Moisture-associated skin damage: use of a skin protectant containing manuka honey
The skin is the largest organ in the body, providing an effective barrier against excessive fluid loss and invasion from bacteria, but the barrier function of the skin can be lost when it is damaged by prolonged contact with moisture. Moisture-associated skin damage can be caused by prolonged exposure to perspiration, urine or faeces, wound exudate or stomal output. Prevention and treatment of moisture-associated skin damage involves application of skin protectants, but there is a wide range of these products available to nursing staff, and clinical decision making is hampered by a lack of robust comparative evidence. Medihoney® Barrier Cream may be used for a number of indications related to moisture-associated skin damage, including incontinence-associated dermatitis. The use of Medihoney Barrier Cream has been shown to lower pruritis complaints associated with intertrigo, and promotes patient comfort.
The skin provides an effective barrier against the external environment, preventing desiccation of the body through moisture loss (Madison, 2003), permeation of exogenous substances and infection. This barrier function is predominantly achieved by the upper layer of the skin, the epidermis, and in particular the outermost layer, the stratum corneum (Voegeli, 2012) (Figure 1).
Within the stratum corneum the skin cells (corneocytes) are arranged in a ‘brick wall’ structure, held together by lipids. Normal skin has a pH of 4.5-6.2, creating an acid mantle that also contributes to the barrier function against bacteria and other irritants (Holroyd and Graham, 2014). When the skin is damaged, its barrier functions are lost. This article describes the pathophysiology of moisture-associated skin damage and incontinence-associated dermatitis (IAD) in particular. Regimens for prevention and treatment of IAD are discussed and the evidence for, and appropriate use of, barrier creams is presented, with a focus on Medihoney® Barrier Cream.
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