If ingrown nails develop, see your primary care provider or podiatrist.

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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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Equipment

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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Temperature

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

• Heat — Avoid sunburn by covering up or using sunblock. Don’t put plates of hot food on your lap without protecting your skin. When riding in a car, keep your feet away from the heat outlet and check vinyl seats before you sit on them to make sure they aren’t too hot. Any exposed pipes in your kitchen or bathroom sink should be wrapped to protect your legs from burns. When you go camping, protect your feet by sitting a safe distance from the campfire.
• Cold — Be sure to dress warmly to prevent frostbite if you are out in cold weather for long periods of time. Dressing in layers of clothing will provide extra warmth. Avoid putting frozen foods on your lap.
• Fever — Your skin tolerances can change due to the increased body temperature that occurs with a fever. You will need to shorten the time you lay in one position. Check skin extra carefully.

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Body Weight

• Too much — Being overweight can cause increased pressure on bony prominences. Delayed healing may occur because there are fewer blood vessels in fat tissue.
• Too little — Excess pressure over bony prominences may occur because there is less padding (muscle and fat) over these surfaces. In addition, underweight persons may lack the proper nutrition to maintain healthy skin.

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Clothing

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

• Too loose — Loose clothing can form wrinkles that put pressure on your skin.
• Too tight — Overly tight clothing can hinder circulation.

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Alcohol

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

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

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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