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Skin Problems in Multiple Sclerosis

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By ACCORDANT HEALTH SERVICES

There are three skin problems that may be experienced by patients with MS. Each of these problems can be effectively treated. Treatment is easiest when problems are detected early, making regular self-examination of the skin a good practice. Many skin problems can be avoided altogether by establishing a good care routine.

Pressure Sores
Pressure sores are also called bedsores, or decubiti. Pressure sores occur in places where skin has remained under pressure for a long time. They often result from a lack of mobility, causing a person to remain too long in one position in a chair, wheelchair or bed.

Constant unrelieved pressure stops or slows the blood flow to the area, causing a blister to form. The blister can become infected if it is not treated, and the infection can reach into the tissues below and even extend to the bone. Such an infection can worsen the patient's overall health.

Pressure sores are most common in areas where bone lies directly under the skin, such as the elbow, hip, tailbone, shoulder blades, ankles, heels or even the head. People who are underweight are at greater risk for pressure sores because their bones are more prominent. Other risk factors include smoking, poor nutrition, obesity, dry skin, cognitive confusion, incontinence, decreased sensation, moist skin, diabetes, anemia or cardiovascular problems.

Pressure sores begin benignly as small areas of red or purplish skin. If pressure continues on this area, the skin begins to break down, evidenced by blistering, swelling, and continued redness. If untreated, the problem will continue to progress until live tissue begins to die. The fat and tissue underneath the pressure sore will be affected, creating a hole or crater with an offensive smell. The ulcer can continue deeper, eventually reaching deep muscle tissue and bone. Infection can occur and the size of the sore can increase.

Pressure sores can be treated at any point along this declining path, but more advanced sores are harder to treat. If a sore is noticed early, it can heal if the source of pressure is simply eliminated. More advanced sores require protective covering, medication and special medical care.

Pressure sores can be prevented by following these guidelines:

Patients should...

    • Stay mobile or have their positions changed at least every two hours
    • Drink plenty of fluids and eat a well-balanced diet, including a daily multi-vitamin as recommended by a physician
    • Use a mattress pad that evenly distributes pressure (foam "egg-crate" mattresses are not recommended)
    • If incontinent, use underpads or briefs that absorb moisture and offer a quick drying surface. Creams may provide a barrier to moisture
    • Keep skin clean using a gentle cleanser with minimal rubbing and friction
    • Minimize dryness and use moisturizers, especially over areas prone to pressure sores
    • Minimize exposure to cold
    • Use sheepskin and/or elbow and heel protectors
    • Use a gel cushion for wheelchairs
    • Avoid placing rough fabrics next to the skin

Itching
The itching that sometimes occurs with MS does not result from an external cause. That is, there is nothing actually irritating the skin, such as a rash, insect bite or an allergy to something in the environment. This type of itching is neurologically caused. It is one of several possible paresthesias - abnormal sensations that result from the loss of myelin along the nerve fibers. Other paresthesias can include a feeling of "pins and needles," burning, numbness or prickling.

This kind of itching can be intense and may begin suddenly on any part of the body. Because it is not externally caused, nothing applied to the skin can relieve it. It can be remedied by several medications that must be prescribed by a physician. Carbamazipine and phenytoin (anticonvulsants), amitriptyline (an antidepressant), and hydroxyzine (an antihistamine) have been used to successfully treat itching in patients with MS.

Incontinence and Skin Breakdown
Skin is more likely to break down when it is moist. Bladder or bowel incontinence increases the risk of developing pressure sores or rashes. Skin should be examined daily for signs of breakdown. After an episode of incontinence, the skin should be gently washed with a mild cleanser and gently dried. Washing and drying should be done without rubbing, which creates friction.

People with incontinence problems can use products that help protect the skin from moisture. Special topical lotions that create a moisture barrier for the skin, and absorbent padding materials that keep urine away from the skin, are available.

Last Modified Date: March 01, 2009 © Accordant Health Services, a CVS/Caremark company. All rights reserved.
This article has been reviewed for accuracy by a member of the Accordant Health Services Medical Advisory Team.
This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.