Medical Adhesive-Related Skin Injuries

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Medical adhesive-related skin injuries (MARSI) occur when superficial layers of skin are removed by medical adhesive, in which erythema and/or other manifestation of skin trauma or reaction including formation of vesicles, bulla, skin erosion, and epidermal tears, persist longer than 30 minutes after removal of the adhesive. MARSI not only affects skin integrity, but also causes pain, increases risk of infection, potentially increases wound size, and delays healing.

Another category of MARSI is dermatitis reactions such as irritant contact dermatitis, and allergic dermatitis. Complete differentiation between an irritant and an allergic response is somewhat difficult. Other types of MARSI include maceration and folliculitis.

Symptoms of Medical Adhesive-Related Skin Injuries

There are various types of MARSI based on the cause on the reaction. Each type has its own set of symptoms.

In dermatitis reactions, such as irritant contact dermatitis, the skin appears red, is well marginated with precise borders and usually resolves in a day or two if the adhesive is removed and not replaced.

With allergic dermatitis, a cell-mediated immunologic response occurs in response to a component of the adhesive or backing of the tape or dressing. Symptoms include the skin becoming red with vesicles, persisting for up to a week.

Maceration is when the skin appears white, or gray in color, and becomes wrinkled, leaving it susceptible to damage from friction or irritants.

Folliculitis, an inflammatory reaction in the hair follicle that can appear as papules or pustules, can also be considered a MARSI, but is not commonly seen in the NICU population.

Maceration of heel

Figure 1: Maceration of the heel; necrotic foot ulcers caused by ischemia and pressure

Reaction to hydrocolloid dressing

Figure 2: Patch test showing marked reaction to a hydrocolloid dressing

Etiology

MARSI are caused when the skin to adhesive attachment is stronger than skin cell to skin cell attachment. As a result, the epidermal layers separate or the epidermis separates completely from the dermis. Adhesive removal itself results in detachment of varying amounts of superficial epidermal cell layers even in adult skin; and repeated application and removal result in changes in skin barrier function

Risk Factors

  • The elderly with age-related dermal fragility
  • Infants in the NICU with under-developed epidermis
  • Patients with a diagnosis of malnutrition and dehydration
  • Those with moisture and incontinency
  • Patients on medications such as corticosteroids and radiation
  • Patients with dermal pathology, such as eczema
  • Patients requiring frequent dressing changes

Treatments of Neuropathic Foot Ulcers

The same general principles used to manage other wounds should be employed when treating MARSI, but the best way to handle MARSI is through prevention.

MARSI can be prevented by careful selection of adhesive products, correct application and removal. Foam and silicone tapes are gentler to the skin, and while cloth tape adheres most strongly, it can tear the skin. Tapes with stretch ability are excellent to go over joints and areas prone to edema. Using tubular netting or gauze to secure dressings in place rather than tape can help if the skin is compromised or fragile.

Always prepare the skin by cleansing and drying gently, trimming and shaving hair as necessary, and applying skin sealant prior to dressing placement. Remove adhesive "low and slow" in the direction of the hair growth, keeping the tape parallel to the skin and pushing the skin away from the tape with other hand.

Image Source: Medetec (www.medetec.co.uk). Used with permission.

References

Wounds UK. Medical Adhesive-Related Skin Injuries (MARSI): Made Easy. Wounds UK. http://www.wounds-uk.com/made-easy/medical-adhesive-related-skin-injurie.... Accessed May 9, 2017.

Lund, Carolyn. Medical Adhesives in the NICU. Medscape. http://www.medscape.com/viewarticle/838254_4. Published 2014. Accessed May 9, 2017.

NDNQI. Medical Adhesive-Related Skin Injury (MARSI). NDNQI: A Press Ganey Solution. https://members.nursingquality.org/ndnqipressureulcertraining/Module2/ma.... Accessed May 9, 2017.

Wound Care Educational Institute. Oh Mercy, We Have MARSI! Wound Care Education Institute. https://blog.wcei.net/tag/medical-adhesive-related-skin-injury. Published June 13, 2016. Accessed May 9, 2017.

3M. Medical Adhesive Related Skin Injuries (MARSI). 3M. http://multimedia.3m.com/mws/media/1079841O/marsi-taping-techniques-1403.... Published 2014. Accessed May 9, 2017.

3M. Understanding and Preventing MARSI. 3M. http://multimedia.3m.com/mws/media/1236080O/j325617-healthcare-cccsd-05-.... Published 2016. Accessed May 9, 2017.

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