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Moisture-associated skin damage: causes and an overview of assessment, classification and management

25 June 2020
Product Focus
02 June 2020
Volume 29 · Issue 12

Abstract

Moisture-associated skin damage (MASD) can result when the skin has prolonged or continuous exposure to excessive moisture. If the skin experiences too much moisture, it becomes overhydrated and is prone to maceration. This makes it easier for irritants and microorganisms to penetrate the skin, reduce its integrity to mechanical forces and disrupt its protective acid mantle. The condition can greatly affect patient wellbeing. MASD is a collective definition and it has four main causes: incontinence-associated dermatitis, periwound skin damage, intertriginous dermatitis and peristomal moisture-associated dermatitis. Practitioners can use tools such as the Skin Moisture Alert Reporting Tool (S.M.A.R.T.) to identify its aetiology, which informs its management. Management of MASD involves assessment, addressing the underlying cause, and implementing a structured skin care regimen to treat it and prevent its recurrence. Case studies illustrate the use of a structured treatment strategy using Medi Derma barrier products and the principles of Total Barrier Protection to provide a cost-effective solution for the prevention and management of skin compromised by MASD.

Over the past few years, the term moisture-associated skin damage (MASD) has been adopted by healthcare practitioners as a collective definition for the damage of various aetiologies associated with prolonged or continuous exposure of the skin to excessive moisture (Dowsett and Allen, 2013; Young, 2017).

Terminology used to classify skin damage has changed numerous times in recent years, undoubtedly leading to confusion, inconsistencies in clinical practice and ineffective record keeping. Seminal work by Defloor (2005) was among the earliest to recognise the importance of differentiating between pressure ulcers and moisture lesions and, while this was principally valid, it failed to address other moisture-related aetiologies, such as periwound moisture-associated damage or intertrigo.

Moisture lesions became the accepted terminology a few years ago because they were closely associated with prolonged incontinence, mainly via contact with urine and/or faeces (Guy, 2012; Wounds UK, 2014), which meant other causes were not recognised. At the same time, evidence in the literature was emphasising the importance of prevention and management of incontinence-associated dermatitis (IAD) (Bardsley, 2013; Beeckman et al, 2015).

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Moisture-associated skin damage
MASD
Tissue viability
Tissue viability nursing