Key principles of skin care, personal clothing and other accessories

Skin care products

Skin products: Use products that have a mild pH with a low or no fragrance. This can include wet wipes, body wash, moisturiser, and laundry products. 

Barrier cream: A barrier cream controls moisture on the skin, especially in humid conditions. It is best applied in the morning after the shower, to groin and buttock areas that have low airflow when sitting. If using a zinc-based cream, the cream should be ‘invisible’ when applied to the skin.

Moisturiser: To maintain a balance of moisture on the skin and moisturise dry skin if required. If needing to apply moisturiser to the buttocks, this is best done in the evening to allow absorption and reduce moisture when sitting during the day.

Clothing considerations

Natural or wicking fibres: Natural or wicking fibres help pull moisture away from the skin. This is especially important for materials in direct contact with seated skin surfaces. They can help prevent blemishes and rash development.

Hygiene: Regular washing of clothing and cushion covers reduces the bacterial load on fabrics. This can also assist with preventing urinary complications such as infections. 

Underwear: Consider firm-fitting long-leg underwear to reduce friction and improve moisture control. Fitted underwear can also assist with scrotal positioning and reduce the potential risk of sitting on the scrotum. Avoid using continence pads as they reduce immersion into the cushion or mattress, increase skin temperature and increase friction from the elastic edges in the inner pad.

Clothing stretch: Check clothing isn’t too tight and has some stretch for better immersion into the cushion. There are clothing manufacturers that sell clothing designed for wheelchair-users. The better-fitting clothing is designed to prevent bulk underneath the person and pants sliding down at the back when sitting.

Clothing texture: Rough textured clothing can cause friction to the skin. Examples of this can be denim or fleece linings that may pill.

Pressure sources on clothing: Avoid clothes that have thick seams, back pockets, studs and/or buttons. If able, remove the pockets.

Footwear: Footwear should have a firm sole to maintain optimal foot positioning on the footplates and protect the toes if accidently bumped when in the wheelchair. Shoes should be at least one size bigger to accommodate any swelling during the day. Avoid tight shoelaces and socks with seams. Make sure the toes are flat inside the shoe.

Metal objects: Metal zippers or studs can hold heat and caution should be taken near a heater or when exposed to the sun to avoid burns.

Wrinkles: Try to smooth out big wrinkles in clothing and bed sheets.

Wet clothing: Avoid sitting in wet clothes after swimming. Make sure the skin is rinsed and clothing is changed as soon as possible.

Medical devices

Urinary catheters, bags and straps: Indwelling urethral catheters should be secured to prevent pulling. Urine bags should be alternated on each side to prevent erosion of the meatus or suprapubic stoma site. Check urinary tubes and bags after repositioning in bed. Make sure the leg bag straps aren’t too tight or consider using wider straps or a sleeve to secure the leg bag. Silicone catheters may cause blistering as they are textured material. Cover the catheter with a soft cloth to prevent contact with the skin.

Splints and braces: Splints and braces may require adjustment over time and should be checked for correct fit, rubbing, or marking of the skin.

Hand splints: Make sure hand splints are elevated on a towel or pillow to avoid marking the skin.

Collars: Collars should be removed twice a day to clean and check the underlying skin, as well as to make readjustments.

Abdominal binders: Make sure abdominal binders are correctly fitted. They should be firm but not tight as this will mark the skin.

Plaster casts: Consideration should be used when applying plaster casts to limbs with poor sensation, no sensation or no active movement.

Masks/Oxygen therapy: Using a sleep apnoea mask or oxygen therapy such as nasal prongs require close monitoring, especially if someone does not have the hand function to change the device position.  If using humidification, ensure the heated tubing or water does not contact the skin.

Tracheostomy: Tracheostomy tapes should be replaced daily, especially when wet after showering. A foam dressing under the flange can prevent pressure on the skin and manage exudate from the stoma.

Heat packs: Heat packs should not be used on areas with no or impaired sensation due to the high risk of burns.

Other devices: This may include tubing for intravenous therapy, feeding tubes, ventilation tubes or any other device connected to the person. The tubing should be well secured to prevent pulling on stomas and carefully monitored.

Carrying items

Educate the person with spinal cord injury to:

• Avoid keeping anything in pockets such as keys, mobile phones or wallets.
• Take care when carrying hot food items including drinks. Always make sure the hot drink is contained and/or a towel or tray is used to protect the skin from the heat.
• Cigarettes can cause burns, if dropped onto areas of no or impaired sensation, as well as onto flammable materials on the bed, clothing or wheelchair cushion. They can also cause burns when the cigarette burns close to the fingers of someone that has no or impaired sensation.