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Know about your skin

How the skin normally works

Your skin is your body’s largest organ.

It serves as a protective barrier against most external agents like infection, dirt and harmful rays from the sun. It permits the senses of touch, pain, heat and cold to travel from the nerve endings in your skin to your brain through the spinal cord and helps regulate your body temperature. 

Your skin regulates your body temperature through the dilation and constriction of blood vessels and the process of sweating.

When you’re in cold weather, your skin signals your blood vessels to constrict and keep you as warm as possible.

When you’re in hot and/or humid weather, your skin signals blood vessels to relax and triggers sweat glands under your skin to produce water and salt which in turn increases sweating. This process cools you down as the water evaporates from your skin.

side profile of the layers that make up the skin
labelled diagram of the skin and its layers

Effects of a spinal cord injury on skin integrity

In people with a spinal cord injury, the nerves that carry messages back and forth between the skin below the level of your injury, spinal cord and brain don’t work the way they should.

The following happens to the skin in people with a spinal cord injury:

  • Decreased or absent sensations to register touch, pressure, pain, heat and cold below the level of a spinal cord injury.
  • Reduced sweating to help cool body down below the level of the spinal cord injury.
  • Excessive sweating may occur above the level of a spinal cord injury.
  • Weakness or loss of muscle strength below the level of the spinal cord injury can produce swelling or oedema of the lower limbs due to pooling of the fluids.
  • No change to the protective function of your skin below or above the level of a spinal cord injury allowing the skin to protect internal organs against heat, light, injury and infection.
  • A pressure injury involves damage to the skin and the tissue underneath the skin due to prolonged or excessive pressure or pressure applied in combination with shear or sliding
    and friction.
Pressure is applied for too long or at a very high pressure over a bony prominence
Results in a compromised blood supply reducing oxygen to the affected area
The end result is skin breakdown or a pressure injury

Before your spinal cord injury, your body sent signals for you to move, squirm or change positions when you became uncomfortable. After your spinal cord injury, your early warning system doesn’t work as well. You need to actively think about your body and regularly relieve pressure.