Moisture-associated skin damage Resources

Moisture-associated skin damage (MASD) affects people of all ages and patient groups (Voegeli, 2019). It describes a range of inflammatory conditions that occur in response to prolonged exposure of a person’s skin to moisture, i.e. perspiration, urine, faeces, wound exudate and ostomy effluent (Gray et al, 2011). Prolonged exposure to these irritants damages the natural barrier function of the skin and, if not managed effectively, can lead to tissue damage and subsequent breakdown (Dykes and Bradbury, 2016).

Changes to skin integrity and damage to the skin can occur at the end of life (EOL), despite appropriate interventions that meet or exceed standards of care. It can also be difficult to determine which wounds can be prevented and which ones are unavoidable (Sibbald et al, 2010; Beldon 2011). It is therefore the role of the nurse and carer to consistently deliver the best end-of-life (EOL) care, support palliation of symptoms, and maintain optimal skin integrity. Best practice for EOL skin care is about maintaining skin integrity for as long as is possible, followed by a goal of a dignified death (Kennedy, 2016) in line with patient/family wishes. This article discusses factors associated with maintaining skin integrity, and how skin damage can be prevented and a skincare regimen managed in EOL patients.

Moisture can affect the normal function and permeability of the skin, leaving our bodies susceptible to infection. The damaging effects of moisture-associated skin damage (MASD) impact a wide range of patient groups, however, wounds caused by moisture are often mistaken for and treated as if they are pressure ulcers. Moisture can come into contact with the skin from a number of sources, but damage can be treated in the same way, despite its cause. In the authors’ clinical opinion, if nursing staff are able to identify and treat skin damage correctly according to its aetiology, faster rates of healing, improved quality of life, and fewer resources used on wound care would be seen. This article looks at the identification of seven aetiologies of MASD following an audit, and the subsequent development and implementation of a protocol to improve and standardise skin care in the authors’ trust, which it was hoped would provide a dynamic and unified approach to the management and education of MASD.

The definition of incontinence is acknowledged as any involuntary loss of urine or the inability to control the bowels (International Continence Society [ICS], 2013). It is not a life-threatening condition, but has a significant and distressing effect on the physical, psychological and social quality of life of those affected (Lukacz et al, 2011). Isolation, anxiety, depression and embarrassment are commonly reported by people who have a bladder or bowel issue (Wan and Wang, 2014). Urinary incontinence is more common than breast cancer, heart disease or diabetes among older women (Sexton et al, 2011; Tannenbaum et al, 2013). Incontinence is not gender or age specific, it can affect people of all cultures at any point from childhood to old age and can have devastating implications for the individual and their family. Many people may fail to seek help with incontinence for years due to embarrassment and stigma.

Moisture-associated skin damage (MASD) results from an extended period of exposure to various types of moisture, commonly urine or faeces, sweat, and wound exudate¹. It can result in extensive skin breakdown through erythema, maceration and eventually moisture lesions, with the most common presentations being incontinenceassociated dermatitis (IAD), intertriginous dermatitis, periwound moisture-associated dermatitis, and peristomal moisture-associated dermatitis¹. MASD is not caused by moisture alone — other factors including friction, hygiene products, or microorganisms are usually involved¹. MASD can be painful and effect the patient’s quality of life², potentially resulting in moisture lesions if not properly managed.