What appear to be sweat and hot conditions seem to cause my arm stump to become irritated and develop a mildly itching, red bumpy rash – similar to a baby butt / diaper rash or heat rash.

Proper stump care is key to controlling this. Also, check the water conditions.

Generally, the prosthetic arm will be the culprit, one way or another. So there are eight simple questions to ask if you need to know whether a particular prosthetic arm will work for everyday use in real work situations  [link]. All this is not exactly rocket science or neurosurgery though [link].

So even after just an hour or so, my arm may be dripping wet. Many of you may be able to avoid that by having air condition surround them – but in our hot summers and no air conditioning, I am getting this almost daily.

Sometimes the rash gets more pronounced at the rim of the liner just below my elbow – sometimes the rash can cover the whole stump, even if only very mildly. Then it is time to act, act all the time, act fast, prevent. I take this very seriously as I don’t want a serious itch or not be able to wear my arm.

Here is what I do about that (and a lot of research went into this):

• Every 1-2 hours if possible, at least every 3-4 hours: Take off prosthesis and dry both the liner and the stump completely if it is wet. It has to be a clean towel that I use and where necessary I make sure I have a towel with me. I do not wash or soap it every 1-2 hours, but I may dry it if I sweat and it feels wet.
• Every evening: Wash stump and liner thoroughly – not just by rinsing, but by gently rubbing it – using skin-friendly neutral soap (such as pH 5.5 soap). No disinfection required, or, even helpful, as that could on the long run create other risks.
• Every 1-2 days – if necessary more often – if the skin shows signs of reddening, I apply a gentle amount of baby butt creme containing zinc-oxide on the whole stump to treat any existing or developing heat rash, and to impede the development of any new heat rash. In cooler weather I am able to do without baby butt creme for a week or even two. But preventive strikes have proven useful here.
• Every evening, I put some soothing skin care on my stump. This can be (a) baby butt creme, (b) shea butter, (c) cocos oil / butter, (d) olive oil.
• Once a week or so, in the shower, I use skin-friendly neutral soap and DIY olive oil salt scrub to very gently exfoliate and keep the skin supple.
• A couple of times a week I air the skin and do not wear the prosthesis. Usually when I do not need the prosthetic function really badly.
• Water: I use cold tap water. If I use warm water, I let the tap run for quite a while. Most houses have luke warm water sit in the tubes for hours and then, microbes grow. They are harmless for the most part but damaged or overused skin such as on the stump can suffer weird infections. More details here.
• Treat eczema: I don’t use corticosteroid cremes if possible. My doctor prescribed Protopic (R) containing Tacrolimus as active ingredient. Really neat stuff.
• Silicone liner: Make sure to get a good fitting liner. Commercial products such as Ossur liners may not provide a good fit but instead cause eczema.
• Friction reduction: By far the most important step to prevent rashes from occurring is wearing tubular gauze between silicone liner and the skin. That in essence solves the rash issue almost totally. When I wear tube gauze, it does not matter whether I wash the liner or stump – I just won’t get a rash. The material is cotton and as it is a two-way stretch material, one needs to buy it slightly smaller than the limb width.
  • I usually get myself the Tubifast Green Line by Molnlycke (1,0 inch / 5 cm width, for small to medium sized limbs). I cut a piece to correct length, and I will wear it over weeks – I was these bits that I cut for wearing, either manually, or put them into the washing machine, until they fall apart. I have not gone through a whole roll of 10 meters yet in five or six years.
  • They also have a Red Line (smaller limbs, only 1,3-1,4 inch / 3,5 cm width) and a Blue Line (wider limbs 2,9 inch / 7,5 cm width).

The underlying problem of rash initiation due to wrong socket or liner materials when wearing a prosthetic arm is also discussed in this article:

Publication [link]

Keywords – arm stump irritation – arm stump rash