๐ In This Article
Common skin conditions can affect anyone โ but for people living with spinal cord injury, reduced or absent sensation means a rash, infection, or irritation can go unnoticed far longer than usual. Regular, thorough skin inspection is your most powerful tool.
Common skin conditions can occur in any individual, but people living with SCI face unique challenges in detecting and managing them. Reduced or absent sensation means a rash, infection, or irritation may go unnoticed longer โ making regular skin inspection essential.
Rashes or dermatitis (derm = skin, -itis = inflammation) of all types are extremely prevalent. They can arise from irritants on the skin โ urine, feces, lotions, soap, shampoo, pollen, sweat, or friction โ or from something taken into the body such as food, drinks, medications, or inhaled substances. Anxiety and stress can also produce a rash.
External Irritants
Urine, feces, soaps, lotions, friction from equipment or clothing
Internal Triggers
Food, medications, inhaled substances, stress or anxiety responses
Infections
Bacterial, viral, or fungal โ able to progress silently without sensation
The SCI Difference
Without normal sensation to signal discomfort, skin conditions can worsen significantly before they are detected. What might be a minor irritation in someone without SCI can become a serious infection. Check your entire skin twice daily.
Acne
Typically appears on the face or back. If surgery is necessary on your back or spine but you have severe acne, the acne may need to be treated first to avoid risk of internal infection during the procedure.
Location: Face ยท Back
Athlete’s Foot
An itchy, red fungus typically between the toes, caused by sweating or wearing the same shoes daily without airing. In people with SCI, fungus can also appear in the folds of skin elsewhere on the body โ check all skin folds carefully.
Location: Toes ยท Skin Folds
Atopic Dermatitis
A long-term rash that is scaly and itchy. Eczema is a well-known example. Can flare repeatedly over time and may be worsened by heat, sweat, or certain fabrics.
Contact Dermatitis
Develops after skin contact with an irritant โ creating red, itchy, or sore skin. Assistive or positioning equipment is a common trigger in people with SCI. Introduce new equipment gradually and monitor the skin carefully.
A callus is a patch of thickened skin that forms from repeated friction โ such as a shoe rubbing your heel, hands from propelling a wheelchair, or elbows from leaning or assistive device contact. With decreased movement, calluses also form when skin is not stimulated to shed old cells naturally.
Heels
Shoe friction
Hands
Wheelchair propulsion
Elbows
Leaning & devices
Callus Care Reminder
Always reduce calluses slowly โ soak first, then buff gently with a towel. Never use sharp objects. For large or thick calluses, consult a podiatrist. See Article 1 for the full safe reduction guide.
Skin cancer can be benign or malignant. Not protecting skin where sensation is decreased significantly raises the risk โ because sunburn can occur without any pain or warning signal reaching the brain.
Basal Cell Carcinoma
Rarely Life-Threatening
Usually found on the head, neck, or back. The most common form of skin cancer. Slow-growing and highly treatable when caught early.
Melanoma
Malignant ยท Act Promptly
Not common but well known as a serious malignant skin cancer. Overexposure to the sun โ especially through a weakened ozone layer โ increases risk significantly.
Sunburn is a burn from sunlight. Typically the skin turns red (first-degree burn). A red rash with blisters is a second-degree burn. Third- and fourth-degree sunburns have been noted in people with SCI who had no sensation warning them of exposure.
1st Degree
Red skin โ surface burn
2nd Degree
Red rash with blisters
3rdโ4th Degree
Noted in SCI โ no sensation warning
Groin / Diaper Rash
Occurs as a response to urine or feces on the skin. Plastic-covered incontinence products that do not allow air circulation create an environment for bacterial growth โ with or without soiled skin. Common in adults using incontinence padding, especially within skin folds while seated. Good hygiene and airing of skin are essential prevention.
Herpes Simplex Virus (HSV)
HSV-1 causes cold sores and fever blisters. HSV-2 is a sexually transmitted disease. Both can present with visible skin changes โ report any unusual sores or blisters to your healthcare provider promptly.
Herpes Zoster (Shingles)
A viral infection arising from dormant chickenpox. Very painful. A rash develops along the path of a dermatome (nerve pathway) within three days of initial pain or itch. Vaccines are available that can reduce the chance of getting shingles, or reduce the pain and duration if it does occur.
Ask About Shingles Vaccination
Ask your healthcare provider whether you are eligible for a shingles vaccine. It is available for adults and can significantly reduce severity if shingles does develop.
Hives
Sudden Onset
A breakout rash that appears suddenly from allergens or unknown causes. Can appear anywhere on the body and may resolve quickly or persist.
Psoriasis
Knees ยท Elbows ยท Anywhere
An itchy red area with thickened skin and silvery patches. Can appear anywhere on the body. Some people with psoriasis develop psoriatic arthritis.
Rosacea
Face ยท Cheeks ยท Nose
A red rash with visible blood vessels on the cheeks, nose, chin, and sometimes forehead. Primarily affects middle-aged, lightly pigmented women โ but can affect anyone.
Because sensation is decreased or absent after spinal cord injury, many of these conditions may not be felt in the usual way. You may not notice a rash, irritation, or early infection until it has become more serious.
Check your entire body at least twice a day โ morning and evening.
Use a long-handled mirror or your phone camera to check areas that are difficult to see directly.
Look for skin colour changes, unusual temperature differences, rashes, or any open area.
Contact your healthcare professional promptly if you detect any change. Early intervention is always more effective than treating an advanced condition.
โ Don’t Wait
Assuming that no pain means no problem. Without sensation, serious skin conditions can develop silently and worsen quickly.
โ Act Early
Report any visual skin change to your care team immediately โ even if there is no pain or discomfort. Early detection is your best protection.
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
American Academy of Dermatology
aad.org โ skin condition guides, find-a-dermatologist tool, and sun safety resources
Your Rehabilitation or Primary Care Team
Contact your physiatrist, occupational therapist, or GP promptly if you notice any skin change โ especially if you have reduced sensation in the affected area.
Reduced or absent sensation means skin conditions can develop and worsen without any pain signal โ making daily visual inspection non-negotiable.
Rashes can arise from external irritants (urine, friction, equipment), internal triggers (medications, food, stress), or infections โ all require prompt attention.
Fungal conditions like athlete’s foot can appear not only between toes but in any skin fold โ check all folds thoroughly during each inspection.
Sunburn can reach second, third, or even fourth degree without sensation warning โ always protect skin from sun exposure regardless of whether you can feel it.
Check your entire body at least twice daily using a mirror or phone camera. Report any skin change โ colour, texture, temperature, or open area โ to your care team immediately.
๐ SCI Skin Care Series โ 4-Part Series
Article 1
Understanding Your Skin
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
