Back to Basics: Skin Care

The skin is the largest organ of the body. Unlike other organs that are internal, the skin is the only organ that directly communicates with the outside world. Maintaining the integrity of the skin is important to your health and well-being. Much like previous back to basics in this series, just the highlights of maintaining the skin will be the focus of this blog. You have a skin care maintenance program that is unique to you. Presentation of some of the finer points of skin care will help you fine tune your program.

Skin maintains itself by replenishing skin cells quickly. Old skin cells flake off the body as new cells replace them. This is hardly noticed. The turn over is quick compared to other, internal cell replacement. One way to keep the skin healthy is to supply moisture from within the body. This is done through fluids which can consist of things you drink, water being the best, or even through foods you eat. Foods with high water content will help you skin as well as other bodily functions such as your kidney and bowel function. A balanced diet will provide the body, particularly the skin, with the nutrients to maintain skin health.

After a spinal cord injury, you might notice your skin becoming flaky along with dryness. This is because movement helps the body shed skin cells. When your skin moves against your clothes, the skin cells that are being replaced tend to flake off. Mostly, we don’t see this happening because it is so subtle. However, you can assist in this process by doing your range of motion exercises to the part of the body that does not move so well.This has many benefits for your entire body as well. Sometimes use of a lanolin-based lotion or skin oil will help moisten the surface of your skin.

Hydration from the inside of the body is the most important but surface moisture assists the surfac

hands touching skin

e of the skin. Dermatologists are recommending oils can be used such as olive oil. When adding moisture to the skin, be sure to use lotions or oils sparingly with removal during bathing. Don’t apply to dark, moist areas of the body such as in the groin, around the rectum or in skin folds. The heat of your body will cause the applied moisture to spread which can lead to skin breakdown or even infections.

Some individuals will have peeling of the skin especially in the thicker skin areas of the palms of the hands or soles of the feet. The skin is thicker in these areas. Flaking of large bits of skin must be handled very cautiously. Tearing dry strips off can lead to small openings in the skin that might not even been seen. However, bacteria can find their way in, entering your system and leading to major infection. The best way to remove peeling skin is to soak the area to soften the flakes. Then use a washcloth to create friction which mimics the natural removal of skin tissue. You do not need to be aggressively rubbing, a gentile action will do. Apply lotion or oil to continue to soften the flaking skin. Several applications of friction and softening will be needed.

Calluses are areas of excessively thickened skin. You can reduce calluses in the same way by first soaking the area with warm water, applying friction with a wash cloth and moistening with lotion or oil. Reducing calluses should take several attempts as removal of too much of the callused skin at one time will leave the skin under the callused skin exposed which can be extremely soft and easy to tear. Calluses left unreduced can dry and crack making an opening for bacteria to enter. Foot calluses are particularly vulnerable due to possible poor circulation since they are so far from the heart, edema and moisture from socks and shoes.

Of course, the most critical issue for individuals with spinal cord injury is pressure release. So many individuals rely on their pressure devices to do this activity. Pressure cushions and bed surfaces help by dispersing pressure, but this equipment does not eliminate all pressure. Where ever there is a boney prominence that is close to the surface of the skin, there is a chance for a pressure injury. The bone applies pressure to the skin from the inside of the body causing destruction of the inner tissue, before you see the dreadful red spot on the surface of lightly pigmented skin or an ashy or dark spot on darkly pigmented skin. Sometimes people see a spot and think, ‘oh it is only a spot on the surface’ but in fact the damage is much greater inside the body where you cannot see. Think of a spot like an iceberg. You see a small amount of damage on the surface, but like an iceberg, the bulk of damage is below the surface where you cannot see.

The red or dark spot that you see is damaged capillaries that have restricted blood flow through them. Sometimes, they reopen within 15-20 minutes but if it takes longer, there is probably some significant damage. Whenever a spot appears, you need to stay off the area completely. Even if just a quick few seconds of pressure is applied, your work of staying off the area is eliminated, and you have to start all over. Sitting on pressure dispersing equipment still puts some pressure on the area. It is much easier to stay off the spot area for a few days until it is totally resolved than continually reapplying pressure. A spot on you skin could lead to a more serious wound. Surgery for wounds requires you to be completely off the area for six to eight months or longer. Earlier treatment is better and easier.

Once a pressure injury has occurred, you will have a scar. Damaged skin forms a scar which is how it heals itself. Scars do not have the elasticity or stretch of undamaged skin. Skin injury is always more delicate than undamaged skin. Once a pressure injury is healed, skin conditioning to the area slowly starts. This includes pressure to the area for five to ten minutes, checking for redness, then advancing ever so slowly until you reach your individual needs.

Avoiding pressure injury involves many factors. Fluid and a healthy diet are what the skin needs to maintain itself. You should also use medical grade pressure dispersing seating and bed surfaces. These reduce pressure to your body however they do not eliminate pressure. Pillows and other cushions do not have the pressure dispersing factor. Use of these items increase pressure to the area as they collapse under the weight of your body making the danger areas even harder on your skin. Remember your upper body and head can also sustain a pressure injury.

Since your equipment will not totally solve the issue of pressure injury, you do need to do pressure releases about every 10 to 15 minutes depending on your individual needs. You can lift yourself off your chair with your arms, gently lean over the side of your chair being careful not to lose your balance and fall out or use mechanical devices in your chair such as the tilt feature. This moves the pressure from one spot of your body to another. In bed you will need to turn, have someone turn you, or have a mechanical bed that will turn you. Use a timer to perform your pressure releases or find a clue in your environment such as at TV commercials or other activity that occurs about every 10 minutes.

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Building your muscles will create a better internal body environment. Healthy muscles create pressure dispersion inside your body. Weak or thin muscles do not allow for pressure dispersion. You can build muscles by actively moving them by yourself through range of motion exercises or by having someone do it for you. A physical therapist can teach you therapeutic exercises which can help.

Maintenance of you skin is critical to your well being. You may find that the needs and nature of your skin changes over time. What worked for you a few years ago may need to be advanced as your body ages. Everyone’s skin changes with age by becoming thinner and a bit less elastic, which is why we have wrinkles. Keeping on top of skin care is essential. You could go through your life without a spot on your skin until one day, suddenly one is there. You might think but I have been doing my routine, which you have but aging goes on anyway.

If you cannot see your skin to do skin checks every morning and evening at a minimum, use a mirror. Take a picture so you will have a record of when something appeared or became worse. If you have an assistant, let them look for skin trouble but be sure to look yourself. It is your body and important to know what is going one with it.

Pediatric Considerations
The younger skin is, the more resilient it is. Infants skin heals quickly and often a scar cannot even be seen. However, turning and moving your child is critical to maintaining skin. Use of health grade pressure dispersing products are needed just as for adults. Learning to do pressure releases with the child makes it a part of their lifestyle as they get older. It can be difficult for young children to remember to do a pressure release, so an alarm watch might be necessary. As children get older, they will need inspiration to do pressure releases. Point out how others are always moving in their environment even if without a spinal cord injury. They are doing pressure releases, too.

About the Author - Nurse Linda

Linda Schultz, Ph.D., CRRN is a leader, teacher, and provider of rehabilitation nursing for over 30 years. In fact, Nurse Linda worked closely with Christopher Reeve on his recovery and has been advocating for the Reeve Foundation ever since.

Nurse Linda

The opinions expressed in these blogs are the author's own and do not necessarily reflect the views of the Christopher & Dana Reeve Foundation.