Skin care following an SCI
Your skin is the largest organ in your body. Skin is an amazingly complex structure that performs many tasks for your body. It provides you with information about your surroundings and alerts you to danger. It keeps you cool in hot weather and warms in cold.
Skin is made up of 2 main layers, the outside layer is called the epidermis, and the inner layer the dermis.
What is the Epidermis?
The epidermis is the thin, outer layer of the skin that is visible to the eye and works to provide protection to the body. It does not contain any blood vessels and is, therefore, dependent on the dermis, the layer of the skin underneath it, to provide access to nutrients and dispose of waste.
The inner tissue layer of skin contains many tiny blood vessels and nerves sensitive to both light touch and deep pressure. The root system of hairs, called follicles, grows in the dermis. The dermis also houses two types of 'miniature pumps' called glands, the sweat glands and the sebaceous glands.
The Sweat Glands
The sweat glands 'pump' a salty water solution to the surface of the skin. When the sweat is evaporated off our bodies it cools us down. Sweat also contains some salts and minerals that the body needs to dispose of.
The Sebaceous Glands
These glands secrete an oily substance into the hair follicles. The oil flows along the hair to the surface of the skin. Here, it forms a protective film that keeps skin soft.
An Early Warning System
All these parts of the skin perform a vital task in instructing the brain which parts of your body are too hot or cold, where clothing is too tight and where you are about to or have already been damaged by cuts, bruises, or burns. In response to messages from the brain, your skin opens and sweats to keep you cool or closes up and raises your hair to warm you.
Most importantly, your skin keeps an ever-vigilant, 24 hours per day, running report on how much blood is being supplied to every square millimetre of your skin. In thousands of ways that most of us are not even aware of, our bodies constantly adjust, relieving pressure here and moving away from harmful surfaces there. This wonderful interaction between body and brain never stops, not even in your sleep - until your spinal cord is damaged.
Skin & Spinal Cord Impairment
After spinal cord injury, changes occur in the skin. Collagen which gives strength to the skin is decreased as is the blood supply to the skin. There is also a decrease in muscle size due to immobility which is replaced by an increase in the fat layer. The perception of sensation is also decreased or absent depending on the type of spinal cord injury. These changes can cause an individual to be more susceptible to pressure injury.
A spinal cord impairment means that you must consciously take over the task of looking after your skin. Because you cannot react to sensations of damage as it occurs, you now have to predict and prevent that damage before it occurs.
This is a huge responsibility to take on. If there is one key point to take note of, it is…
"an ounce of prevention is worth a ton of cure."
Advanced pressure areas are the number one reason why people return to spinal units.
What is a Pressure Area?
A pressure area is a term used to describe an injury to the skin and tissue which has occurred as a result of sustained pressure. Following an SCI, you can no longer feel when your skin is becoming starved of blood.
If you sit or lie in the same position for a long time the pressure on small areas of your body can squeeze shut the tiny blood vessels that supply the tissue with oxygen and nutrients. This is most likely to occur in bony areas where your bones are closer to the surface of your skin.
If starved of these 'fuels' for too long it begins to die, and a pressure area starts to form. Damage can range from a change in the colour of unbroken skin to severe deep wounds affecting muscle and bone.
For more information on pressure areas, go to the following page Pressure Injury Prevention.