Skin infections are caused by bacteria, viruses, funguses, or parasites that are directly on or in the skin. They can develop in anyone with or without neurological injury or disease. Bacterial skin infections may appear as a pimple, abscess, impetigo, or cellulitis (infection of skin cells). Viral skin infections include a wart, measles, chickenpox, shingles, and hand, foot and mouth disease. Fungal infections may include athlete’s foot, ringworm, nail fungus, mouth thrush, diaper rash, or yeast infection. Skin infections from parasites include lice, bedbugs, or scabies.
The skin is the body’s external defense against any invader from entering. However, infections can slip into an opening in the skin or even just burrow in through healthy skin tissue.
Typically, the body will mount a defense against an invader of the skin. The immune system will detect an invader causing a message to be sent to the brain. The brain then will respond by sending naturally occurring antibodies to eliminate the invader. However, with a neurological disease or injury, the autonomic nervous system (ANS) may not detect the invader, may not send a message to the brain quickly or fully, and may not relay the message to destroy the invader effectively, or any combination of these actions. This allows the invader to multiply. At first, the skin infection may not be detected in other ways by not being seen or felt which allows more time for the invader to multiply.
Treatment for skin infections depends on the bacteria, virus, fungus, or parasite causing the issue. Typically, prescription antibiotic ointments, antiviral creams, antifungals, or antiparasitic medication are needed. Keeping the areas clean and thorough drying is needed. Providing air and light to dark body parts by use of positioning can assist in resolving the area requiring treatment. Remember, bacteria love warm, dark, moist body parts such as armpits, groin, under breasts, and skin folds.
Seborrheic dermatitis looks a lot like dandruff but is more serious. In children, it is seen as a ‘cradle cap’. It is a reaction to normal substances on the surface of the skin which allows Malassezia yeast to overgrow causing the immune system to overreact. This becomes a circular process of flair-ups and clearing. The condition looks like redness, greasy scales, and slight swelling predominantly in the areas of the nose, eyebrows, chest, and upper back, and can occur in the groin and armpits. It may appear on the head in adults and especially in children. It can be confused with diaper rash.
Connections of seborrheic dermatitis occur in neurological conditions such as stroke, head injury, spinal cord injury, Parkinson’s Disease, and epilepsy, among many others. Stress and hormonal changes due to extreme illness as well as depression and alcoholism can trigger the condition.
Treatment is to keep seborrheic dermatitis under control by using a 2% zinc pyrithione cleanser and a moisturizer. A medicated shampoo, antifungal cream, or over-the-counter dandruff product may be prescribed. For cradle cap petroleum jelly or dandruff shampoo may be all that is needed to loosen and remove scales.
Toenails and fingernails are considered part of the skin. In neurological injury, an ingrown nail especially a toenail occurs from the nail growing into the skin or the nail being cut to taper around the shape of the nail which allows the skin to grow over the nail. The symptoms are nail redness, swelling, warmth in the area, pain, and pus. You may not feel the symptoms, but your body will still react to them. Ingrown toenails often trigger episodes of autonomic dysreflexia (AD).
Risks for ingrown nails, of the toes or fingers, include not cutting the nail straight across. Many individuals like to shape the nail around the toe, but this allows the nail to grow into the skin or the skin to cover the nail. Other issues are shoes that are too tight, poorly fitting, or rub with movement such as walking or with tone (spasms). Hitting or bumping your toe or finger can create damage to the nail and swollen tissue around the nail leading to an ingrown nail. Other risk factors are decreased sensation from poor nerve function and diabetes. In children, shoes that are outgrown are a cause.