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Spinal Cord Injury Paralysis Resource Center

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Skin Care

People with paralysis are at high risk of developing skin problems. Limited mobility coupled with impaired sensation can lead to pressure sores or ulcers, which can be a devastating complication.

The skin, the largest organ system in the body, is tough and pliable. It protects the underlying cells against air, water, foreign substances and bacteria. It is sensitive to injury and has remarkable self-repair capabilities. But skin just can't take prolonged pressure. A pressure ulcer involves damage to the skin and underlying tissue. Pressure ulcers, also called bed sores, decubiti or decubitus ulcers, range in severity from mild (minor skin reddening) to severe (deep craters that can infect all the way to muscle and bone). Unrelieved pressure on the skin squeezes tiny blood vessels, which supply the skin with nutrients and oxygen. When skin is starved of blood for too long, tissue dies and a pressure ulcer forms.

Sliding around in a bed or chair can cause blood vessels to stretch or bend, leading to pressure ulcers. An abrasion can occur when a person's skin is pulled across a surface instead of lifted. A bump or fall may cause damage to the skin that may not show up right away. Other causes of pressure sores are braces or hard objects that put pressure on your skin. Also, people with limited sensation are prone to skin injuries from burns.

Skin damage from pressure usually begins on the body where the bones are close to the skin surface, such as the hip. These bony prominences apply pressure on the skin from within. If there is a hard surface on the outside, too, the skin is pinched off from circulation. Because the rate of circulation is reduced by paralysis to begin with, less oxygen is available to the skin, lowering the skin's resistance. The body tries to compensate by sending more blood to the area. This may result in swelling, adding still more pressure to the blood vessels. A skin sore begins as a red area on the skin. This reddened area may feel hard and/or hot. For those with darker skin, the area may appear shiny. At this stage, the progression is reversible. The skin will return to its normal color if the pressure is removed.

If the pressure is not removed, a blister or scab may form -- this means that the tissue underneath is dying. Remove all pressure over the area immediately.

In the next stage, a hole (ulcer) forms in the dead tissue. Frequently, this dead tissue is small on the skin surface, but damaged tissue may extend deep to the bone.

A skin sore can mean several weeks or even months of hospitalization or bed rest in order for the sore to heal. Complex pressure sores may require surgery or skin grafting. All of this can cost thousands of dollars and mean valuable time away from work, school or family.

Skin wound treatment by any means is complicated by hard-to- treat infections, spasticity, additional pressure and even the psychological makeup of the person (pressure sores have been linked to low self-esteem and impulsive behavior). It is an oversimplification to say pressure sores are always preventable but that's almost true; with vigilant care and good overall hygiene, skin integrity can be maintained.

A wide variety of pressure-relieving support surfaces, including special beds, mattresses, mattress overlays or seat cushions are available to support your body in bed or in a chair. Work with your therapists to know what is available. Search AbleData for specific seating and sleep surface products. Here's an example of a product to help people who can't turn at night and who may not have an attendant to do it for them: FreedomBed is an automatic lateral rotation system that quietly turns through a 60-degree range of rotation.

Remember that the first line of defense is to be responsible for your own skin care. Look at it: Check your skin daily, using a mirror for hard-to-see areas. Skin stays healthy with good diet, good hygiene and regular pressure relief. Keep the skin clean and dry. Skin that is moist from sweat or bodily discharges is more likely to break down. Drink plenty of fluids. A healing wound or sore can lose more than a quart of water each day. Drinking 8 to 12 cups of water a day might not be too much. Note: Beer and wine do not count; alcohol actually causes you to lose water or become dehydrated. Watch your weight, too. Being too thin causes you to lose the padding between your bones and your skin and makes it possible for even small amounts of pressure to break down the skin. Getting too heavy is risky, too. More weight may mean more padding, but it also means more pressure on skin folds. Don't smoke. Research has shown that heavy smokers are more prone to skin sores.

Sources:Paralyzed Veterans of America, Craig Hospital, National Library of Medicine, University of Washington School of Medicine/Rehabilitation

AAHD NewsletterThe American Association on Health and Disability published this Spring 2004 article, "Preventing Pressure Sores," in their Health and Disability Newsletter.

A Reeve Foundation Fact Sheet on Skin-Pressure Sores (PDF)

decubitus.orgNational Decubitus Foundation

emedicine.comeMedicine: Decubitus Ulcers

findarticles.comGale Encyclopedia of Medicine: Bedsores

familydoctor.orgFamily Doctor.org's Pressure Sores

Model Systems Knowledge Translation CenterThe factsheets listed at the MSKTC were produced through a collaboration between the MSKTC and the SCI Model Systems. These materials undergo expert and consumer reviews to ensure they are up-to-date, evidence-based, and consumer-friendly.

MedlinePlusStart here with 750 topics on conditions, diseases and wellness. MedlinePlus will direct you to information to help answer health questions. MedlinePlus brings together authoritative information from NLM, the National Institutes of Health (NIH), and other government agencies and health-related organizations. Preformulated MEDLINE searches are included in MedlinePlus and give easy access to medical journal articles. MedlinePlus also has extensive information about drugs, an illustrated medical encyclopedia, interactive patient tutorials, and latest health news.

merck.comMerck Manual of Diagnosis and Therapy: Pressure Sores

KCIKinetic Concepts Inc. (KCI) offers a "Wound Management Reference Guide."

National Library of Medicine (NLM)Offers deep resources on numerous medical conditions.

npuap.orgNPUAP stands for National Pressure Ulcer Advisory Panel. Visit their website to learn about some of the panel's latest research and recommendations.

spinalcord.orgHere is the National Spinal Cord Injury Association's fact sheet on skin care.

spinalinjury.netSpinal Injury.net's Pressure Sores

SCI-Info Pages: Skin CareFrom the SCI-Info-Pages: Spinal Cord Injury: Skin and Pressure Sores Synopsis

travisroyfoundation.orgTravis Roy Foundation: Pressure Sores

VAC TherapyVacuum Assisted Closure (VAC) Therapy: An Advanced System for Wound Healing.

Paralysis Resource Center The Reeve Foundation Paralysis Resource Center Information Specialists are reachable business weekdays, Monday through Friday, toll-free at 800-539-7309 from 9:00 am to 5:00 pm ET. You may also schedule a call or send a message online.

Reeve Foundation Online Paralysis Community Connecting people living with paralysis, families, friends and caregivers so we can share support, experience, knowledge, and hope.

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The Reeve Foundation Paralysis Resource Center Information Specialists are reachable business weekdays, Monday through Friday, toll-free at 800-539-7309 from 9:00 am to 5:00 pm Eastern U.S. Time. International callers use 973-467-8270. You may also schedule a call or send a message online.

This project was supported, in part by grant number 90PR3002, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.