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Management of skin problems

Manage a problem ‘just-in-time’

Serious complications can arise if pressure injuries are not managed in a timely way.
In the long term, these issues can lead to:

Worsening of the pressure injury:
The pressure injury may get larger and deeper, and result in tunneling which is a formation of track between layers
of muscle, fat or bone that may be hard to heal.

In a deep pressure injury, the bone can become infected, known as osteomyelitis. The infection can spread into your bloodstream making you extremely sick, in some cases leading to death.

Most superficial injuries heal by forming scar tissue. Scar tissue has poor blood supply, is less elastic and more susceptible to breakdown than normal skin, making reoccurrence of a pressure injury more likely. If you have scar tissue on a weight-bearing area, limit your time in that position to prevent recurrent breakdown.

woman in wheelchair doing research on a laptop with coffee on hand

‘Just-in-time, or the right care at the right place at the right time, will reduce risk and prevent complications. As a result, you will maintain your quality of life, independence, health and wellbeing.

Be proactive and take responsibility for managing your own health risks

This involves:
  • Education to know how your spinal cord injury affects your skin and what the research tells us.
  • Becoming a partner in decision-making with your doctor and health professionals.
  • Developing an individual health management plan.
  • Engaging in ongoing health and wellness activities for healthy skin by:
    • Relieving pressure regularly
    • Knowing how to identify a pressure problem
    • Maintaining a healthy diet and drinking plenty of water
    • Scheduling an annual check-up to rule out other causes of skin breakdown.

What does research tell you?

arrows moving down with a circle showing one third

One third
of people with spinal cord injury had one or more current pressure injuries

arm illustration with circle showing one quarter

One quarter
of individuals reported having other skin-related problems, such as skin rashes and dermatitis, venous/arterial ulcers, infection (osteomyelitis and cellulitis), sinus and ingrown toenails

hip bones with circle showing two thirds

Two thirds
of pressure injuries were located over the ischial tuberosities (sitting bones), sacrum and greater trochanters (bone at side of hip)

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Pressure injuries are most common between 
21-30 years post-injury

2015 Rural Spinal Cord Injury Project survey of 681 people living with spinal cord injury in rural NSW

Pressure injuries

A pressure injury (also known as bedsore, pressure ulcer, pressure sore or decubitus ulcer) is an injury to your skin and/or underlying tissue over a bony prominence.

Pressure injury occurs as a result of pressure, shear and/or friction. there are four stages that describe the severity of the pressure injury (for more details refer to the toolkit).

Symptoms of pressure injury

  • Skin swelling
  • Pain or tenderness
  • Changes in skin color (non-blanchable redness in lighter skin tones and non-blanchable blue/purple skin in darker skin tones)
  • Skin that feels cooler or warmer to the touch than other areas
  • Skin loss, exposing deeper layers of skin
  • Pus-like drainage from an open area of skin for severe grade.

How to treat pressure injuries

Treatments for pressure ulcers (sores) include:

  • Regularly changing your position
  • Using special mattresses to reduce or relieve pressure
  • Use dressings to help heal the ulcer
  • Surgery may sometimes be needed.

For details prevention and management strategies, please refer to the pressure injuries toolbox

Skin rashes and dermatitis

A skin rash describes an area of irritated or swollen skin, which may be dry, itchy, red, painful, rough, smooth, cracked, moist or blistered in appearance.

A rash can affect only a small part of the body or cover a large area. Possible causes of rashes include dermatitis, infections, allergic reactions to taking a medication and certain diseases. 

Dermatitis is a general term that describes a common skin irritation, with 3 common types: atopic dermatitis (eczema), seborrheic dermatitis (e.g., scalp dandruff) and contact dermatitis from exposure to an irritant. Applying a moisturising cream regularly helps control the symptoms of dermatitis. Treatment may also include medicated ointments, creams and shampoos. 

See your doctor if your skin becomes painful, if you are experiencing discomfort that distracts you during everyday life or interferes with your sleep, if you think that your skin is infected, and/or you have tried self-care steps, but the signs/symptoms persist. 

Ingrown toenails

  • If the area around the nail is red and you see pus when you press on the edge of the nail, your nail may be cutting into the skin.
  • Soak your foot in soapy water, wash it well, rinse and gently dry.
  • Place a small piece of cotton under the nail to keep the edge of the nail away from the skin. Change the cotton daily.
  • If it does not begin to heal in 2 or 3 days, see your doctor or healthcare provider.
  • Make sure your socks and shoes leave plenty of room for your toes.
  • Keep your feet clean and dry.
  • Keep your toenails trimmed.
image of an ingrown toenail on a foot

Heat and cold injuries

Heat injuries

Loss of skin sensation puts you at risk for a burn injury.

How to treat heat injuries

Apply cool water and administer first aid immediately. Do not use ice or an ice pack on a burn. Seek medical attention as soon as possible.

Cold injuries

Loss of skin sensation increases your chances of getting a cold injury, also known as frostbite.

How to treat cold injuries

Since skin may be numb, people with frostbite can harm themselves further unintentionally. Seek medical attention as soon as possible.

thermometer showing hot temperature

Did you know?

Chilblains are patches of discoloured (red, blue, white) skin, along with swelling and blistering on your hands and feet. Chilblains are thought to be caused by a combination of cold weather and poor circulation. The toes are particularly vulnerable and tight shoes can contribute by further reducing circulation to the toes. Most chilblains don’t cause any permanent damage to tissue, although sometimes they can cause skin ulceration.

thermometer showing cold

Moist skin

Sweating, urine incontinence or diarrhoea make your skin wet increasing your chances of a skin infection.

Healthy tips

  • Keep your skin clean and dry.
  • Pay special attention to cleanliness in sweating areas.
  • Clean and dry well under skinfolds.
woman with sweating hands wiping them on a towel


Sunburn is a form of radiation burn affecting living tissue, e.g., skin, as a result of overexposure to ultraviolet or UV radiation, usually from the sun. 

beach bag with sunscreen, hat and towel

Healthy tips

  • Check weather conditions on your weather app or check online and make sure you apply sunscreen with a recommended sun protection factor.
  • Wear a hat and a long-sleeved shirt when you are out in the sun.
  • Certain medications, such as antibiotics and local skin ointments, can make your skin more sensitive to sunburn. Check with your pharmacist.

More fragile skin over scar tissue

Scarred skin can be thinner and susceptible to re-injury than healthy skin. An old scar may also be more prone to breakdown if overlying bone. With ageing, the skin may become more fragile and prone to tearing due to skin atrophy. 

Signs and symptoms of fragile skin

  • Skin that appears thin, dry, or transparent
  • Skin that tears or bleeds easily
  • Thinning (atrophy) of the top layers of the skin
  • Frequent skin bruising.

How to treat scarred skin

  • Stay hydrated: good skin needs proper moisture and hydration, and one of the best ways you can achieve this is by staying hydrated and drink a total of 6-8 glasses per day. The more water you consume, the better you can flush out all the toxins and pollutants in your body. Staying hydrated also removes any dry patches on your skin too
  • Improve Your Diet: your diet nourishes your body and can make a huge difference on your skin as well. 

Cellulitis, an infection of the skin

Cellulitis is a serious infection of the skin, where bacteria enter the skin through a crack or break. The infection can further spread to other part of the body and may sometimes lead to blood poisoning (sepsis). This needs urgent treatment with antibiotics. 

Signs and symptoms of cellulitis

  • The skin appears swollen, red and warm to the touch
  • Cellulitis usually affects the lower legs, but it can occur on the face, arms and other areas of the body.

How to treat cellulitis

  • Finish full course of your antibiotics (typically 7-10 days) even if you start to feel better.
  • An important strategy for prevention is to
    • maintain good skin hygiene,
    • ensure feet and between toes are dried, and
    • avoid cracking of the skin.

Osteomyelitis, an infection of the bone under the skin, fat and muscle layers

Osteomyelitis is inflammation or swelling that occurs in the bone. It can result from an infection that can reach bones through the bloodstream or spreading from nearby tissue. Testing for osteomyelitis may involve a bone biopsy, as well as x-rays, CT or MRI scans. 

Signs and symptoms of Osteomyelitis

Pain, fever, failure of healing or recurrent wound breakdown. 

How to treat osteomyelitis

Treatment is usually surgery, to remove the sections of bone that are infected or dead. This is followed by intravenous antibiotics in hospital and a prolonged course of oral antibiotics for 3-6 months.