by Milo Careaga

Lesions can and do appear anywhere. They often start as blisters, but quietly turn into raw, open sores which need covering. Treating these wounds is no different than treating burns. We all have the same basic concerns. This article presents what worked for me.

Infection. Infection is the number one worry and should supercede all other concerns. Infection can increase the time needed for healing and even cause life-threatening complications. Also, because our disease is immune-stimulated, infections might lead to more skin activity. Keep the wounds clean. Wounds should be cleaned once or twice a day. Water is the absolute minimum, but a diluted bleach and water mix is suggested. Do not use harsh cleansers or iodine, and do not scrub too hard. All of these can cause more damage. Bathing and whirlpool baths are best. Soaking helps remove debris, scabs and dead skin.

Keeping wounds moist. Yes, this sounds like what you would not want to do, but keeping wounds moist is a must for healing. Vaseline, auquaphore, or the above creams and ointments can help. Also, some bandages do the job, but be alert for infection because moisture creates a breeding ground for bad stuff.

Poor bandages. The skin is the largest organ we have. It's jobs is to protect usfrom the outside world and keep moisture in. Without the skin, we have to do this on our own. This is done with bandages. There are several types of bandages on the market, all for different kinds of sores.

• First of all, anything dry is bad, very bad! Dry bandages cling to the skin, removing moisture and causing a great deal of damage when removed.
• Secondly, bandages with adhesives (band-aids, medical tapes, and so on). They can cause the skin to lift around sores when they are removed.
• Thirdly, bandages with iodine. Some medical bandages have iodine built into them and this can cause the wound to take longer to heal.

Decent bandages. Teflon patches claim not to stick to wounds. Don't believe this for a second. They did not have pemphigus in mind when they made these. Add a little ointment, Vaseline, or cream to them, however, and teflon bandages can work. They are inexpensive and can cover large areas. When my scalp flairs severely, I use teflon with silvadine cream and then wrap it with coban (a medical wrap which sticks only to itself). Vaseline impregnated gauze comes prepackaged. It is relatively cheap, comes in large sizes, and works quite well. For large areas and for home use, this might be the best. Best bandages.

Silicone bandages. Burn wards have been using silicone bandages for years. These are bandages made of silicone and water. They provide moisture, protection and are easy to remove. They are by far the best thing for burns. They are, however, expensive and many health care programs don't cover bandages at all. Vigilon is the name of the bandage hospitals use. It comes in various sizes. Vigilon is a medical bandage, and can probably be ordered though your local pharmacy. You can also find it in some camping and dance stores. Larger sizes of this product come labeled as "unsterile," but if you use them with antibiotics it should be okay. I have been able to find patches up to 6x8 inches which come in sterile packaging. Second Skin is the brand name of a product like Vilgilon. It comes in lots of sizes, but I found it very hard to find the large sizes in camping or dance stores. Mepitel is a newer silicon bandage which can be washed and reused. It is available from Scott Health Care, 140 Gardner Pl., Danville, CA 94526, 800-992-9939, extension 3. Anticoat is a brand new bandage that has the antibiotics in it, but it is not yet on the market. I hope this helps you.

(Note: Mr. Careaga's experience on this subject is extensive, but your situation may be different. Discuss your individual situation with your physician.)

Updated November 1998

The fine art of bathing

A modified Dakin's solution bath is good infection prevention, and useful at bandage changing time. This consists of two teaspoons of household chlorine bleach mixed with one gallon of water. For 20 gallons of water, enough to partially fill an average size bathtub, you need about seven ounces of bleach. Mix it into the bath water before you go in. Soak in the bath for 15 to 20 minutes. If you are using bandages that tend to stick, enter the bath with those bandages that cannot be easily removed. After the bath, they should come off easily. The modified Dakin's soak can be used everyday or three times a week, with plain water baths on the other days. After soaking, very gently clean healing wounds with plain water and a washcloth. Take care not to scrub too vigorously or you will remove the healing areas of skin. It is good to apply Vaseline or something similar to the wounds and dry area to promote healing.