Treatment

Act early to care for skin issues

Early treatment is a key factor in preventing very serious complications from skin problems.

Good habits

A skin care program should include the following:

• Perform skin checks at least twice a day. Treat any and all skin problems immediately.
• Practice basic first aid and good foot care.
• 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.
• Ensure that clothes and shoes fit properly.
• Avoid heat sources that can cause burns.
• Use correct padding and positioning to protect bony areas.
• Perform safe and correct transfers. Do weight shifts and turn schedules as prescribed.
• Check wheelchair cushion for wear and tear and ensure that the person does not slump in the chair.

Good hygiene

Good hygiene is very important to healthy skin. This includes bathing or 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. Lotions such as Moisturel and Curel lotions are very moisture-rich products. Note that the elbows should remain a little tougher since they receive a great deal of contact with objects such as desktops and armrests throughout the day, so avoid applying cream to elbows, as this could soften the skin too much and cause sores or other skin breakdown.

Pay careful attention to body areas that are prone to excess moisture and consequently fungal and/or 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. If an area is prone to infection, try washing the area with an antifungal shampoo such as Nizoral.

Conditions to watch for

Blister or burn

• 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. Try not to disturb the area.

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 a vinegar-based solution works well to remove the dead skin and callouses.

Open area of the skin

• 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 to the sore.
• Cover the sore with an absorbent dressing if it is draining, or a regular gauze pad if it is not draining.
• Treat the area twice a day.
• Perform skin inspections more frequently.

Rash

• Leave rash area open to air, and dry well.
• Consider positioning the person in a way to keep high moisture areas (such as the groin) open to air.
• Inform the doctor. Do not apply any medications unless the doctor tells you to do so.
  • Antifungal powders or creams help in preventing moisture rashes.
  • If an antifungal cream does not improve the rash in three days, call the physician for further treatment options.

Red or dark areas

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.

Treatment recipes

Sterile normal saline

1. Prepare a mixture of 1 quart of water and 2 teaspoons of table salt.
2. Heat until it comes to a boil.
3. 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.
4. Make normal saline fresh every day.

Vinegar soak

1. Apply a solution of one part warm water to one part white vinegar to a towel.
2. Wrap the affected hands and feet in the towel for 20-30 minutes.
3. Scrub the affected extremity with the same towel. Rinse, dry, and apply a moisturizing cream.
4. Do this once a day for three days.
5. Do not do this if there are open sores on the skin in the affected extremity.