Bariatric Skin Conditions: Treatment Tips for the Caregiver

Caring for someone who is considered obese requires its own special skill set.

Medicine defines obesity as having a BMI (body mass index) of 30-39. Morbid obesity is categorized as having a BMI of 40+. In contrast, a “normal” and healthy BMI for people of average height is 25 or less. 

While body mass indexing is controversial, it gives us a grasp on how much weight is too much weight for a body to carry before medical problems occur. People with heights over six feet will need to consult with their doctor about an ideal weight that may differ from what their BMI indicates.

Obesity-related medical conditions requiring special attention or the use of bariatric supplies are often seen starting in people weighing 300 pounds or more. One condition that cannot be ignored is the health of the skin.

If you care for someone who is morbidly obese, the amount of excess skin on their body requires special treatment. The folds of skin trap moisture like water and sweat, along with microbes, yeast, bacteria, and the naturally shed skin cells. 

These folds are a perfect breeding ground for wounds if not cleaned regularly and treated properly. A skin wound in an obesity fold is difficult to treat. Preventing such skin breakdown from happening is important.

When skin cells are constantly wet, from water or sweat, they become water-logged in a sense. The barrier between cells starts to break down, allowing the microbes that water and sweat carry to enter the epidermal layers. These microbes set up house and start to breed in the moist, and often dark, conditions. Once a skin condition like this has started, it is difficult to stop.

Moisture is not the only way skin infections begin. Chafing from the skin rubbing together causes the skin to break down over time. Chafing from adult diapers, or from too-tight underwear, also irritates the skin. 

Pressure sores erupt when a person has not moved from the same chair or couch, or is not turned in bed, every few hours. A pressure sore is skin breakdown caused by the constant weight of the entire body on a small part of the body (like the weight of a person’s entire body constantly pressing on the legs or buttocks). If a person is unable to move regularly, or is bed-ridden, pressure sores can occur. 

Contact dermatitis from an allergic reaction to latex or aloe in a product can also irritate the skin and, if prolonged, can cause it to breakdown. An allergic reaction does not always have to be a severe anaphylactic reaction for it to be troublesome. Over time these allergies can do long term damage on the cellular level.

Please note, these kind of skin breakdowns take some time to occur. The skin is not going to break down overnight, but the irritations can be painful from the start. It is best to prevent them at all. 

As a caregiver and/or medical professional, talking to your patient with a gentle tone, yet poignant words, is the best way to get the point across — An obese person must take care of their skin.

Better treatment of the skin, up front, leads to less admissions and readmissions to the doctor’s office, ER, and hospital. 

So what are the best ways to treat your skin and skin folds if you are a bariatric patient or the caregiver for one?

The first step in caregiving should be regular skin-fold inspections. All of the folds of skin must be inspected into the crease. To start, put on non-latex gloves and mentally note your starting point. A good rule of thumb is to start at the neck and work your way down. The neck, breasts or chest, abdominal pannus, groin, armpits, buttocks, and knees are especially important to check, especially if your patient also has incontinence issues. Urine and fecal waste add to the list of irritants that cause skin breakdown.

If redness appears in these folds, skin breakdown could be on the way. Talcum powder (but never cornstarch) is an inexpensive way to dry the skin in these folds. Cornstarch could feed yeast into overgrowth, while talc will not. While powders can be messy, they are effective. Caregivers should wear a mask to prevent inhaling any powder. 

If the skin is well, after applying the talc, your patient should be good to go.

If the skin is compromised, a test should be run at the doctor’s office to identify the skin irritant. Treating a bacterial infection with an antifungal powder will not help, and vice versa. And, the time it will take to see if the treatment is working is valuable time lost to treat the infection.

As a caregiver, it will be important for you to keep organized notes on the regimen and treatment of skin issues. The doctor will need to know what steps have occurred. Make lists of the areas of infection, dates of skin breakdown or redness, photographs (if possible) of the compromised skin, and treatments and measures taken to prevent infection. Include what over-the-counter or prescription topical medications are being used on the skin and how often.

Timing is crucial when treating skin infections. As a caregiver, work with your patient and work with your patient’s doctor to prevent potential problems from becoming life-altering.

SuLauren Wilson is the founder of Finnegan Medical Supply, an online medical supply store based in Little Rock, Ark. She blogs regularly on issues affecting the company’s patients. Although, she has many years of experience in the healthcare industry, she is not a licensed medical professional, and the content of her posts should not be considered medical advice.