Moisture associated skin damage (MASD). refers to inflammation or skin erosion that is caused by prolonged contact with moisture sources such as urine or stool, sweat or wound drainage. MASD is thought to be caused by more than just moisture exposure. There are many possible factors, including friction, chemical factors (irritants in the moisture source), and microorganisms. The skin’s moisture barrier plays an important role in maintaining body homeostasis. It slows down the movement of water from the body (transepidermal or TEWL) as well as regulating the absorption and absorption of solutes and water from outside. The skin can become irritated by excessive moisture and will soften, swell and wrinkle.
The four specific types of moisture-associated skin damage that will be discussed here are periwound moisture-associated dermatitis, peristomal moisture-associated dermatitis, incontinence-associated dermatitis, and intertriginous dermatitis.
Periwound Moisture-Associated Dermatitis
Exudate is normal during the inflammation stage of wound healing. The advent of moist wound heal has led to the realization that the key to optimal results is moisture balance. The skin around the wound edges can become macerated or even fall apart if there is too much wound exudate. This is known as periwound moisture associated dermatitis.
The potential damage that can result from wound exudates greatly depends on their chemical composition. The amount of exudate, including bacteria, proteins or proteolytic enzymes, can reduce the skin’s barrier function and lead to maceration. Exudate from chronic wounds contains a higher level of proteolytic enzymes than exudate from acute injuries. Periwound maceration can also be caused by skin damage by aggressively removing adhesive wound dressings. These dressings cause severe irritation to the skin and compromise the integrity of the skin’s barrier by tearing away portions of the epidermis.
Periwound moisture associated dermatitis is characterized by erythema, maceration (white, gray, or pale skin that has softened and/or wrinkled), irregular edges, and diffuse edges. This is in contrast to pressure ulcers, which have distinctive edges. Periwound maceration is more common in wounds that have more viscous exudate. This is because the moisture will be less likely to evaporate through the dressing. As a result, the individual might experience burning, pain, or itching. Due to the pooling of exudate, damage may be concentrated on the affected area in the extremities.