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Thread: Sore Skin Frustration

  1. #1

    Sore Skin Frustration

    Honestly, I could scream, shout, cry, break something, hit somebody, but it wouldn't get the anywhere, so I've just got to try and stay positive.

    For years and years I have had a slight problem with the hot weather in the crease of my backside. Sometimes when it's quite warm I will develop dry cracked skin, or it may get a little bit soggy and sore. I've always been able to keep it at bay and it's never really developed into anything that has caused me serious problems, until now it seems. When we checked my backside this morning I literally had a horrible black mark. It's running under the crease of my backside towards and onto my scrotum. I've had problems before with pressure on these areas of five. In fact, just a few weeks ago my Roho developed a puncture and I got a very similar black mark on the left-hand side on my sit bone area. Thankfully it wasn't too bad and we managed to heal that completely in less than two weeks.

    This time the cushion is fine, there's no puncture at all. It's all corresponded with some slightly hotter than average weather we are getting here in the UK. My now seems to think that it is sweat related, however is this black mark that is worrying, just don't know how it got there. There was nothing there the morning before apart from the slight soreness due to the heat.

    Just wondering if anyone else has had a similar experience and can help me get on top of this. Are there any solutions that I can use to try and stop the sweat causing a problem? Should I be putting a dressing on, or will that just cause more problems? I should add that I have stayed in bed today.

    I sit on my Roho so obviously they can generate quite a bit of heat. Is there anyway that I can introduce cold air into my sit area? I did wonder about installing some kind of fan that could connect to my wheelchair batteries and somehow introduce cold air, but have no idea how to do this.

    Anyway, thanks for reading. Stuck in bed on a beautiful warm sunny day and completely fed up.

  2. #2
    Hi Ironside, the thing that jumped out at me from your post was tghe recent failure of your roho. Maybe the area wasn't totally healed over when you got the second problem?

    Good luck

  3. #3
    The area that got damaged when my Roho got a puncture back in late April early June was on my left buttock, this is on the right-hand side but is going right into the crease at the bottom of the buttock. In fact, the mark goes on to the back of the scrotum, that's how far tucked in it is. When I checked the Roho yesterday it was domed. I don't know what my carer was thinking of, she's been checking my Roho for the last few years above not had any problems. But she put some more air yesterday and it was obviously far too much.

    At the moment is very much a waiting game. I've got this black mark that looks like a slug on my backside. I'm just praying that the tissue underneath hasn't been compromised. I'm hoping it's just the surface that has been affected. I got away with with the other mark which turned a kind of blackish, that came to nothing and was healed within two weeks.

    This is the reason why I'm interested in this new (newish) Roho Smart Check cushion. If it works properly then you should always have the right amount of space in between the bottom of the chair on your backside, there's no guesswork with people putting my hand in.

    Roho have made me another custom 5 inch Roho which hasn't arrived yet. So I've been using a 4 inch cushions which has been perfectly okay for the last month. It's just when the weather got hot, it seemed to correspond with me getting this sore patch which didn't really open up into a sore, it was just sore looking. But I've had an area here for over 20 years that often flares up in hot weather. So it's not something we've ever been that worried about.

    The other cushion I've been looking at is called Star Lock, this looks very interesting.

  4. #4
    The warm weather is going to cause problems for a lot of people. You might try doing weight shifts more frequently or if at all possible, getting off of your butt completely. Do not use powder in the area as it can cause caking and more moisture. Also, you can possibly try wearing lighter pants.

  5. #5
    How bad do skin problems get that are caused by the heat and moisture? I was having a few issues but we were on top of that. But all of a sudden I've got this black mark that almost looks like a slug. Problem is, my carer put too much air in my cushion, my Roho is actually bold slightly which I know is way over the top. However, I have a Permobil which I constantly used to tell myself back. No more than half an hour goes between me tilting back so I am surprised it happened.

  6. #6
    Quote Originally Posted by Ironside View Post
    How bad do skin problems get that are caused by the heat and moisture? I was having a few issues but we were on top of that. But all of a sudden I've got this black mark that almost looks like a slug. Problem is, my carer put too much air in my cushion, my Roho is actually bold slightly which I know is way over the top. However, I have a Permobil which I constantly used to tell myself back. No more than half an hour goes between me tilting back so I am surprised it happened.

    Hello from the Texas Gulf of Mexico, the heat and moisture capital of America.
    Skin rashes from warm sweat are usually raw, meat-red looking and sometimes have raised white spots if there's an accompanying fungal infection.
    If you have a patch of blackened skin on a sitting area, then complete pressure relief, time, and fixing the ROHO sounds like you're on the right track. If the black area doesn't lighten up like you described it doing before, please see a Doctor so they can check if there's deep tissue damage under the skin surface.
    I hope you heal soon and get to enjoy the rest of summer.
    Last edited by 2drwhofans; 07-09-2017 at 08:45 PM.

  7. #7
    Thanks for the experient reply. The district nurses visit me every day at home at the moment. This is the third full day since discovering the mark. What I don't understand is why I got the mark in the area it is. When I had the problem a few weeks ago the area on the other side of my backside (the left buttock) was affected. However, it was more in the area that takes all of them weights when you are sitting. This mark isn't in the same area, is running right into the crease and onto the back of the scrotum.

    I can't understand how my carer got it so wrong when she was adjusting my cushion. When you look at the cushion now it's domed and obviously has far too much air in it. The other thing is that I sit in the Permobil corpus 500 which has a tilt and recline function. It's literally programmed into me now to tilt and recline throughout the day. In fact, I find myself tilted back more than I'm sitting upright in many cases, especially if I'm just sitting around doing nothing. That's another reason why I can't understand why this happened.

    Anyway, by the end of the week I should know the severity of my case. I'm either going to get very lucky like I did before, or I am going to be up dung Creek without a paddle. I have actually prepared myself for the worst scenario.

    If there is deep tissue damage then I suspect it will die and I will be left with a crater. Whether that will mean surgery to close are just have to wait and see. Thankfully I've created a bed space that enables me to carry on with many of the tasks I do when I'm sitting up. I have my computer next to the bed. I've got my Kensington trackball mouse which means using the computer is easy. I've used Dragon NaturallySpeaking for many years so that is something I cannot do without. I've also got a brilliant adjustable TV wall bracket which is on my long adjustable arm bolted to the wall behind me. You can literally position the television anywhere around the bed which means when you are lying on your side you can bring the television right down so you haven't got to literally twist your neck to watch TV.

  8. #8
    A black/dark brown/grey area with intact skin usually indicates a sDTI (suspected deep tissue injury) type of pressure injury. In people with dark skin it may appear as a darker, purple, or "shiny" area. It is not caused by moisture, but instead by excessive pressure for too long of a period of time. The perineal area can be a location of excessive pressure, especially in men who have a lot of gluteal muscle atrophy.

    A standard Roho only equalizes pressure over the entire seating area, but does not selectively off-load or reduce pressure in a specific area. Some of the other types of Roho cushions (example being the Quatro) can do this, by allowing setting of different pressures in select cells.

    Sitting in a reclined position, either in wheelchair or bed, increases the pressure and adds shear forces to this area of the seating surface, and may be the cause of your recurrent problems in this area. Tilt-in-space (without recline) is an acceptable way to off-load the ischiums for weight shifts, and reduces shear, but this works by increasing pressure over both the perineum and sacral/coccyx area during the weight shift, so the position should not be used for long periods of time. Sitting up in bed while laying on your back, even with a good pressure reducing mattress, also significantly increases shear in this area, especially if the head of the bed is kept up over 30 degrees for long periods of time.

    Treatment for a sDTI is off-loading. If caught early, staying completely off your back in bed, and not sitting in your wheelchair at all may allow you to dodge a bullet and the wound many not open but this can easily take 6-8 weeks to resolve. There is no ointment/cream/dressing that will help this area to heal; I prefer not to use a dressing to make it easier to inspect the area periodically during the day to see if it is improving or deteriorating.

    Moisture is unlikely to be a factor in this pressure ulcer. I would strongly encourage you to get a new seating evaluation, ideally with computerized interface pressure testing, and with your chair in both regular and tilt-in-space position (avoid recline) on a variety of different cushions. You may even need to consider a custom cushion such as the customized Ride cushion, which can be sculpted to completely off-load the perineum in addition to other bony areas such as the ischium.


  9. #9
    My nurse came in this morning as she does every morning at the moment to change the dressing and inspect the area. She said that around the edge whether black is now dying off, it doesn't look as though it's gone deeper. But obviously it's a waiting game until everything comes off.

    I did have a very similar problem a few weeks ago when my cushion developed a leak. However, this time the mark was on the other cheek which as well as never had any problems whatsoever. This was almost black as well. However, that cleared up in just over a week and luckily left no underlining damage at all.

    I'm well aware that the recline function on the chair can cause shearing which is why I never use it. I only ever tilt the whole chair back and forward. The last time I was pressure mapped I believe the point of looking at the screen whilst tilting the whole seat back and I could see that in fact all pressure was relieved before I got back to the full tilt.You mentioned this custom ride cushion. Can that give better protection than a Roho if designed properly to fit your backside? I'm not even sure if a are available in the UK, have to check.

    What's odd in this recent case is that the area on the left that was affected a few weeks ago has been untouched completely. I've had problems in the past around the sit bone area on the right-hand cheek but this area is completely unaffected as well. This black mark is right in the crease going in towards the scrotum. It's such an odd area to have a problem because it's never happened before.

    You mentioned this custom ride cushion. Can that give better protection than a Roho if designed properly to fit your backside? I'm not even sure if a are available in the UK, have to check.

  10. #10
    The tissue viability nurse came to see me this morning. She had a good look at my sore and all the surrounding skin. The majority of my skin on my backside is very good apparently. However, I've got this little bit rights in the crease going around the bat which tends to stay moist whenever I'm sitting up. The split of skin isn't quite as healthy and that is why I tend to get problems here when the weather is hot. She is certain that because of the hotter than normal conditions last week, coupled along with a cushion that was probably too hard, and me jiggling up and down in my wheelchair going back-and-forth to a barbecue, I caused trauma to the skin. She is confident that there is no undermining damage and it's just a case of waiting for the dead skin to come off and the raw area to Hill back up again.

    I'm pleased about this because I know it's not the cushion that is at fault. I'm going to use some barrier ointment from now on which will hopefully help my skin in the hot weather. Obviously this is still classed as a pressure sore, I know that, it wouldn't have happened if I wasn't sitting in the chair. However, if I can be careful in hot weather than it shouldn't happen again.

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