A spinal cord injury is a catastrophic, life-changing event that can lead to a variety of consequences for the victim, from psychological stress to physical impairment. These individuals are required to make complete changes to their lifestyle to accommodate this sudden and unexpected change.
An important area for spinal cord injury victims to focus on is dermatological management (skincare). Many individuals do not realize that the skin can be severely impacted after the spinal cord is damaged and that a large part of overall health and well-being is directly connected to the epidermis. Skin problems often result from changes in blood circulation to the skin.
Your skin is by far the largest body organ system affected by spinal cord injury. Skin problems, unfortunately, represent one of the leading causes of anxiety, morbidity, and interference with rehabilitation, educational, vocational, and social goals among SCI victims. Therefore, although dermatological issues after SCI are not critical in SCI outcomes, they can negatively affect quality of life. If you have suffered a spinal cord injury, both you and your caregivers must be educated about appropriate skin care and routine dermatological examinations.
Common Skin Problems Following a Spinal Cord Injury
Spinal cord injury victims often suffer from lower body circulation issues due to nerve damage in their spinal cord, which makes them more vulnerable to environmental damage or general skin damage. Skin circulation is vital to maintaining regular health and wellness of the body, both internally and externally. Changes due to autonomic dysfunction cause excessive sweating, especially in patients with SCIs with a level T6 and above, which can subsequently lead to skin disease as well as behavioural alterations in skin hygiene secondary to paralysis of the upper and lower extremities, all contribute to changes in skin integrity after SCI.
From a physical or lack of movement perspective – skin tolerance can vary depending on the individual. However, skin tolerance is generally lower after an individual has experienced a spinal cord injury due to nerve damage, lower blood circulation, and lack of sensation.
Overall, skin problems can be caused by neurological issues, as well as lack of physical movement and/or improper skin care. Medical journals, particularly the Journal of Spinal Cord Injury Medicine, have reported over 350 dermatological conditions or skin problems in SCI victims. The most common dermatological condition is fungal infection, followed by seborrheic dermatitis. The most common skin problem after a spinal cord injury is pressure sores or pressure ulcers.
Pressure Sores are a Significant Issue For SCI Victims
Also known as pressure sores or bed sores, pressure ulcers are sections of damaged flesh that can become irritated and inflamed and cause holes in the skin. They are caused by increased or continued pressure on the skin, which cuts off blood flow and circulation to that area. As a result of decreased blood flow, damage occurs. The elderly are prone to pressure sores when bedridden for an extended period of time. Even younger people can get pressure sores if they are in bed for long periods of time.
Generally, the first sign of a pressure ulcer is the change in skin pigment. This usually manifests either as red skin or darker patches of skin. Once this occurs, if the area is not treated or addressed properly, this wound will worsen, and a blister can develop. This blister leads to a hole in the skin and severe damage to the skin tissues.
Pressure sores can be mild or can be severe. More severe pressure sores can go into the muscle. Very severe pressure sores can go into the bone. The stages of a pressure sore start with reddened skin. If the pressure sore gets worse, the reddened skin forms a blister. The blister then forms an open wound. The open wound can become a crater. Each of these stages has a number. The less severe stage is number one. The most severe stage is number four. Stage four pressure sores often require surgery.
Persons with spinal cord injuries need to be aware of the signs of infection so they can seek proper medical care. Normally, the signs of infection are thick yellow or green pus, a foul smell from the sore, redness or warmth around the sore, and swelling and tenderness around the sore. The signs that the infection has spread to the rest of the body are fever or chills, mental confusion or difficulty concentrating more than normal, rapid heartbeat and overall weakness.
If left completely untreated, pressure ulcers have the potential to cause severe complications in the body that could have fatal consequences. They can become infected and cause sepsis, which can be life-threatening. According to the Journal of Spinal Cord Medicine, approximately 60,000 individuals in the United States die from pressure ulcer complications annually. For this reason, it is incredibly important to focus on prevention and treatment wherever possible.
How are pressure ulcers treated?
When pressure ulcers are found, it is essential to take action immediately. If left untreated, a pressure ulcer can be life-threatening.
While it does not take long for a pressure ulcer to develop, it takes a significant amount of time to heal. Once damaged, red, or dark skin is noticed, the individual should immediately remove pressure from the area. Sometimes, this may mean that the individual must lie in bed to ensure that pressure is removed completely. While on bed rest, placing a pillow between the legs, thighs, or ankles is sometimes recommended to prevent further friction while lying down. If the wound begins to decrease in size or close up, it is healing. Some blood at the wound site is also a good sign, as this indicates blood flow to the area.
A doctor may provide topical medication or antibiotics for pressure ulcers if they are discovered in the early stages. However, these should be utilized at the health care provider’s discretion as some products may come with the risk of spreading infection or worsening the wound.
If the wound does not heal while on bed rest, a health care provider or spinal cord injury specialist should be contacted immediately. Home visits may need to be arranged to control and monitor the area in addition to applying medical dressing. A surgical procedure may be required to close the wound in severe and extreme cases.
How to prevent pressure ulcers:
It is important to undergo a skin care routine after experiencing a spinal cord injury in order to prevent pressure ulcers and other skin issues as effectively as possible. Pressure ulcers are difficult to heal, which means that it is more important to focus on prevention to avoid these wounds entirely.
Spinal cord injury victims should be cautious when moving or transferring and conscious about where their bodies are being touched or dragged. Keeping the body dry is also essential, as pressure ulcers can develop from excess moisture, specifically urine, feces, and sweat. These bodily fluids contain toxins that can cause damage when in contact with the skin.
Utilizing a properly fitted wheelchair cushion is vital to distribute body weight and avoid significant pressure from sitting. While the cushion is designed to assist in pressure ulcer prevention, these individuals should also be sure to relieve pressure as often as possible. Doing so at least every 20 minutes is recommended. If the individual has upper body strength, this can be done by lifting the body off the chair by the arms while brakes are applied. The individual may also opt to move the body from side to side or tilt forward periodically to relieve pressure.
Adequate nutritional intake is also an integral part of maintaining skin health and preventing pressure ulcers. When the body is ingesting an adequate amount of vitamins and nutrients, the skin absorbs those properties and obtains the nutritional benefit. A healthy diet that includes iron-rich foods can assist in preventing or maintaining anemia, which is common after spinal cord injury and can affect blood flow and circulation. Protein is important to assist in wound healing, and vitamin C is beneficial for skin thickness and healthiness.
Additional Skin Management Tips For Spinal Cord Injury Victims
In addition to the prevention of pressure ulcers, spinal cord injury victims should also take additional skin management precautions to protect their skin and maintain overall health. With lowered skin tolerance combined with paralysis, the individual may be at risk for overheating, freezing, or other issues.
Some essential skin management tips to follow include:
- Perform regular skin checks, especially in areas where mobility and sensation are impaired;
- Keep the skin clean and dry. Wash with soap and water daily. Rinse and dry thoroughly;
- Wash skin folds and creases (groin area and underarms) more frequently, twice a day;
- Wear sunscreen and a hat at all times when going outside in the sun;
- Keep a safe distance from heat sources to avoid burning vulnerable skin;
- Avoid wearing too many layers of clothing to reduce pressure and skin irritation, and choose clothing with minimal buttons, zippers, or other devices that could also irritate skin;
- Limit alcohol intake as this can interfere with cell regeneration and blood flow;
- Avoid smoking;
- Eat a well-balanced diet;
- increase your intake of protein and vitamins A, B6, C, R and Zinc;
- Avoid using soaps labelled “antibacterial” or “antimicrobial.” These tend to reduce the skin’s acidity. The skin’s acidity acts as a protection against infection;
- Don’t use harsh soaps or alcohol-based products because they dry the skin;
- Lubricate dry skin with moisturizing creams or ointments. Use care in applying creams over bony areas because they may promote skin breakdown;
- Soiled skin can break down easily. If you have a bowel or bladder accident, be sure to clean up immediately;
- Avoid using talc powders. They may support yeast growth. They can also absorb moisture and keep it close to the skin, which will cause skin breakdown;
- If you get calluses on your feet and hands, be sure to soak frequently in warm water and towel briskly to remove dead skin. Moisturizing creams can help soften calluses;
- Take special care of your fingernails and toenails. Soak them and rub them gently with a towel to remove dead skin and decrease the chance of hangnails. Cut your nails after soaking;
- use properly fitted assistive devices, wheelchairs, mattresses, leg bags, splints and braces;
- Make sure you or your caregiver inspect your skin frequently and
- If there are areas you cannot see, use a mirror.
Have you or a loved one suffered a traumatic spinal cord injury?
We understand that a traumatic spinal cord injury (SCI) can have devastating physical, psychological, social and vocational effects on a person that will require a lifetime of care and understanding. Since 2003, Matt Lalande has worked with some of the top experts in Ontario in order to identify and quantify the life-long economic impact that spinal cord injury victims will face throughout their lifetime.
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This information was taken from research from the Journal of Spinal Cord Injury, as well as the combination of various research and peer review articles from pubmed.