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Moisture-Associated Skin Damage: Overview and Pathophysiology

Gray, Mikel; Black, Joyce M.; Baharestani, Mona M.; Bliss, Donna Z.; Colwell, Janice C.; Goldberg, Margaret; Kennedy-Evans, Karen L.; Logan, Susan; Ratliff, Catherine R.

Journal of Wound, Ostomy & Continence Nursing: May/June 2011 - Volume 38 - Issue 3 - p 233–241
doi: 10.1097/WON.0b013e318215f798
Wound Care

Moisture-associated skin damage (MASD) is caused by prolonged exposure to various sources of moisture, including urine or stool, perspiration, wound exudate, mucus, saliva, and their contents. MASD is characterized by inflammation of the skin, occurring with or without erosion or secondary cutaneous infection. Multiple conditions may result in MASD; 4 of the most common forms are incontinence-associated dermatitis, intertriginous dermatitis, periwound moisture-associated dermatitis, and peristomal moisture-associated dermatitis. Although evidence is lacking, clinical experience suggests that MASD requires more than moisture alone. Instead, skin damage is attributable to multiple factors, including chemical irritants within the moisture source, its pH, mechanical factors such as friction, and associated microorganisms. To prevent MASD, clinicians need to be vigilant both in maintaining optimal skin conditions and in diagnosing and treating minor cases of MASD prior to progression and skin breakdown.

Mikel Gray, PhD, CUNP, CCCN, FAANP, FAAN, Professor and Nurse Practitioner, Department of Urology and School of Nursing, University of Virginia, Charlottesville, Virginia.

Joyce M. Black, PhD, RN, CPSN, CWCN, FAPWCA, FAAN, Associate Professor, CON-Adult Health and Illness Department, College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska.

Mona M. Baharestani, PhD, APN, CWON, CWS, FAPWCA, FACCWS, James H. Quillen Veterans Affairs Medical Center, Wound Care Program Coordinator and Clinical Associate Professor, Quillen College of Medicine, Department of Surgery, East Tennessee State University, Johnson City, Tennessee.

Donna Z. Bliss, PhD, RN, FGSA, FAAN, Professor in Long-Term Care of Elders, School of Nursing, University of Minnesota, Minneapolis.

Janice C. Colwell, MS, RN, CWOCN, FAAN, Clinical Nurse Specialist, Department of General Surgery, University of Chicago, Chicago, Illinois.

Margaret Goldberg, MSN, RN, CWOCN, Wound Consultant, Delray Wound Treatment Center, Delray Beach, Florida.

Karen L. Kennedy-Evans, RN, CS, FNP, Medical Consultant, KL Kennedy, LLC, Tucson, Arizona.

Susan Logan, BSN, RN, CWS, FACCWS, Clinical Consultant, Kindred Healthcare, Inc, Louisville, Kentucky.

Catherine R. Ratliff, PhD, APRN-BC, CWOCN, Department of Plastic and Reconstructive Surgery and School of Nursing, University of Virginia, Charlottesville, Virginia.

Copyright © 2011 by the Wound, Ostomy and Continence Nurses Society