CHAPTER 30
CARE OF THE SKIN
The vital importance of maintaining a good hygienic condition of the skin and its organs
from the very beginning of paraplegia and tetraplegia is now generally well recognized,
though not always practised by both the patient and his or her attendants.
Cleanliness of the skin promotes better blood circulation by preventing clogging
of the pores, thus facilitating the function of the cutaneous glands, which take part in
the elimination of metabolic waste products of the body. In fact, it was found in this
centre that, in cases with acute renal deficiency—for instance, after nephrostomy or
during acute pyelitic attacks—the increased activity of the sweat glands represents an
important auxiliary mechanism for the elimination of waste products. Scrupulous cleanli
ness is especially essential in those cutaneous areas which are easily saturated with urine
and faecal matter, and the soles and heels should never be allowed to become scaly, but
must be kept soft and clean, as this is an important measure for preventing ill-effects of
pressure. Indeed, it is no exaggeration to say that the degree of cleanliness of the soles and
heels is an excellent indicator of the efficiency of the medical and nursing staff concerned
with the management of paraplegics. Fig. 194 demonstrates a paraplegic admitted to
Stoke Mandeville with thick scaly skin on the soles of his feet demonstrating utter neglect.
The toe-nails also need careful attention and must be trimmed at regular intervals.
Ingrowing toe-nails are not infrequent incidents in paraplegics and should be dealt
with immediately. Not only are they a constant irritation to the peripheral nerve-endings
FIG. 194.
484
