Skin care and pressure injury prevention after spinal cord injury

Why skin care matters after SCI

Pressure injuries (also known as pressure sores or pressure ulcers) occur when pressure, friction, or moisture damages the skin and underlying tissue.

For people living with spinal cord injury, pressure injuries can become serious very quickly and may lead to:

• Infection

• Reduced mobility and independence

• Long recovery periods

• Hospitalisation

Even minor skin changes should be taken seriously.

Check your skin every day

It’s recommended that you check your skin at least twice a day, usually morning and night.

If you can’t easily see some areas of your body, you may need:

• A mirror

• Assistance from a support person

• Help from a carer or family member

What to look for

When checking your skin, watch for:

• Redness or discolouration

• Scrapes or cuts

• Bruising

• Blisters

• Swelling

• Areas that look different from usual

Early identification is important because skin damage can worsen quickly if pressure or friction continues.

Common causes of pressure injuries

Pressure injuries can happen in many different ways, including:

• Pressure and shearing: poor posture, sitting upright in bed, or sliding in a chair can create pressure and tissue damage inside the body

• Moisture: skin that stays damp from sweat, incontinence issues, or poor drying after getting wet can become damaged more easily

• Tight clothing or footwear: seams, buckles, studs, tight shoes, or clothing can create pressure points on the skin

• Friction: dragging across bed sheets or surfaces can damage the skin

• Burns and temperature: reduced sensation can make it difficult to notice:

  • Hot water

  • Heated car seats

  • Hot pavements

  • Sun exposure

• Equipment and tubing: catheter tubing, straps, or unnoticed objects on seats (e.g., phone, keys) can place pressure on the skin for long periods

• Diet and hydration: poor nutrition and not drinking enough fluids can affect skin health and healing

Tips for preventing pressure injuries

There are many small daily habits that can help protect your skin.

Relieve pressure regularly

This may include:

• Turning regularly in bed

• Pressure lifts

• Weight shifting in your wheelchair

• Limiting sitting time if you have a skin concern

Use appropriate equipment

Having the right:

• Mattress

• Pressure cushion

• Seating support

Can make a significant difference.

Occupational Therapists can help assess your equipment and ensure it’s meeting your needs.

Keep your skin clean and dry

Good hygiene is important, but avoid products that can dry or irritate the skin, such as:

• Harsh soaps

• Powders

• Alcohol-based products

If your skin is dry, moisturising creams or ointments may help. Apply gently and allow products to absorb properly.

Wear loose, comfortable clothing

Avoid items that can create pressure or friction, such as:

• Tight shoes

• Thick seams

• Studs or buckles

• Tight straps or cords

Temperature regulation after spinal cord injury

Did you know spinal cord injury can affect your body’s ability to regulate temperature?

Depending on your level of injury, you may:

• Feel hotter or colder than the surrounding environment

• Sweat more above the level of injury

• Sweat less or not at all below the level of injury

This can increase the risk of:

• Hypothermia (dangerously low body temperature)

• Overheating and heat exhaustion

• Burns

• Difficulty cooling down during exercise or hot weather

Tips for managing temperature changes

Helpful strategies may include:

• Dressing appropriately for the weather

• Planning ahead for hot or cold environments (e.g., if it’s hot when going out, finding undercover/cool spots to be near)

• Staying hydrated

• Using cooling or heating supports at home (e.g., air conditioning, fans, blankets)

• Monitoring skin during exercise and outdoor activities

• Being cautious around hot surfaces and water

Seek support early

If you notice skin damage or changes, it’s important to act early and seek advice from your healthcare team.

At estara, our Occupational Therapists and Spinal Nurse Advisors can help with:

• Pressure care education

• Equipment assessments

• Cushion and mattress reviews

• Skin management strategies

• Pressure injury prevention plans