๐ In This Article
Skin is your body’s largest living organ โ and after a spinal cord injury, it becomes one of the most important systems to understand and protect. This guide explains exactly what your skin does, how SCI changes it, and what that means for your daily care.
The skin is the largest living organ system of the body. It covers the entire exterior of the body with a few openings for the eyes, ears, nostrils, mouth, urethra, rectum and vagina in females.
The skin is the major protector of the body’s interior from the outside world. It keeps unwanted things out โ dirt, bacteria, viruses, parasites and fungus โ stands up to moderate pressure, and protects us from chemicals and radiation.
Protection
Keeps out bacteria, viruses, parasites, chemicals and radiation.
Temperature Regulation
Balances body temperature through blood vessel flow, sweat and hair.
Vitamin D Synthesis
Synthesizes and maintains vitamin D levels for the body.
Skin has the ability of sensation. Nerves in every part of the skin help you perceive the outside world โ heat, cold, touch and pain. Your skin can tell your brain if something is uncomfortable outside your body, such as too much sun, or within it, such as a rash.
Sensation and responses of the skin are controlled by the Autonomic Nervous System (ANS) โ the part of the nervous system that operates without your conscious control. The skin sends messages to the brain through the Peripheral Nervous System (PNS), through the spinal cord, and the brain responds automatically.
๐ง Autonomic Nervous System (ANS)
Controls automatic functions including skin regulation, blood vessel dilation, and sweat response โ all without conscious input.
โก Peripheral Nervous System (PNS)
The network of nerves throughout the body that carry signals between skin and brain via the spinal cord. We have no voluntary control over this system.
Important to Know
The skin does not have controlled movement on its own โ it is flexible to allow movement of the bones and muscles beneath it. Natural skin has a certain amount of ‘give’ that accommodates your body’s movement.
Skin is made up of two primary layers, each with a distinct and vital role in protecting your body.
Epidermis
Outer Layer
The visible outer layer of skin. Acts as a protective wall that shields the inner dermis layer from the outside world.
Dermis
Inner Layer
Contains blood vessels, sweat glands, sebaceous (oil) glands, hair follicles, nerve fibers, and many small capillaries.
Below the Skin โ Fat & Muscle Layers
Just below the skin is adipose (fat) tissue, which helps protect the muscles beneath it. Muscles sit next to bones and attach to them via ligaments. Understanding these layers matters after SCI, because fat tissue behaves differently under pressure than muscle does.
After spinal cord injury, several important changes occur in the skin that significantly increase your vulnerability to injury. Understanding each one helps you take the right preventative steps.
Decreased Collagen
Collagen gives skin its strength and elasticity. After SCI, collagen levels drop โ making skin more fragile and prone to tearing and injury from even minor contact.
Reduced Blood Supply
Circulation to the skin is diminished. This means wounds heal more slowly and the skin is less resilient when exposed to pressure, friction, or shear forces.
Muscle Changes
Immobility causes muscles to decrease in size, replaced by increased fat tissue. Unlike muscle, fat compresses under pressure rather than dispersing it โ creating greater risk over bony areas.
Decreased or Absent Sensation
Depending on the type and level of injury, the normal signals that prompt you to shift your weight or move away from discomfort may be reduced or completely absent.
Why This Matters
These four changes together create a cycle of increased risk. Without sensation to warn you, and with reduced healing ability and skin strength, even small amounts of prolonged pressure can lead to serious skin breakdown. Daily skin checks are essential.
Due to Autonomic Nervous System disruption, control of body temperature is affected because the messages that regulate sweating are not communicated effectively. The higher the level of injury, the more temperature regulation is impacted.
๐ง Too Much Sweating
Hyperhidrosis (HH)
Excessive sweating can occur for unknown reasons, as a symptom of autonomic dysreflexia, ANS disruption, or due to syringomyelia โ a post-injury fluid-filled cyst in the spinal cord.
Medications for autonomic dysreflexia and oxybutynin have been used with success.
๐ฅ No Sweating Below Injury
Risk of Overheating
Some people with SCI cannot sweat below the level of injury. This can cause the body to overheat because sweat โ the body’s natural cooling mechanism โ cannot be released.
Use air conditioning, fans, cool cloths, shade, and wide-brimmed hats to prevent overheating.
Friction and shearing injuries occur when the epidermis and dermis become separated โ you might recognise this as a ‘rug burn.’ After SCI, decreased collagen makes this separation far more likely. It most often happens when moving the body by dragging it across a surface rather than lifting.
Friction injuries can also occur with a new piece of adaptive equipment that repeatedly rubs the skin.
โ Avoid This
Dragging or sliding the body across surfaces during transfers. The friction separates the skin layers and can cause immediate or delayed skin breakdown โ especially dangerous without sensation to warn you.
โ Do This Instead
Always lift and move the body rather than dragging it. Use transfer boards and trained technique to reduce surface contact. Perform frequent skin checks whenever new adaptive equipment is introduced.
Calluses can form on the heels, hands, elbows and knees from an inability to slough off dead skin cells. Much of the skin’s natural shedding process occurs through movement against clothing and shoes. When movement is reduced, dead cells accumulate on the body, forming calluses.
Calluses are dry and inelastic โ they crack easily. Cracked calluses can cause pain if you have sensation, trigger autonomic dysreflexia if sensation is decreased, and create an opening that allows bacteria to enter the body.
Soak the area โ soften the callus thoroughly with water before attempting any reduction.
Buff gently โ use a soft towel or washcloth to slowly reduce the callus surface. Never rush this process.
Never use sharp objects โ the skin beneath a callus is soft and will split open easily if cut.
Large or thick callus? Discuss treatment with a podiatrist rather than attempting reduction at home.
Never Reduce a Callus Quickly
Rapid removal or use of sharp tools can split the soft skin beneath the callus. This creates an open wound that is prone to infection โ and may not be felt if sensation is reduced below the injury level.
Reeve Foundation Information Specialists
800-539-7309 ยท MondayโFriday, 9:00 am to 8:00 pm ET โ free expert support for people living with paralysis and SCI.
Christopher & Dana Reeve Foundation
christopherreeve.org โ comprehensive resources on SCI health, skin care, and secondary conditions
Your Rehabilitation Team
For large or thick calluses, friction injuries, or any skin concerns โ consult your physiatrist, occupational therapist, or a podiatrist for safe, personalised care.
Skin is your body’s largest organ โ after SCI it becomes one of the most important systems to actively protect through daily habits and monitoring.
SCI causes decreased collagen, reduced blood supply, muscle changes, and reduced sensation โ all of which increase skin fragility and slow healing.
ANS disruption affects sweating and temperature regulation โ know whether you hypersweate or cannot sweat below your injury level, and take appropriate precautions.
Always lift rather than drag your body during transfers to prevent friction and shearing injuries โ and check skin whenever introducing new equipment.
Reduce calluses slowly and gently using only water and a soft cloth โ never sharp tools. Consult a podiatrist for large or thick calluses.
๐ SCI Skin Care Series โ 4-Part Series
Article 2
Pressure Injuries & Prevention
Article 3
Daily Skin Care Routine
Article 4
Wound Care & When to Seek Help
For more information, contact the Reeve Foundation Information Specialists at 800-539-7309, MondayโFriday, 9:00 am to 8:00 pm ET ยท © 2026 AccessLife
