Moisture-Associated Skin Damage

WoundSource Practice Accelerator's picture

The outer layer of the skin, the epidermis, is the body's physical barrier to the environment. This barrier is compromised when moisture or trauma damages the epidermis. Frequently, moisture or adhesives can damage the skin and cause painful injuries. The damaged area is then more susceptible to infection and delayed healing.

Overexposure to moisture can compromise the skin's integrity by disrupting the delicate molecular arrangement of intercellular lipids in the stratum corneum and the intercellular connections between epidermal cells or corneocytes. The term moisture-associated skin damage (MASD) encompasses a spectrum of injuries characterized by denudation (inflammation and erosion) of the epidermis resulting from prolonged exposure to various sources of moisture or irritants such as wound exudate, perspiration, urine, stool, or ostomy effluent.

WoundSource Practice Accelerator's picture

Vulnerable skin within the skin microclimate is caused by a multitude of factors that are often aggravated by one another. Urine and feces, for example, have a negative impact on the skin as a result of the microorganisms and enzymes they contain. These factors break down the skin barrier and cause inflammation through the release of cytokines that trigger an immune response leading to symptoms of dermatitis (i.e., moisture-associated skin damage [MASD]). Incontinence-associated dermatitis (IAD) is one type of MASD, and the external factors that contribute to IAD include microclimate (water, temperature, pH), mechanical forces (friction, pressure, shear), and biochemical factors (fungi, irritants, bacteria, enzymes).

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Urinary incontinence is a relatively common condition marked by loss of control of the bladder. In severe cases, it can have a detrimental impact on the quality of life of patients with this condition. Because of the sensitive and embarrassing nature of the topic, urinary incontinence tends to be underreported.

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Absorbent briefs: Briefs used to absorb urine and stool and to help prevent moisture-associated skin damage in patients with incontinence issues. Briefs with high breathability and wicking help to maintain the skin microclimate.

Barrier products: Creams, sprays, wipes, or other products used to seal the skin and protect it from breakdown caused by moisture or incontinence.

Cyanoacrylates: A skin sealant that bonds to the skin surface and integrates with the epidermis. Cyanoacrylates are strong and resistant to washing off.

Dianne Rudolph's picture

Moisture-associated skin damage (MASD) is a common problem for wound clinicians. It connotes a spectrum of skin damage caused by inflammation and erosion (or denudation) of the epidermis resulting from prolonged exposure to various sources of moisture and potential irritants. These can include urine, stool, perspiration, wound exudates, or ostomy effluent. MASD includes several different categories: incontinence-associated dermatitis (AID), intertriginous dermatitis, periwound skin damage, and peristomal MASD. Of these categories, IAD is one of the more challenging issues for clinicians to recognize and treat. It is not uncommon for IAD to be inaccurately assessed as a stage 2 pressure injury. For the purposes of this blog, the focus is on differentiating between IAD and pressure injuries. Treatment strategies are also addressed.

WoundSource Editors's picture

By the WoundSource Editors

Scrotum injuries can be caused by one or more mechanisms of injury such as trauma, pressure, friction, and moisture. Minor injuries frequently result in pain to the afflicted area, swelling, or ecchymosis.

Holly Hovan's picture
Wound Documentation Mistakes

By Holly M. Hovan MSN, RN-BC, APRN.ACNS-BC, CWOCN-AP

Documentation is a huge part of our practice as wound care nurses. It is how we take credit for the care we provide to our patients and how we explain things so that other providers can understand what is going on with the patient, and it is used for legal and billing purposes as well.

WoundSource Editors's picture
Risk Assessment Standardization

By the WoundSource Editors

The prevalence of pressure injuries among certain high-risk patient populations has made pressure injury risk assessment a standard of care. When utilized on a regular basis, standardized assessment tools, along with consistent documentation, increase accuracy of pressure injury risk assessment, subsequently improving patient outcomes. Conversely, inconsistent and non-standardized assessment and poor documentation can contribute to negative patient outcomes, denial of reimbursement, and possibly wound-related litigation.

Margaret Heale's picture
Continence Assessment

By Margaret Heale, RN, MSc, CWOCN

Not very long ago, when working in an in-patient rehab center, I was shocked to discover patients calling the adult incontinence garments "hospital underwear." We were making good inroads into reducing the use of these products with the hope that if we used less it would be possible to acquire higher-quality products that would function optimally for patients who really needed them. It was of concern that some facilities had become diaper-free because many of our patients benefited from briefs, particularly as a "just in case security blanket" and we felt it was unrealistic for our patient population to be brief-free.

Fabiola Jimenez's picture
Skin Care

By Fabiola Jimenez, RN, ACNS-BC, CWOCN

Have you noticed the tissue trauma that occurs to the posterior aspect of the scrotum? It appears like road rash, partial tissue loss, and denudation. Many times it is weepy, and looks it appears quite painful to the patient.