Myelodysplasia
Skin Care and Myelodysplasia
This information explains the role of the skin and the causes (“risk factors”)
of skin breakdown in children with myelodysplasia. It also tells you how to check
your child for possible skin problems. The final section is a checklist of ways
to prevent and treat skin problems.
What does the skin do?
The skin, like the heart, stomach or brain, is an organ of the body with its
own special role in maintaining health. Healthy skin protects against infection
and bacteria. It helps to regulate the body’s temperature and hydration (moisture
level). It also serves as a “shock absorber,” helping to protect the body’s internal
systems.
Children with myelodysplasia have special needs for their skin. A number of things
can cause skin to become red and irritated and possibly to develop sores. This
process is called skin breakdown. Skin breakdown keeps the organ of the skin from
performing its jobs properly. It can also be painful.
Proper skin care is essential to good health and the prevention of skin breakdown.
It is important to:
- Look for and recognize possible problems.
- Take action to prevent problems.
- Treat problems when they occur.
What are the risk factors for skin breakdown?
Pressure: As pressure is exerted on the body, the skin is compressed, and it
is more difficult for oxygen and other nutrients to reach the skin and its underlying
structures. Decreased circulation and pressure can cause a pressure sore to develop
in less than one day. Because of the possibility of decreased sensation and movement,
those with myelodysplasia are often at high risk for skin irritation and pressure
sores. Therefore, your child should frequently change positions. Prominent, bony
parts of the body are the most likely places for pressure sores to form because
these places have the least amount of cushioning between the bones and the skin.
Shear and Friction: “Shear,” is a sliding motion that causes bone to move one way and skin to move
another, compressing the blood vessels. Friction occurs when surfaces rub together.
Shearing and friction can both lead to skin breakdown.
Both shear and friction may be prevented by using pillows for positioning and
support between body parts and by avoiding dragging your child when moving him.
Keeping bed linens clean, dry and free from wrinkles may also be helpful.
Moisture: Besides being uncomfortable, sweat, urine and feces provide a medium for bacteria
growth, which delays healing.
Problem areas for excessive moisture are:
- Armpits
- Groin
- Neck folds
- Backs of the legs
- Skin-folds on the abdomen
Keep the skin clean and lubricated, but free of excess moisture. Pat the skin
dry thoroughly after bathing and apply talc-free powders. Moisturize skin with
lotion when it appears to be overly dry.
Poor Nutrition: Poor nutrition can also contribute to skin problems. When cells are poorly nourished,
they reproduce slowly. New cell production is even slower in a child with an illness
or tissue injury. In the event of a skin breakdown, foods that are high in protein
are helpful and a multi-vitamin may be recommended to promote healing.
How do we check for skin problems?
- Inspect the skin completely twice a day, usually before dressing in the morning
and after undressing at night.
- Older children may wish to examine their own skin using a hand-held mirror to
inspect all areas of the body for signs of problems.
- Observe for pressure areas, rashes, swelling, bruises, excessive dryness, sores,
cuts or abrasions.
Areas especially susceptible to skin breakdown:
- Heels
- Tail bone
- Elbows
- Shoulders
- Back of the head
- Ankles
- Knees/between knees
- Hips
- Ear lobes
- Balls of the feet
- Hips
- Between the toes
Signs of too much pressure on the skin are:
- Pinkness or redness of the skin
- Unnatural paleness or darkness of the skin
- Unnatural wrinkles on the skin
- Blisters on the skin
How do we prevent these problems?
To minimize the risk of developing skin irritation and breakdown, you can follow
these guidelines:
- Follow the “30 minute rule” to maintain an effective pressure relief schedule.
In order to determine how often your child needs to be moved or turned, follow
this “30 minute rule.” Check the skin frequently for areas of discoloration (red,
pink or pale). If the discoloration disappears in less than 30 minutes, the pressure
relief schedule you are using is working well. You may try gradually increasing
the amount of time between turns and weight shifts (up to a maximum of three to
four hours in any one position). If discoloration is lasting over 30 minutes,
you must decrease the amount of time between turns and weight shifts until discoloration
disappears in less than 30 minutes.
- Children in wheelchairs must ease pressure on their backs and buttocks.
- Follow the 15/15 rule: Have your child do a “push up” in the chair every 15 minutes
and hold it for at least 15 seconds. Patients can also move from side to side
or lean forward for pressure relief in a chair.
- Use cushions specially designed to help reduce pressure. Never use rubber rings
(doughnuts), which actually interfere with proper circulation. Always sit the
child on a special cushion, as ordered by your doctor.
- In bed, use pillows under the calves to elevate the heels off of the bed. The
heels are very prone to breakdown since the skin overlying them is very thin.
- Bed linens and clothing should be kept clean and dry. They should be free of
wrinkles, crumbs and small articles that may cause increased pressure (i.e. safety
pins, hair clips, buttons, etc.)
- Back rubs help stimulate circulation and relax muscles.
- Sitting on the toilet longer than 30 minutes can cause too much pressure on the
buttocks.
- Choose clothing carefully to cut down on friction: avoid tight or ill-fitting
clothes. Avoid rough fabrics that can irritate the skin.
- Keep the skin clean and dry at all times, especially after bladder or bowel incontinence.
- Use creams and lotions as needed to help keep the skin from excessive drying
and cracking. The Nurse Coordinator at Children’s can suggest products to use.
- Shoes and socks should nearly always be worn to protect the feet.
- Areas around and under splints, braces and casts should be carefully checked
for any signs of irritation.
- Posture is important. Encourage your child to sit up straight. Slumping causes
increased pressure on the tailbone.
- When moving your child from a bed or chair, avoid bumping hips, legs or feet.
Try not to rub or slide skin across a bed or chair, which may cause increased
friction and skin damage.
- If using a sliding board to move your child, powder it lightly (non-talc powder)
to prevent friction burns and other skin damage.
- Watch nutrition and fluid intake. Proper nutrition and fluids are essential for
good skin health.
Is there anything else to be aware of?
- Be aware of decreased sensation (feeling). Because some children have decreased feeling in parts of their body, they may
not be able to feel cold, heat or pain well. This could add to additional problems
with heat and cold.
- Be careful with hot liquids. Never let your child carry hot liquids in his lap. Always test the temperature
of bath and shower water first, or teach older children to always test temperature
on an area of skin that has normal feeling.
- Use ointments with bandage/dressings. Dry dressings may interfere with the production of new cells, causing loss of
new tissue when the bandage is removed. Ask your Nurse Coordinator at Children’s
to recommend products to use on wounds or sores.
- Be aware of side effects from products such as antacids, which can dry wounds and can harm fragile, new
tissue. Antibacterial products such as betadine and hydrogen peroxide are harmful
to new cells.
- Avoid heating pads, electric blankets and other kinds of heat on parts of the body with decreased feeling.
- On hot days, protect the skin by sitting on a cushion or sheepskin on a car seat. Use a sun screen when in
the sun.
- On cold days, avoid over-exposure of the skin to cold, as frostbite could occur.
- Don’t forget those feet! Be sure to keep feet clean and dry. Long toenails, cuts, cracks and calluses
can lead to foot sores and skin problems. If feet have a heavy crust of hard or
dead skin, they may be soaked in a vinegar-water solution (half vinegar and half
water) for 15 to 20 minutes two to three times a week. Dry the feet well and apply
a lotion containing lanolin. This will help remove the dead skin and soften the
feet.
- How to do nails: Keep nails clipped straight across and at the proper length (not too short).
Nails are easier to cut after soaking or after a bath. Check every week for long
nails or sharp corners on nails.
How do we treat skin problems if we find them?
Once a pressure sore is found, your goal in treating it is to make sure it can
heal properly. All pressure sores, at any stage of development, require some conservative
care-a clean environment and a dressing for protection.
Cleansing removes dead cells and any growth of bacteria in the wound. This helps
prevent and eliminate infection and promotes healing.
- Wash your hands well before and after caring for the sore.
- Clean well with a mild soap to loosen up and clean out dirt. Always pat skin
dry.
- Since excessive pressure usually causes the problem, remember to keep all pressure
off sores and irritated areas.
- Keep the area clean and dry.
- Never break open a blister.
- Rinse any burned area immediately for 20 minutes with cold water.
Once the skin has been burned, blistered or opened, it is very susceptible to
infection. Notify your doctor immediately for further treatment.
How can I possibly remember all this?
Yes, this is a lot to remember, but it all gets easier with practice. If you
read over these guidelines and simply remember to check your child’s skin frequently,
he will have fewer problems. If you have questions, your doctor or nurse at Children’s
will be glad to help you.
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