Moisture Associated Skin Damage

Intertriginous Dermatitis (ITD)
1. Risk Factors:
  1. Hyperhidrosis
  2. Obesity
  3. Pendulous breasts
  4. Deep skin folds
  5. Immobility
  6. Diabetes
2. Excessive Moisture: sweat and sebum
  1. Increased TEWL and higher pH
  2. Secondary fungal or bacterial infections
    1. Fungal
    2. Bacterial
      1. Hemolytic streptococcus
      2. Staphylococcus aureus
      3. Pseudomonas aeruginosa
      4. Cornyeobacterium
      5. Proteus mirabilis
3. Symptoms
  1. Burning
  2. Itching
  3. Redness
  4. Scaling
  5. Satellite rash if fungal
4. Interventions
  1. Keep skin clean and dry
  2. Dust with absorbant skin barrier powder
  3. Spearate skin surfaces with skin barrier, sealant, or soft cotton material
  4. Commercially available textiles to wick away moisture
Peristomal
1. Risk Factors:
  1. Urine
  2. Stool
  3. Chemical irritants
  4. mechanical injury: pouching system
  5. Excessive exposure to urine, stool or mucus from ostomy
    1. Can also be caused by irritation fro removal of pouch
2. Symptoms
  1. Erythema
  2. weepy
  3. shallow ulcerations
3. Interventions
  1. Determine cause of leakage
  2. routine skin cleanser and moisturizer
  3. skin sealant, skin barrier ointment, skin barrier paste or solid wafer to protect skin
  4. Adequately absorbative dressing
  5. Change dressing before saturated
Periwound
1. Risk Factors:
  1. Wound exudate
  2. chemical irritants
  3. mechanical injury
  4. Acute vs chronic
  5. infected vs not infected
2. Inflammation and erosion of the skin associated with exudate or bacteria from the wound
3. Exudate Assessment
  1. Sanguinous
    1. Maceration potential
  2. Serosanguious
    1. Maceration potential
  3. Serous
    1. Maceration Potential
  4. Seropurulent
    1. Increased MMPs, toxins
  5. Purulent
    1. Increased MMPs, toxins, can't absorb
4. Interventions
  1. Cleanser and moisturizer to keep skin clean and dry
  2. Skin sealant, skin barrier ointment, skin barrier paste, or solid wafer to protect skin
  3. Change dressings before saturated
  4. Use low air loss support surface for moisture control of large surface areas unable to be protected by dressings
Incontinence Associated Dermatitis (IAD)
1. Risk Factors:
  1. fecal incontinences
  2. Urinary incontinence
2. Inflammatory response to the injury of water-protein-lipid matrix of the skin
3. Signs
  1. Erythema
  2. Swelling
  3. Oozing
  4. Vesiculation
  5. Crusting, scaling
  6. Burning
  7. Itching
4. Intervention
  1. Treat etiology
  2. Identify at risk patients
  3. Absorptive padding and change when saturated
  4. Mild incontinence skin cleanser
  5. Moisturizer to skin
  6. Skin barrier
  7. Condom cath or external pouch
  8. Indwelling catheters
  9. Skin sealant
  10. Change undergarment often
Prevention and Treatment
1. Liquid acrylates
  1. Skin prep
2. Ointments
  1. Petroleum, xinc oxide, dimethicone
3. Windowed dressings
  1. Barrier products around wounds
4. External collection devices
  1. Ostomy pouches/wound managers
5. Reduce exudate and edema
  1. Compression, elevation
6. Super absorbent dressings
  1. Hydrofibers, calcium alginates, foams

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Moisture Associated Skin Damage

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