It's all about identifying risk factors and of course, also those early signs for both MASD and in the case that you present, MARSI. So, one thing that I've learned over the years is that the skin does not damage almost suddenly. There are warning signs. And I think as clinicians, we really need to learn how to recognize those warning signs. I sometimes say that experienced clinicians, they develop kind of an eye for the vulnerable skin. And before you ever see open skin, there are really subtle changes. For example, the skin becomes more shiny, slightly softer, perhaps a little bit swollen because of the edema. And maybe there is a change in color, mild erythema that was not there before, or early maceration around the wound edges. So, I think it's really important to look for and train people into identifying those early signs.  

And of course, our patients, they notice these signs far before we do. So, they will really tell the clinician that the area burns, for example, a little bit after cleaning or cleansing. Or, that the dressing change becomes more comfortable in comparison with the previous time. And we have to listen. 

I think these comments are incredibly valuable because pain and discomfort are often those early identifiers for barrier disruption—specifically with MASD, or moisture associated skin damage, and we have to look for persistent changes in color. In light skin tones, this is the redness, sometimes there is whitening, there are changes in the texture, an increase in fragility, itching, and burning. Specifically for MARSI, I would say please pay close attention to what happens during the removal of a dressing. Do we see any erythema that follows the adhesive border, for example, or any tiny areas of the epidermis that are lifting, small blisters that appear? Does the patient brace themselves because they know the removal will hurt? And we're doing quite a lot of research on tape removal and patient experience. And I think that these clinical signs, they are really, really expressed by patients. And I don't think that we should accept painful dressing removal as just being normal. If the dressing changes are consistently painful, it really tells us as a clinician, it tells us something. It tells us that the interaction between the dressing, the adhesive and the skin is not optimal. And whenever a clinician notices those early signs, (they may choose) an alternative, another product, instead of being just reluctant and just considering this to be normal.  

We have to ask ourselves, why is this happening? Do we see an increase in exudate, for example? Do we see that the dressing saturation goes too quickly? Are we changing dressings more often than is necessary? So it's not only related to the device or the product, but also to the process, the practice of care. For example, can we use a silicone adhesive to reduce the trauma? Can we reduce friction somewhere else? So, there are so many factors that we have to consider. I think good wound care is often about, of course, observing the skin, but also asking better questions rather than just immediately looking for another solution. And the good thing and the beauty even about recognizing those early signs is that we still have options. So we can intervene before the patient even develops a significant skin breakdown. And well, as we know, the prevention of that skin breakdown is always easier than trying to repair it.