Prevention and management of moisture-associated skin damage
Disruption to the integrity of the skin can reduce patient wellbeing and quality of life. A major cause of skin breakdown is prolonged exposure to moisture, but this is often overlooked. When skin is wet, it becomes more susceptible to damage from friction and shearing forces, and skin flora can penetrate the disrupted barrier, causing further irritation and inflammation. If untreated, moisture-associated skin damage (MASD) can rapidly lead to excoriation and skin breakdown. MASD includes incontinence-associated dermatitis (IAD), which is caused by prolonged skin exposure to urine and stool, particularly liquid stool. For patients at a high risk of developing IAD, preventive measures should be instituted as soon as possible. The main one is to prevent excessive contact of the skin with moisture. Optimal skin care should be provided to patients with any form of MASD. It should be based on a structured regimen and include the use of a gentle skin cleanser, a barrier product and moisturiser. Derma Protective Plus is a liquid barrier that gives long-lasting protection against chafing or ingress of urine and stool into the skin. This product is less greasy than others, and provides a barrier and a healing environment, with resistance to further maceration from IAD or persistent loose stools.
The promotion and maintenance of skin integrity is a common challenge in all care settings and is often used as an indicator of the overall quality of nursing care provided. In simple terms, skin integrity can be defined as the skin being ‘whole, intact and undamaged’ and disruption to skin integrity can have a negative effect on patient wellbeing and quality of life (Woo et al, 2017; Fletcher et al, 2020).
While the threats to skin integrity presented by pressure, shear and friction are well known, frequent exposure of a patient's skin to excessive moisture is often overlooked as a major cause of skin breakdown.
The term moisture-associated skin damage (MASD) has been adopted to describe the spectrum of damage that results from prolonged exposure of a patient's skin to various sources of moisture, including urine or stool, perspiration, wound exudate, mucus and saliva (Voegeli, 2019). However, MASD is a general umbrella term to describe any skin damage caused by moisture, and generally considered to include four commonly encountered separate conditions that often coexist. These are: incontinence-associated dermatitis (IAD); intertrigo; periwound moisture-associated dermatitis; and peristomal moisture-associated dermatitis (Figure 1).
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