MASD: What is it?

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.¹

The four common types:



¹Gray M, Black JM, Baharestani MM, et al. Moisture-Associated Skin Damage: overview and pathology. J Wound Ostomy Continence Nurs. 2011; 38(3):233-241

Moisture Sources

MASD occurs when the source of moisture remains in contact with the skin for a prolonged period, when the moisture contains irritating substances, when the moisture contains bacterial or fungal pathogens, and/or when moisture increases friction on the skin surface.

• Urine  The solutes urea, chloride, sodium, potassium, and creatinine are present in urine.  (Ammonia in urine has been shown to exacerbate skin damage only when applied to skin already inflamed by IAD.)  The duration of exposure is a primary predictor of IAD risk, since skin moistened with either water or synthetic urine led to a significant decrease in temperature, tissue hardness, and blood flow.  A higher skin pH also increases the likelihood of IAD.
• Stool  Liquid stool, which contains a higher concentration of active enzymes, poses a particular risk of IAD. In fact liquid stool is often associated with severe MASD and extensive skin erosion.  The presence of both urine and either liquid or solid stool also poses a higher risk of IAD.
• Perspiration  Primarily consisting of water, perspiration also contains urea, glucose, sodium, and chloride.  Chronic perspiration most often results in MASD when in a skin fold, where evaporation is minimized.  When prolonged moisture is accompanied by friction between opposing surfaces in the fold, ITD—characterized by inflammation and erosion—can occur. 
• Wound exudate  While exudate plays a role in wound healing, chronic exudate often contains proteolytic enzymes, inflammatory cytokines, and bacteria.  Epidermal stripping from adhesive bandage changes can increase the likelihood of periwound maceration.
• Effluent from an ostomy  Urostomy: urine from a urostomy carries a far higher concentration of bacteria, as well as mucus produced by the ileal or large bowel conduit.  Ileostomy: The effluent from an ileostomy is more liquid in consistency (especially in the first year after formation) and contains active digestive enzymes.  It can damage skin after even brief periods of contact. Colostomy: The effluent (formed vs more liquid consistency) depends upon the anatomical location of the stoma in the large intestine.  For any type of ostomy, the volume of effluent, pouching technology, and other factors can influence the risk of MASD.

Prevention and Treatment Of MASD

1. Have consistent skin care program in place—one that involves cleansing and protecting the skin.
2. Avoid occlusion—use products that wick moisture away from the skin. 
3. Be proactive in preventing secondary infection.
4. Control or divert the source of moisture.
5. Be vigilant in examining skin: while redness and inflammation are often the first signs of MASD, in other cases erosion may be first visible sign of damage (the latter is especially true for critically ill patients who have liquid diarrhea).

Reference:
 
¹ Lyder CH, et al.  Structured skin care regimen to prevent perineal dermatitis in the elderly. J ET Nurs. 1992;19:12-16

MASD: Show Me the Evidence

WOCN Annual Conference Breakfast Symposium
Monday, June 6, 2011

Speakers:      Mikel Gray, PhD, CUNP, CCCN, FAANP, FAAN
                         Joyce M. Black, PhD, RN, CPSN, CWCN, FAPWCA, FAAN

Click here to watch the video.

MASD Overview: The Skin is In

MASD: Education Videos

WOCN Annual Conference: In-Booth Presentations
June 2011

MASD: Incontinence-Associated Dermatitis
Catherine Ratliff, PhD, APRN-BC, CWOCN

MASD: Intertriginous Dermatitis
Joyce M. Black, PhD, RN, CPSN, CWCN, FAPWCA, FAAN

MASD: Peristomal Moisture-Associated Dermatitis
Janet Stoia-Davis, RN, CWOCN

MASD: Periwound Moisture-Associated Dermatitis
Deb Netsch, DNP, APRN, CNP, CWOCN

JWOCN Publications

Journal of Wound Ostomy & Continence Nursing

MASD Overview:
Gray M, Black JM, Baharestani MM, et al. Moisture-Associated Skin Damage: overview and pathology. J Wound Ostomy Continence Nurs. 2011; 38(3):233-241

Incontinence-Associated Dermatitis & Intertriginous Dermatitis¹:
Black JM,  Gray M, Bliss DZ, et al. MASD Part 2: Incontinence-Associated Dermatitis and Intertriginous Dermatitis. J Wound Ostomy Continence Nurs. 2011; 38(4):359-370

Peristomal Moisture-Associated Dermatitis & Periwound Moisture-Associated Dermatitis²:
Coldwell JC,  Ratliff CR, Goldberg M, et al. MASD Part 3: Peristomal Moisture-Associated Dermatitis and Periwound Moisture-Associated Dermatitis: a consensus. J Wound Ostomy Continence Nurs.

¹ Article available on the JWOCN website
² Publication in progress