Protection and Prevention Are Keys to Comfortable Skin
防止和预防是保持皮肤舒服的关键
People with ALS need extra care to keep their skin healthy and comfortable.
First, there are the changes wrought by the disease. Skin becomes extremely fragile whenever there are nutrition or breathing problems. ALS also seems to change the biochemical properties of collagen and elastin, which run in thin fibers through the middle layer of skin called the dermis. As ALS progresses, these fibers become irregular in size and shape. Blood vessels in the dermis also display irregularities and protein deposits.
Then, there are the common itchy or painful ailments brought on by weather and immobility. Caregivers can take several steps to ease skin woes for loved ones with ALS.
ALS患者需要特别的照料才能保持皮肤的健康和舒适。
首先，疾病会带来一些改变。一旦累及到吞咽和呼吸的时候，皮肤会变的非常脆弱。ALS也好像改变了真皮层中胶原蛋白的生物特性。随着ALS患者病情的逐渐发展，这些纤维在大小和形状上变得不规则，真皮层中的血管也变得不规则，并伴有蛋白质沉淀。
Dry, itchy skin
Winter air sucks moisture from the skin. To put it back, try these tips:
Put moisture into the air. Use a humidifier or place a bowl of water on the heating vents.
Avoid hot baths or showers. Hot water strips the skin of moisture; use lukewarm instead. A 15-minute lukewarm soak saturates the skin, giving it that “prune” look. If a hot soak is a must, use bath oil. It’s not necessary to take a full bath every day; a “parts” cleanup with a sponge usually is sufficient.
Pat dry, don’t rub. Skin specialists compare rubbing with a towel to rubbing with sandpaper. Patting the skin leaves more moisture behind.
Use heavy, greasy lotions. Immediately after patting, seal in moisture with the greasiest lotion tolerated.
Shave with lotion. It’s much gentler than foam. When washing, use mild or soap-free cleansers. Avoid deodorant soap.
Wash itchy scalps. This complaint comes up regularly among ALS patients. Try using cooler water in shampooing, changing hair products, moisturizing the scalp, using anti-itch or antifungal shampoos, and consulting a dermatologist.
干燥、发痒的皮肤
冬天的气候会从皮肤中吸走水分，为了保持湿润，可以尝试这么做：
1） 保持空气湿度。可以使用加湿器或者在通风口放一碗水。
2） 不要用太热的水洗澡。热水能带走皮肤上的水分；尽量用温热水代替。一次15分钟的温水浴可以让皮肤充分吸收水分，白里透红。如果要泡热水浴的话就需要先涂好洗浴油。没有必要天天都洗个完整的澡，用洗浴球洗部分地方就可以了。
3） 用手轻拍，不要擦干。皮肤专家通常将用毛巾擦干比喻为用砂纸在摩擦。用手轻拍可以留住更多水分。
4） 用保湿的、油性的润肤乳。轻拍后立即擦拭润肤乳，可以阻止水分的挥发，从而达到锁水的效果。
5） 用润肤乳刮胡子，比用泡沫更温和。清洗的时候，使用温和的或者无皂的洗面乳，不要使用除臭的肥皂。
6） 发痒头皮的清洗。ALS患者头皮会经常发痒。可以尝试使用冷点的水来洗头、换换洗发水、增加头皮的水分、用止痒或者杀菌的洗发水并且可以咨询皮肤科大夫。
Fungal infections
At the opposite end of the spectrum are skin problems caused by too much moisture.
“It’s ironic that you would develop ‘jock itch’ as a result of being confined to a wheelchair,” says Diane Huberty of Fort Wayne, Ind., a retired neuroscience nurse who has ALS.
Being seated all day in a wheelchair or a recliner creates warm, damp pockets in underarms, groin and skin folds that are ideal for fungal growth.
To combat infections:
Dry off completely. After gently washing and drying, dry the area further with a hair dryer on the cool setting.
Wear absorbent clothing. Look for materials that draw moisture away from the surface of the skin.
Use medicated remedies. Avoid cornstarch, talcum or other nonmedicated powders that can encourage fungus when they get damp.
Try herbal remedies. Some tried-and-true remedies include applying apple cider vinegar or vitamin E; eating six cloves of fresh garlic or six to nine garlic capsules a day; eating yogurt with live cultures; and taking more B-complex vitamins.
真菌感染
太潮湿的环境也会引起一些皮肤问题。身为ALS患者的印第安纳州前神经科护士 Diana Huberty 提醒说长期坐轮椅容易生股癣，一整天都坐在或者斜靠在轮椅上使得腋下、腹股沟、皮肤褶皱的部位温暖、潮湿，容易滋生真菌。
应对措施：
完全烘干。温和的清洗和干燥后，可以使用电吹风的冷风档进一步吹干。
穿易吸汗的衣服。穿一些易吸汗的材质的衣服。
用药物控制。不要用玉米粉、滑石粉或者其它的无药效的粉剂，因为一旦他们变潮湿就会更容易滋生真菌。
尝试用草药。一些可靠的办法包括可以涂抹苹果醋或者维他命E；吃6-9颗大蒜胶囊；吃常温存放的酸奶；或者摄取更多的维他命B复合物。
Pressure sores
褥疮
Whenever skin is under prolonged pressure, tiny blood vessels are compressed, the supply of oxygen and water is interrupted, and skin starts to die. People who are immobile should have their skin checked thoroughly at least once a day. An area that stays red longer than 15 minutes after pressure is removed is the beginning of a pressure sore. (For dark-colored skin, look for areas that are darker or purplish-blue in color.)
对于长时间被压在身下的皮肤，毛细血管因为受压而导致氧气和水分供给中断，然后皮肤组织开始死亡。对长期卧床的患者至少每天彻底检查皮肤一次。当皮肤被压发红超过15分钟，褥疮就开始滋生。
To prevent sores:
应对措施“
Keep pressure off bony areas. Use padding to protect the most common pressure points (see graphic, above). When making a foam pad, don’t cut out the center (as is done for bunions or corns), as this can further decrease circulation. In bed, real or synthetic sheepskin pads are effective, as are “egg crate” foam mattress pads.
Avoid giving massages over bony areas, or positioning a person directly on the hipbone.
保证骨瘦的地方不受压。用一些垫板来保护最常见的压力点（见上图）。制作泡沫板时，不要把中间给挖空，这样会减少空气流通。在床上可以铺上用真羊皮和人工合成的羊皮制作成的蛋架型的床褥寝具是很有用的（目前患者较多使用防褥床垫，淘宝或医疗商店都有卖）。
不要按摩骨头突出的地方，不要直接让臀骨受力。（在坐轮椅的时候需要加坐垫）
Beware of recliners. In sitting, the coccyx (tailbone area) takes the brunt of pressure. “As soon as mobility is affected, a pressure relief cushion, like a ROHO or Jay cushion, is a basic necessity,” Huberty says. Ordinary foam or air cushions “just won’t do the job.”
Huberty warns that recliners aren’t meant for people with limited movement and can cause bad pressure sores, especially when people sleep in them at night. Outfit the chair with a proper pressure cushion and keep a close eye out for problems.
Ideally, immobile people need to be turned every two hours. At a bare minimum “one or two position changes a night will greatly reduce the risk of pressure sores,” Huberty says. A programmable automatic turning mattress can regularly shift an occupant’s weight, helping caregivers get some sleep.
使用躺椅的时候要注意，当坐的时候，尾椎骨承受大多数的压力，Huberty说，一旦影响到患者的运动能力后，使用ROHO或者JAY轮椅垫就非常有必要了，普通的泡沫板或者空气坐垫不能有效的起到保护作用。
ROHO坐垫 JAY坐垫
Huberty提醒运动受限的患者不要只关心褥疮的问题，给轮椅配合适当的减压坐垫也会减少很多问题。
通常，卧床患者需要每2个小时翻身一次。最少一晚上也需要翻身一到两次将会极大的避免褥疮的发生，Huberty说，一种可控的自动翻身床垫可以均匀的移动一个人的质量，能帮助护理人员得到更多的休息。
Don’t drag the skin. “Shearing force” is created when one layer of skin moves but the other doesn’t. This happens when a person is dragged or sits up in a hospital bed raised to greater than 30 degrees.
Be as active as possible. Nancy Schuman, neuromuscular nurse practitioner at the MDA/ALS Center at the University of Washington in Seattle, says the center doesn’t see many pressure sores among ALS patients. She credits education and a philosophy that “encourages patients to be active and not to be in bed, which is probably the worst thing a person can do.”
切勿拖拽皮肤。当某一层皮肤在动，而其他层皮肤没有在动就会形成了一个“层差力“。特别是当患者向下滑或者躺在超过30°角的病床上的时候。
尽可能的积极面对。Nancy Schuman,西雅图华盛顿大学MDA/ALS医疗中心的神经科护士说，该中心ALS患者中滋生褥疮的不多。她归咎于教育和理念“尽可能的鼓励患者更积极的面对，尽少的卧床，卧床可能是一个人能做的最坏的事情“
Comfort Food for Skin Skin is best nourished from the inside out, through healthy foods and eight to 10 glasses of water a day. Because vitamins and minerals work cooperatively to aid skin, start with a daily multivitamin-mineral supplement. From there, follow healthy eating practices: plenty of fresh fruits and vegetables, whole-grain breads and cereals, cooked dried beans and peas, milk, and extra-lean meat or fish. Skin care experts recommend including one linoleic acid-rich food in the daily diet, such as safflower oil, nuts, avocado or seeds. Other essential fatty acids, which help moisturize skin, are found in soybeans, salmon, tuna, shrimp and corn oils. Repairing skin damaged by pressure sores requires extra protein, zinc, and vitamins A, C and K. Vitamin C also builds collagen, which is adversely affected by ALS.
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皮肤是由内而外得到滋养的，每天需要喝8-10杯水和保证健康的饮食。健康的皮肤需要补充矿物质-维他命。可以吃以下食物：大量的新鲜水果和蔬菜，面包和谷类产品，烧熟的干扁豆和豌豆，牛奶，另外还有瘦肉和鱼类。
皮肤护理专家推荐食用富含亚油酸的食物，例如红花子油、坚果等。还需一些能滋润皮肤的脂肪酸包括大豆、大马哈鱼、金枪鱼、虾和玉米油。修复因褥疮而损伤的皮肤可以多食用额外的蛋白质、锌和维他命A、C、K。维他命C也能有助于生成由ALS损伤的胶原蛋白。
狗仔卡
发表于 2012-10-23 12:39:13
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发表于 2012-10-23 13:11:13
发表于 2012-10-24 09:35:09
