Skin Care for Spinal Cord Injury Patients

Skin is your body's largest organ.

It not only protects your body but also plays a role in:

• Sensation.
• Fluid regulation.
• Temperature regulation.

An SCI can affect your skin in many ways.

You may:

• Have decreased or no sensation.
• Sweat more or less in different areas.
• Swell because there's no voluntary muscle action below the injury site.

Read on to learn ways to protect your skin and how the UPMC Rehabilitation Institute can help.

Contact the UPMC Rehabilitation Institute

To learn more about spinal cord injury rehabilitation or to refer a patient, call 1-877-287-3422.

What Can Affect My Skin After a Spinal Cord Injury?

Nutrition

What you eat can affect your skin.

You need vitamins A, C, E, and B6 for skin development and maintenance. You can get them from supplements, but it also helps to eat a healthy and balanced diet.

Weight

Staying at a proper weight can help lower the risk of skin breakdown.

Ask your health care team what the right weight range is for you and how to maintain it.

Shearing

Shearing happens when two layers of skin get pulled in opposite directions. This often occurs when you slip down in a wheelchair or bed.

It can lead to skin breakdown and tears. Shearing can also increase your risk for pressure sores.

Friction

Constant rubbing or pulling on the skin when you drag any part of your body across a surface causes friction. Spasms also can cause it.

Friction can make you get blisters.

What Can Damage My Skin After an SCI?

• Hot and cold extremes. Extreme heat or cold can cause the loss of skin feeling that you might not notice right away.
• Alcohol abuse can interfere with proper cell reproduction.
• Moist skin is more prone to breakdowns.
• Edema or swelling. When tissues are too swollen, it's 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 puts you at risk for sunburn, like any person with or without an SCI.

Preventing Skin Damage After Spinal Cord Injury

Here are some steps you can take to protect your skin after an SCI:

• Always be aware of how close you are to possible hazards. For instance, don't sit too close to fires or space heaters.
• Be careful not to bump into things when moving around or going from one place to another.
• Avoid trying new maneuvers in your wheelchair until your care team trains you on how to do them.
• Do not sleep in your wheelchair.

Daily Skin Care and Hygiene Tips After SCI

There are things you can do to help protect and take care of your skin after your spinal cord injury.

You may have done many of these before your injury without thinking about them.

Daily skincare routine

• Check your skin twice a day. Check places that may have had pressure when lying down and sitting.
• Check all bony places below the level of your injury. Use a mirror if you need to check your ankles, elbows, heels, hips, tailbone, or any other place on your body.
• Look for and check out anything that seems different, such as:
• Reddened areas.
• Scrapes.
• Bruises.
• Blisters.
• Cuts.
• Lumps or tender spots.
• Check clothing areas:
• Thick seams, like those found on jeans.
• Binding in the groin area.
• Tight shoes.
• Socks with elastic tops.
• Straps holding the urine drainage system.

Skin hygiene for people with SCIs

It's vital to practice good hygiene.

It doesn't mean you have to bathe every day. In fact, that can make your skin drier.

It does mean making sure you don't let dirt and grime settle on your skin for long periods.

Here are some hygiene points to keep in mind:

• Clean your fingernails and toenails daily. Keep them short for your safety.
• Wash your urine-collecting equipment every day.
• Clean your armpits and groin daily.
• Air out the groin area at least once a day.
• Wash your groin before going to bed each night. Thoroughly dry it after washing. If you use powder, be careful not to use too much. It can cause irritation, rashes, and cracks in your skin.
• Dry between your toes and fingers after bathing.
• Put lotion on dry skin, except between your toes.

How to Prevent Pressure Issues After Spinal Cord Injuries

You need adequate blood circulation to keep your cells alive.

When your cells can't get blood and oxygen, they can die within 30 minutes.

The pressure of your weight pushes your bones onto blood vessels and cuts off blood flow. This can occur when sitting or lying in one place for a long time.

See our tips below to help you avoid pressure issues.

Pressure releases

To take pressure off your tailbone and other bones that you sit on, you should do pressure releases every 15 minutes.

Hold the position for between 30 and 60 seconds.

Releases may include:

• Leaning side-to-side.
• Bending your chest to your knees.
• Using powered seating systems.

Your rehab team will help decide the best releases for you.

Positions and turning

Changing your body posture and position will take pressure off bony areas. You can do different things, depending on whether you're in a bed or a wheelchair.

In bed

• Change your position according to your skin's 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 can't do it yourself.
• Think about getting a special mattress.

In a wheelchair

• Check your posture. Make sure your ankles, the sides of your knees, and your hip bones aren't leaning against the wheelchair.
• Sit up as straight as possible.
• Make sure you adjust the foot pedals for your height.
• Always use a well-maintained cushion.

Clothing

Avoid pressure problems after an SCI by:

• Checking your skin for redness or chafing after wearing new clothes.
• Buying jeans with low profile seams. Consider removing back pockets.
• Buying pants a size larger.
• Wearing socks that aren't too tight or too loose.
• Making sure your shoes fit correctly.

Dealing With Pressure Sores

There may be early warning signs that pressure is causing skin damage.

These signs include redness and firmness. You should check for them when you do your skin checks.

Pressure sore warning signs

There are four stages of pressure sores, which are also known as decubitus ulcers.

The deeper the pressure sore, the more severe the problem.

• Stage 1: The skin is intact, but you'll see areas of redness that don't fade or blanch.
• Stage 2: The sore breaks the skin. It may look like a scrape, blister, or shallow crater.
• Stage 3: A deeper crater that goes through to soft tissue.
• Stage 4: The deepest stage of a pressure sore. It goes all the way to the muscle, bone, or tendon.

Unstageable pressure sores have a thick yellow slough covering or a scab.

Deep purple or maroon pressure sores may be a deep tissue injury that hasn't yet opened on the skin's surface.

Treating Pressure Sores

Pressure sores are treatable. But successful treatment depends on finding them early and removing the cause.

Treatment includes:

• Removing all pressure.
• Staying off the pressure sore.
• Keeping the sore clean and dry.

Do not:

• Massage the sore.
• Clean the wound with any solution unless prescribed by a doctor.
• Dry the sore with a heat lamp or hair dryer.
• Put sugar, vitamins, or antacids into the wound.
• Use antibiotic ointments unless prescribed by your care team.

You may need to see a specialist to help with treatment.

Pressure sores take a long time to heal, and the skin will still have scar tissue.

Contact the UPMC Rehabilitation Institute

To learn more about spinal cord injury rehabilitation or to refer a patient, call 1-877-287-3422.

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