Early treatment is a key factor in preventing very serious complications from skin problems. This lesson will review suggestions for general hygiene and treating common skin problems.
Good hygiene is very important to healthy skin, and includes bathing/showering regularly. Body parts such as urinary and bowel areas should be washed after incontinent urination or after a bowel movement. Consider using gentle, non-irritating cleansers such as Dove soap. Avoid harsh or heavily perfumed products.
After washing and drying, apply moisturizing lotion to keep the skin from becoming dry and cracked. Moisturel and Curel lotions are very moisture rich products. Avoid applying cream to elbows, as this could soften the skin too much and cause sores or other skin breakdown. The elbows should remain a little "tougher" since they receive a great deal of contact (leaning on armrests, desktops, etc.) throughout the day.
Pay careful attention to body areas that are prone to excess moisture and consequently fungal/yeast infections. Wash these areas with soap and water. Dry very well.
Consider leaving these areas open to air whenever possible. For example, place the person in a frog leg position while lying on the back if the groin is prone to high moisture from sweating, obesity or naturally occurring skin fold anatomy. In addition, consider using anti-fungal creams or powders instead of regular moisturizing lotion. See the "Groin Rash" lesson for detail on treating fungal infections of the skin. If an area is prone to fungal/yeast infection, try washing the area with an antifungal shampoo such as Nizoral.
Dry, Flaky Skin and Calluses
A common problem for people who are no longer walking is dry, flaky skin on the feet. This occurs when callouses that are no longer needed to protect the feet or hands begin to peel off. Soaking the affected area with vinegar works well to remove the dead skin and callouses. Use the following vinegar soak recipe.
Vinegar Soak Recipe
- Apply a solution of one part warm water to one part white vinegar to a towel.
- Wrap the affected extremity (feet, hands) in the towel for 20-30 minutes.
- Scrub the affected extremity with the same towel. Rinse, dry and apply a moisturizing cream.
- Do this once a day for three days.
- Do not do this if there are open sores on the skin in the affected extremity.
Red Or Dark Areas
Warm, Raised or Hardened Areas, Bruises and Other Color Changes
A reddened area can be prevented from becoming a deeper sore simply by keeping all pressure off the area until the color returns to normal.
- Keep pressure off the area by using padding and positioning, or remain in bed if necessary.
- Decrease time between turning over.
- Inspect the skin more than twice a day.
- If the area actually opens, call the doctor right away.
- Find out what caused the problem in order to prevent it from happening again.
Rash
- Leave rash area open to air; inform the doctor.
- Dry well.
- Do not apply any medications unless the doctor tells you to do so.
- Antifungal powders or creams help in preventing moisture rashes.
- Consider positioning the person in a way to keep high moisture areas (such as the groin) open to air.
- If an antifungal cream does not improve the rash in three days, call the physician for further treatment options.
Blister or Burn
- Leave the blister alone.
- Put cold water on burns immediately and leave on for 20 minutes.
- Cover area with antibiotic ointment and a clean, dry, non-stick dressing.
- Clean and change dressing two times a day.
- Keep all pressure off the area.
Open Area
- Call the doctor right away.
- Stay off the area completely even if it means staying in bed.
- Flush the area with sterile normal saline in a spray bottle; pat dry. See below for instructions for making homemade saline.
- Apply antibiotic ointment (over-the-counter brand) to the sore.
- Cover the sore with an absorbent dressing if it is draining, or a regular gauze pad if it is not draining.
- Do this twice a day.
- Do skin inspections more frequently.
- Make sure the doctor approves treatment.
Recipe for Sterile Normal Saline
- Prepare a mixture of 1 quart of water and 2 teaspoons of table salt.
- Heat until it comes to a boil.
- Store normal saline in a clean, sterile jar. The jar and lid should be cleaned and sterilized as for canning or preparing baby milk bottles.
- Make normal saline fresh every day.
Prevention
A skin program should include the following:
- Perform skin checks at least twice a day.
- Do weight shifts as prescribed.
- Maintain turn schedule as prescribed.
- Use correct padding and positioning to protect bony areas.
- Treat any and all skin problems immediately. Early treatment can prevent serious problems later.
- Practice basic first aid.
- Practice good foot care.
- Ensure that clothes and shoes fit properly.
- Perform safe and correct transfers.
- Avoid heat sources that can cause burns.
- Check wheelchair cushion for wear and tear and ensure that the person does not slump in the chair.
- Use powders to keep dry.
- Use a barrier cream (such as a diaper rash ointment) to cover skin on buttocks if diarrhea is a problem.
