10
MOISTURE
LESIONS
SIMPLIFIED
This simplified leaflet is intended to give you
guidance on the prevention and management
of MASD to aid clinical practice
MOISTURE ASSOCIATED SKIN DAMAGE
There are many terms used to describe moisture induced
skin damage (Beekman et al, 2004). A moisture lesion is
defined as being caused by urine and/or faeces and
perspiration that is in continuous contact with intact skin of
the perineum, buttocks, groins, inner thighs, natal cleft,
skin folds and where skin is in contact with skin (AWTVF,
2014).
Moisture lesions can occur in any age group, but within the older age group the skin is
more fragile and it can become damaged more easily.
Prolonged exposure causes the skin to become increasingly permeable, making it
weaker and less elastic and more susceptible to physical damage from friction and
shearing forces (Beeckman et al, 2009).
Moisture lesions and Moisture Associated Skin Damage (MASD) occurs when moisture
remains in constant contact with the body for prolonged periods of time, when the
effluent contains irritating substances or when the effluent contains potential bacterial or
fungal pathogens, or when moisture exposure increases friction at the skin surface.
FOUR TYPES OF MOISTURE ASSOCIATED
SKIN DAMAGE
Incontinence associated dermatitis (IAD)
• The skin maintains a naturally acidic pH, usually between 4.0 and 5.5 (Bianchi, 2012)
• Ammonia from urine and enzymes from stool can disrupt the acid mantle of the
skin and eventually cause the skin to break down stools (Rees and Pagnamenta,
2009)
• A systematic approach to the assessment of IAD, helps with early recognition of
whether a patient is at increased risk of complications (Bianchi, 2012)
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Tel: 08444 125 755
Periwound moisture associated dermatitis
• Excessive amounts of exudate can cause maceration and breakdown
of periwound skin
• Exudate from chronic wounds has been found to contain a higher concentration of
proteolytic enzymes as compared to exudate from acute wounds
(Romanelli et al, 2010)
• Accurate and in depth wound and patient assessment must take place so that
the most appropriate treatment can be planned for each individual (Forder, 2014)
Peristomal moisture associated dermatitis
• Inflammation and erosion of skin related to moisture that begins at the stoma/skin
junction and can extend outwards in a 10cm radius
(Colwell et al, 2011)
Intertriginous dermatitis
• An inflammatory skin condition that affects opposing skin surfaces
• Commonly found in the axillary and inguinal skin folds as well as under breasts in
females
• Sweat is trapped in skin folds with minimal air circulation
• Leads to inflammation and dehydration of the skin making the area more prone to
infection
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PRESSURE ULCER V’S MOISTURE LESIONS
There is often confusion between a pressure ulcer and a moisture lesion
due to the presence of moisture, which may be as a result of incontinence
of urine and/or faeces (EPAUP, 2010)
• Moisture lesions are often reported as Stage II pressure damage
• Important to identify the cause of any skin damage, as the treatment and
management of pressure damage and moisture lesions may differ (Fletcher, 2008)
PRESSURE ULCERS MOISTURE LESIONS
Causes Pressure and/or shear must be Desiccation and loose skin may
present indicate additional shearing injury
Location A wound NOT over a bony Moisture lesion may occur over a bony
prominence is unlikely to be a prominence.
pressure ulcer Pressure and shear should be excluded
as causes, should moisture be present
Shape Circular wounds with a regular Diffuse, different superficial spots are
shape that are limited to a single more likely to indicate moisture lesions
spot are likely to be a pressure
ulcer
Depth Partial thickness up to full Superficial to partial thickness skin loss
thickness skin loss Depth may increase if they become
infected
Necrosis Necrosis can be present No necrosis
Edges Distinct edges Diffused or irregular edges
Colour Non blanchable, red skin is likely to Redness that is not uniformly distributed
be a pressure ulcer. However, is likely to be a moisture lesion whereas
within a wound red tissue indicates pink or white skin surrounding a wound
granulation whereas black necrotic is likely to be maceration due to moisture
tissue is likely to be a pressure
ulcer
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PATIENT AND SKIN ASSESSMENT
Skin assessment and hygiene is a fundamental part of
nursing care that is often neglected (Wounds UK, 2012)
A full and detailed patient review should include an
assessment of the patient’s continence status,
mobility, nutrition, allergies and previous skin
problems/wounds (Dowsett & Allen, 2013)
A risk assessment for skin breakdown that includes
pressure ulcer risk assessment should be performed
using a recognised tool (NPUAP/EPUAP 2009)
If skin is excoriated consider use of an excoriation
Tool (HIS/NATVS, 2009)
PREVENTION AND TREATMENT OF
MOISTURE LESIONS AND MOISTURE
ASSOCIATED SKIN DAMAGE
• Wash skin after every episode of incontinence using water and emollients
Do not use soap (Beeckman et al, 2009)
• Ensure skin is thoroughly dried after washing
• Use moisturisers after washing and drying; antimicrobial content may be considered
• Consider a barrier protectant film or cream
• Consider the use of antifungal or antimicrobial creams
• Consider the use of body worn pads to protect the skin
• Consider the use of incontinence management aids
• Refer to a continence nurse where available (Guy, 2012)
References
Beeckman D, Schoonhoven L, Verhage S, Heyneman A, Defloor T (2009) Prevention and treatment of incontinence
associated dermatitis: literature review J Adv Nurs 65(6): 1141-54. Bianchi, J. (2012) Top tips on avoidance of IAD.
Wounds Uk Supplement. The Identification and Management of Moisture Lesions. 8 (2). Colwell JC, Ratliff CR, Goldburg
M,et al (2011) MASD part 3: perisotimal moisture-associated dermatitis and periwound moisture-associated dermatitis: a
consensus. J Wound Ostomy Continence Nurse 38(5): 233-241. EPAUP (2010) Pressure Ulcer classification –
Differentiation between pressure ulcers and moisture lesions. EPAUP panel. Washington DC USA: NPAUP. Fletcher, J.
(2008) Understanding the differences between moisture lesions and pressure ulcers. Nursing Times. 104,50/51 38-39
Forder,B.(2014) ActivHeal PocketGuide. Exudate. 4th Ed. Guy, H.(2012) The differences between moisture lesions and
pressure ulcers. Wound Essentials Vol 1.36-44. Health Improvement Scotland/National Association of Tissue Viability
Scotland (2009) Wound Excoriation Tool. All Wales Tissue Viability Nurses Forum (2014) Prevention and management of
moisture lesions, available at: http://www.welshwoundnetwork.org/files/5514/0326/4395/All_Wales-Moisture_Lesions_
final_final.pdf. Dowsett, C and Allen, L (2013) Moisture Associated Skin Damage. Wounds UK (9) 4.
