If you’ve been in the wound care industry for quite some time, you’re probably familiar with the acronym MASD or moisture-associated skin damage.
It’s safe to say that it’s been common knowledge in clinical practice that long-term exposure of the skin to moisture can be harmful. In fact, it can even lead to skin breakdown if not given the proper medical attention.
What is MASD?
MASD or moisture-associated skin damage is defined as the erosion and/or inflammation of the skin due to extended exposure to moisture as well as its content such as mucus, perspiration, saliva, stool, and urine.
This condition is classified into four types namely, incontinence-associated dermatitis or IAD, intertriginous dermatitis, also known as intertrigo or ITD, peristomal moisture-associated dermatitis, and periwound moisture-associated dermatitis.
Incontinence-Associated Dermatitis or IAD comes with a lot of aliases. It is also known in some circles as diaper dermatitis, diaper rash, maceration, moisture lesions, and perineal dermatitis, among others. This condition develops as a form of irritant dermatitis leading to extended or chronic exposure to urine of stool.
IAD usually occurs in the perineum that includes the labial folds and vulva to the anus (in women) and from the scrotum to the anus in men. They may also appear in the buttocks, the groin, the gluteal cleft and may even extend to the inner and posterior thighs.
When a patient has IAD, the use of alkaline cleansers, soaps, detergents, and aggressive cleaning devices are not recommended mainly due to the fact that they may lead to further skin damage.
Also known as intertrigo, this condition is an inflammatory dermatitis caused by the accumulation of moisture in the skin folds and the friction between opposing skin surfaces. usually occurs in the bariatric population, especially those who suffer from diabetes as well as those who are on bed rest. The said condition may also be associated with any type of medical device capable of trapping moisture in a skin fold.
ITDs are usually found in the groin area, the axilla, under the breast, or in the pannus or abdominal panniculus and may manifest with itching, erythema, oozing, denudation, and weeping, among others. To avoid this condition, it is crucial to check all skin folds whenever possible.
Peristomal Moisture-Associated Dermatitis
Peristomal moisture-associated dermatitis is another form of MASD and is an erosion or inflammation of the skin due to moisture from chemical, fecal, or urinary irritants that starts at the stoma skin junction and may extend outward. This location may potentially affect the peristomal skin as well as the choice of treatment aimed at protecting or treating the skin.
This form of dermatitis may also exist on other ostomy sites such as percutaneous gastrostomy tube insertion sites or patients with tracheostomies.
Periwound Moisture-Associated Dermatitis
Periwound moisture-associated dermatitis occurs when the wound exudate comes in contact with periwound skin for a long period of time due to the former containing proteolytic enzymes which can make the problems worse because it contains a high concentration of bacteria.
The prolonged exposure of periwound skin to excessive moisture as well as proteolytic enzymes can lead not only to maceration, but also to excoriation which is defined as an injury to the skin caused by trauma, chemical, or thermal burn.
Prevention and Treatment
Thorough skin assessment
proper , yet gentle skin cleansing
Use of pH balanced cleansers
Use of emollients is highly recommended because it can help retain moisture in the stratum corneum by rehydrating the corneocytes