Caring for the Beautiful Skin you are in

Posted by Nurse Linda in Life After Paralysis on June 16, 2021 # Health
woman in wheelchair holding a flower outsideSkin is the largest organ of the body. It is living tissue that confronts the world outside of your body while it protects the inside of the body. The eyes are another organ that meets the outside world but gets covered by the eyelids (skin) for protection or when in danger. Skin, the great body protector, is my favorite organ because it is so fascinating. It is the only organ you can easily see, right there all over your body.


Protection of the body is the primary function of skin, although it serves many purposes. The skin keeps toxins, germs, and other hazardous materials out of your body as it holds essential moisture, minerals, and nutrients within the body. Skin keeps out excess water. When you bathe or swim, your body does not fill with water because skin keeps water from overwhelming the inside of it. It helps to regulate the delicate balance of fluid within your body.

To me, one of the greatest properties of skin is elasticity. Skin will mold your body. It stretches and contracts when needed. For example, over knuckles, elbows, and knees, the skin stretches when you move your joints. Even more fabulous is that the skin over joints will snap back into place when the joint is relaxed. You can notice this articulation of skin over these joints. Over other, larger joints, the skin has the same stretch capacity, but the articulation of skin is not as noticeable. For example, the skin stretches for large movements over hip joints, but it is smooth, not as articulated. Movement in the rest of the body is accommodated by stretching smooth skin such as when you lean to the side or turn your head. The skin is placed just where it needs to be for maximum function of the body. Skin grows as your body grows to keep you protected.

Another property of the skin is its ability to heal quickly after injury. If you have a small cut or opening in your skin, you will see the area heal in as short as a day or two. Larger wounds take a while for the skin to repair itself. The skin has a quick recovery time because new skin cells are constantly being developed. Skin cells are the quickest to develop in the body. This is a necessary process as the skin is constantly confronting the world, including surfaces of all kinds, sunlight, temperature variations, touching other things and people, and all sorts of contacts and stressors. Other organs are housed within the body and not subject to the outside world. Therefore, skin must be tough and easy to repair.

Sensory information is gathered through the skin. You can feel something against your skin, such as a breeze, temperature, vibration, pressure, and injury. Skin allows you to feel the touch of another person or even something as small as an ant. You can also choose to identify objects just by feeling them. In the skin, thousands of sensory nerves can perceive even the smallest of sensations to the largest. The skin constantly sends messages to the brain, which regulates how the body needs to respond.

Thermoregulation or control of body temperature occurs through the skin. This happens in a couple of ways. First, blood vessels will dilate to allow the body to cool and constrict to retain heat when you are cold. The skin will release sweat on the outer layer of skin, which can evaporate to cool your body. The sweat glands can also release unwanted waste such as uric acid, ammonia, urea, and excess water.

The skin contains a chemical, 7-dehydrocholesterol, which, when exposed to sunlight, helps synthesize Vitamin D. Vitamin D is responsible for building and maintaining healthy bones, is an anti-inflammatory, antioxidant and has neuroprotective properties for immune health, muscle function and brain cell activity. It also has been noted to have a positive effect on mental wellness. Just a few minutes of sunlight on your skin can have positive results.

All these functions of the skin are controlled by information sent to the brain. Notice that what the skin does is not under your voluntary control. These functions just occur automatically by the Autonomic Nervous System (ANS). When the ANS is affected by paralysis or disease, skin functions can be disrupted. Therefore, caring for your skin becomes a significant activity to ensure the health of your entire body.

General skin care and maintenance need to be considered. It needs to be cleaned regularly. Use warm (not hot) water so as not to damage the top layer of skin. A terry cloth washcloth will add enough friction to your skin to remove shedding skin cells that would typically be removed by moving your body. A loofa or a poof may be too severe for your skin because it is not being challenged daily by the movement of rubbing up against clothing or other environmental objects. Use an emollient-based lotion to add moisture to your outer layer of skin.

Because of mobility challenges, the skin may build up on your hands and feet. It tends to peel off your body in sheets rather than the cells dropping off that you do not even see. Some people want to pull off the dead skin but do not do this. Pulling off the skin rips it at the connection where the skin is still attached to your body, leaving tiny abrasions or open areas in the top layer of skin. This is a perfect entry point for bacteria. Instead, soak the area with water, then use a terry cloth washcloth to gently remove the skin. It may take several attempts at separate times to remove the abundance of shedding skin. Use emollient moisturizer in between removal sessions. It will only take a few sessions to accomplish your clear skin goal.

Calluses are a thick accumulation of skin cells. They are skin cells that should have fallen off but did not for a variety of reasons. Individuals with and without sensation can develop calluses as a protective mechanism of the skin from irritations such as a shoe rubbing the foot or a device rubbing against the skin. Callouses do not have the same body protection ability as skin. They are an accumulation of dead skin cells that have adhered to an irritated or immobile part of the body. They do not have the elastic property or the needed ability to stretch as the skin has. Callouses become dry and crack over tender, thin skin below. This is a perfect entry point for bacteria. An individual with decreased sensation may not feel the intense pain of a cracked callous, but the body will still react through increased spasms (tone) or episodes of autonomic dysreflexia.

Reducing a callous too quickly does not allow time for the tender skin below to rebuild. Instead, use the same process as above by reducing the callous very slowly first by soaking, then using a terry cloth washcloth to scrub the calloused area. Apply an emollient-based lotion in between bathing sessions. Work slowly to reduce the callous because, as you do, the tender skin beneath the callous will build as the callous is reduced. It will take many sessions to complete the reduction task, depending on the thickness of the callous. The results will avoid any complications. An area of callous will need continued treatment with the washing and lotion. Remove the source of the callous by changing shoes, modifying a device, or adjusting whatever is rubbing the area. Never reduce a callous with anything stronger than a terry cloth washcloth. The risk of damage to skin tissue is too great.

Drying skin thoroughly is imperative. That sounds simple, but often it is not. Pat skin dry. Even when you feel the skin is dry, check-in hard-to-reach places or areas of the body that do not receive a lot of light, such as the underarms, groin, and buttocks. Any folds of the body should have extra drying attention as dampness can lead to rashes and bacterial growth. Bacteria love to grow in warm, dark, moist areas of the body. Encasing the groin and buttocks in an adult incontinence containment pad can encourage bacterial growth. If incontinency containment is used, such as adult urine collection products, or external urinary catheters with males, remove the device and clean the area thoroughly a minimum of twice a day. A skin prep can be used on the penis to protect the skin from the constant moisture of the urine. Skin ointments are available if a rash develops with urine collection products. Air the area for 15 minutes at least once per day.

Nails are at the endpoints of fingers and toes. They are included in the skin but are of a different texture. Trimming nails can lead to a risk of pricking the skin. Cut the nails straight across to avoid coming too close to the skin. After bathing to soften nails, trim them using a nail trimming device designed for the purpose. Soaking nails in a wet cloth can help soften them before trimming as well. Your payor may allow a podiatrist to trim your toenails, especially if you are over 65 years or diabetic.

Other ways to protect your skin include managing your time in direct sunlight to avoid sun damage and sunburn. Be sure to include UV sunglasses protection for your eyes. The sun can disrupt body temperature regulation. Stay in a cool place to keep your body temperature in a normal range. A wide-brimmed hat and loose, light-colored clothing should be worn. Use cool clothes to reduce body temperature. Humidity will collect in your body regardless of temperature. Know the location of areas with air conditioning where you can refresh when dealing with humid weather. Drink cold fluids.

Smoking causes blood vessels to narrow, especially those fine blood vessels in the skin. It also robs the body of oxygen as nicotine will adhere to cells taking the place of oxygen. Stopping smoking and all inhalants is imperative to skin health as well as your overall health. E-cigs are just as dangerous regardless of what people want to believe about them. Nothing inhaled into your lungs for entertainment is helpful except specific medications needed to help you breathe.

Eating a healthy diet will provide nutrients to your body which includes the skin. Fresh foods, not processed, are best. Drinking water will keep your body hydrated. Other fluids can be enjoyed but use in moderation. Alcohol and caffeine can dehydrate the body.

Taking care of your skin is important to maintaining health. Everyone can see your general health just by looking at you because they see the freshness of your skin! Remember to love the skin you are in. Nurse Linda

Pediatric Consideration:

Caring for the skin of children is much like for adults. People can be lulled into the idea that children’s skin is so resilient that it does not need the same care. Children’s skin is resilient but adding the issue of decreased sensation puts it at risk. Turning, checking, and monitoring is just as critical for people of all ages. Tell your child that you are checking their skin and why each time. Even if they are too young to understand, it makes an impression and sets up a great skin checking habit.

Diapers are the norm for infants and toddlers. Some will continue diapering in children a bit older. However, diapers retain moisture which is their purpose. That moisture can lead to rashes and even pressure injury in individuals of all ages. As soon as appropriate, begin a bladder program and bowel program to keep irritants off the skin. You will find your child, even an infant, does not require a diaper when urine and stool are regulated. If a diaper is used, change it when soiled. Plan time in the day when the diaper can be left off to let the skin air and dry. Nurse Linda

Linda Schultz, Ph.D., CRRN, a leader and provider of rehabilitation nursing for over 30 years, and a friend of the Christopher & Dana Reeve Foundation for close to two decades. Within our online community, she writes about and answers your SCI-related healthcare questions in our Heath & Wellness discussion.

This project was supported, in part, by grant number 90PRRC0002, 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.