What to look for:
Look for any reddened areas, rashes, cuts, bruises, scrapes, or indentations from seams or elastic binding. Check also for blisters, bumps, insect bites, dry flaky skin or pimples. Check toenails for any redness or pus formation around the end of the nail. Whenever you notice a problem, try to figure out its cause and make any changes necessary to prevent further problems. The first step in curing any skin problem is to eliminate the cause.

Preventing skin injuries

Pressure Relief: Are you changing your position often enough to relieve pressure over bony prominences?

In both bed and wheelchair, change your position according to your skin tolerance. (For information on establishing skin tolerance, see our pamphlet on pressure sores. Pressure releases in a wheelchair can be done by pushing straight up, leaning side to side, bending forward over your knees, reclining the seat of your electric wheelchair or having someone tilt you back in your manual chair. Always use your wheelchair cushion. In bed, body parts can be padded with pillows to keep bony prominences free of pressure. Get into the habit of checking your body position for correct alignment and pressure-free positioning of bony prominences.

Equipment you use: Are you using the best equipment? Does it fit you properly? Here are some concerns:

• Wheelchair - Does it support your back? Are your footrests the right height? Are you using the best wheelchair cushion?
• Bed - Are you using a good mattress?
• External catheters - Is the correct size being used? Is it being changed frequently enough?
• Leg bags - Are the straps too tight?
• Braces  - Do they fit properly? Do you do skin checks after wearing them?

Temperature: Extremes of temperature call for extra caution in protecting your skin:

• Heat - Avoid sunburn by covering up or using sun block. Don't put plates of hot food on your lap without protecting your skin. When riding in a car, keep your feet away from the heat outlet and check vinyl seats before you sit on them to make sure they aren't too hot. Any exposed pipes in your kitchen or bathroom sink should be wrapped to protect your legs from burns. When you go camping, protect your feet by sitting a safe distance from the campfire.
• Cold - Be sure to dress warmly to prevent frostbite if you are out in cold weather for long periods of time. Dressing in layers of clothing will provide extra warmth. Avoid putting frozen foods on your lap.
• Fever - Your skin tolerances can change due to the increased body temperature that occurs with a fever. You may find that you cannot lie in one position as long.

Body Weight: A correct or average body weight for your height is desirable

• Too much - Being overweight can cause increased pressure on bony prominences. Delayed healing may occur because there are fewer blood vessels in fat tissue.
• Too little - Excess pressure over bony prominences may occur because there is less padding (muscle and fat) over these surfaces. In addition, underweight persons may lack the proper nutrition to maintain healthy skin.

Clothing / Shoes:  Proper fit is important. Avoid sitting on seams and back pockets, and always check your skin carefully after wearing new shoes or clothing.

• Too loose - Loose clothing can form wrinkles that put pressure on your skin.
• Too tight - Overly tight clothing can hinder circulation.

Alcohol: Over-indulgence in alcohol - or any other drug - may interfere with attention to your personal care needs. For example, while under the influence you might forget to turn yourself, or be too weak to transfer yourself properly.

Stress: Stress and depression can have a similar effect by causing you to lose interest in your personal care and pay less attention to your skin and general health.

Spasticity: Spasticity may cause your arms and/or legs to bump against an object, or to fall off your armrest or footrest, and be injured. Spasms may cause your skin to rub against something (for example, the sheets on your bed), which could produce an open sore.

Pressure Sores
Stages of Pressure Sores
Reapplying Pressure
Skin Management
Prevention Tips