RSD and Skin Ulcers: Prevention and Wound Care

Reflex Sympathetic Dystrophy (RSD), now commonly called Complex Regional Pain Syndrome (CRPS), can affect pain signalling, blood flow, sweating, temperature, movement and skin health. A sore or ulcer may develop when swelling, reduced mobility, fragile skin, pressure, infection or poor circulation combine. Although skin ulcers are not inevitable, people with long-standing CRPS may need careful monitoring of even minor breaks in the skin.

Wound care is especially important in Australia, where hot weather, dry conditions and long distances to medical services can complicate recovery. General information can help with early recognition, but an open wound, spreading redness or sudden change in pain should be assessed by a GP, wound-care nurse or hospital service.

How RSD Can Affect Skin

CRPS may cause skin to become unusually red, pale, bluish, shiny, sweaty, dry or thin. Some people experience marked temperature changes, while others develop swelling that makes shoes, socks or clothing rub against the affected area. These changes can weaken the skin barrier and make small grazes slower to heal.

Pain may also distort the usual warning signals. A person might avoid looking at or touching a limb because it is hypersensitive, while pressure from a heel, brace or footwear continues unnoticed. At the other extreme, severe pain can make routine cleaning and dressing changes difficult. A podiatrist, GP or wound-care clinician can help identify pressure points and suitable protective materials.

An ulcer may begin as a blister, crack, blistered patch or area of persistent redness. Darkening skin, a bad smell, increased warmth, pus or a wound that grows wider requires prompt medical attention. Fever, rapidly spreading redness, red streaks or feeling faint are reasons to seek urgent care, including an emergency department or the ambos.

Diagnosis and Circulation Checks

A clinician will usually examine the wound, surrounding skin, pulses, sensation, swelling and movement. They may ask about diabetes, smoking, vascular disease, medicines, previous infections and how the injury started. Tests can include a swab when infection is suspected, blood tests, an X-ray for bone involvement, or vascular studies when blood flow is uncertain.

There is no single scan that proves CRPS. Bone imaging may sometimes support the overall assessment or help exclude another problem, and bone scans in RSD may be discussed when symptoms and examination findings do not provide a clear picture. The diagnosis remains clinical and should account for other causes of pain, swelling and skin change.

In Australia, many people begin with a local GP, who can coordinate referrals to a public hospital clinic, private specialist, community nurse or podiatrist. Medicare may cover some consultations, but out-of-pocket costs and waiting times vary between states and providers. People living in regional Western Australia, the Northern Territory or far north Queensland may need telehealth, visiting services or travel to a larger centre.

Preventing Pressure and Skin Breakdown

Prevention focuses on protecting the skin while keeping the limb as safely active as possible. Check the affected foot, ankle or hand every day using a mirror or a phone camera if bending is difficult. Look between toes and around nails, heels, scars and areas touched by splints. Compare both limbs for new swelling, colour change, heat or drainage.

Useful daily measures include:

• Wash gently with lukewarm water, then pat the skin dry.
• Apply a plain moisturiser to dry skin, avoiding cream between the toes.
• Wear clean, seamless socks and properly fitted shoes.
• Remove pressure from heels and other prominent areas when resting.
• Change position regularly and avoid tight straps, heat packs and ice directly on skin.
• Keep nails trimmed carefully, or arrange podiatry support when sensation or movement is limited.
• Stop smoking and discuss diabetes, circulation or nutrition concerns with a clinician.

Queensland summers, tropical humidity and prolonged sweating can soften skin and increase friction, while inland Australian conditions may cause cracking and dryness. Avoid walking barefoot on hot pavements or beaches if sensation is altered. A pharmacist can advise about basic moisturisers and dressings, but persistent skin changes still need professional assessment.

Safe Care for an Existing Ulcer

For a minor wound, wash hands before and after care, rinse the area with clean running water or saline, and gently pat it dry. Cover it with a sterile, non-stick dressing that matches the amount of fluid. Do not pour alcohol, peroxide, strong antiseptics or household products into the wound unless a clinician specifically directs it. These substances can irritate healing tissue.

Dressings should be changed according to the product instructions or the wound clinician’s plan. Do not peel off a dressing that has stuck; moisten it first if advised. Keep pressure away from the area, and never cut a hole into a dressing or padding without guidance, as this can create new pressure around the wound.

A wound that is enlarging, increasingly painful, foul-smelling, swollen or draining needs timely review. In CRPS, pain intensity may fluctuate, so visual changes and function are also important. A clinician may recommend debridement, compression, antibiotics, off-loading footwear or vascular assessment, depending on the cause. Compression should not be started without checking circulation.

Rehabilitation and Coordinated Treatment

Movement remains part of CRPS care, but exercise should be graded and individualised. Gentle range-of-motion work, desensitisation, swelling management and functional activity can support circulation and reduce stiffness. A physiotherapist may also check whether a walking pattern, brace or transfer technique is placing repeated pressure on vulnerable skin. Guidance on physical therapy for muscle atrophy can complement a wound-specific plan.

A pain specialist, GP, occupational therapist, physiotherapist, psychologist and wound-care nurse may each contribute. Treatment can involve pain medicines, topical products, nerve-pain strategies, psychological support and equipment that makes bathing, dressing or mobility safer. Medicines should be reviewed rather than stopped suddenly, especially when they affect bleeding, alertness or immune function.

Access may differ between metropolitan and rural Australia. Public pain clinics can have long waits, private appointments may involve a gap fee, and transport can be difficult for people in remote communities. The NDIS may fund some disability-related supports for eligible participants, but it does not replace medical treatment or automatically pay for wound care. A GP can help separate these pathways.

Early action gives a wound the best chance to heal and reduces the risk of infection, deeper tissue damage and hospital admission. Arrange a clinical review for any ulcer that persists, returns or changes, and keep a written record of its size, appearance, drainage and dressing routine to support coordinated care.