Skin Management after Spinal Cord Injury

David Chen, M.D.
Good skin care in important to overall health. After a spinal cord injury, loss of sensation can cause several concerns. These include pressure ulcers, burns and rashes.

Pressure Ulcers: Causes and Prevention
The biggest concern is that of pressure ulcers. You may have also heard them called decubitus ulcers or pressure sores. As you can tell by the name, the main cause of these sores is pressure. When sensation is lost, you may not be aware that a sore is forming. Pressure may result from sitting or lying in the same position without moving. Other causes are shearing force and injury. Shearing forces happen when you move a person in bed by sliding or pulling rather than lifting. The skin can be scraped or rubbed along the bed itself. Injury to the skin may be caused by bumping legs on bed rails or wheelchairs, or by hitting the buttocks on a wheelchair wheel during transfers.
Other factors which may contribute to pressure ulcers are nutritional state, infections and incontinence. To maintain a good nutritional state, be sure to get enough fluids and food with protein. Infections may cause sweating and general malaise. Incontinence or having bowel or urine accidents causes increased moisture to skin areas, promoting skin breakdown.
Prevention of pressure ulcers is possible by paying attention to the above factors and monitoring the skin itself. These methods to help prevent pressure ulcers should begin immediately after the injury and then continue on a daily schedule throughout life.
Two major ways to prevent pressure ulcers are pressure reliefs and skin checks. M A pressure relief is done while in the wheelchair. It is accomplished by using both arms and pushing up, off of the cushion, or by leaning side to side and lifting the buttocks off the wheelchair seat. A skin check is done by looking at where the pressure was exerted on the skin after sitting and turning. For example, you would check the bottom of the tailbone or sacrum and the sitting bones or ischiums. Identify any redness or unusual looking areas. Self-checks can be made utilizing a hand mirror. A red area that does not go away in one hour could mean that a pressure ulcer is developing.
Additional ways to prevent pressure ulcers are by using special mattresses for the bed and special cushions for the wheelchair. These are prescribed by a doctor or physical therapist. They need to me maintained and replaced periodically.

Treatment:
Treatment of pressure ulcers involves several steps; the first is to find the cause of the problem. Was it moisture, increased pressure, trauma of being in poor health? The second treatment is to stay off the area and eliminate pressure until the redness or open sore is gone. That may mean staying in bed lying side to side until the sore is gone. Other treatment includes keeping the sore area clean. If the area is red only, and not open, wash with soap and water. If the skin has broken, contact a doctor for treatment options.

Burns and Rashes:
Other skin concerns, besides pressure ulcers, are burns and rashes. Due to lack of sensation, one needs to be careful with placing hot items where there is no sensation (i.e. lap) and checking bath/shower water before bathing. Increased moisture and friction can cause rashes. Treatment for burns is the same as for anyone. Immediately after the burn, apply cold water, keep the blister intact if possible and protect with a dressing, if necessary. For rashes, keep as clean and dry as possible. For all burns and rashes, you should contact your doctor to determine if further treatment is required.