Management of Moisture-Associated Skin Damage: A Scoping Review

Kevin Y Woo, Dimitri Beeckman, Debashish Chakravarthy, Kevin Y Woo, Dimitri Beeckman, Debashish Chakravarthy

Abstract

Background: Protecting the skin against moisture-associated damage is an important component of comprehensive skin and wound care. Based on a review of literature, the authors propose key interventions to protect and prevent damage in the skin folds, perineum, and areas surrounding a wound or stoma.

Objective: The aim of this scoping review is to identify and provide a narrative integration of the existing evidence related to the management and prevention of moisture-associated skin damage (MASD).

Methods: Study authors searched several databases for a broad spectrum of published and unpublished studies in English, published between 2000 and July 2015. Selected study information was collated in several different formats; ultimately, key findings were aggregated into a thematic description of the evidence to help generate a set of summative statements or recommendations.

Results: Based on inclusion criteria, 37 articles were considered appropriate for this review. Findings included functional definitions and prevalence rates of the 4 types of MASD, assessment scales for each, and 7 evidence-based strategies for the management of MASD.

Conclusions: Based on this scoping review of literature, the authors propose key interventions to protect and prevent MASD including the use of barrier ointments, liquid polymers, and cyanoacrylates to create a protective layer that simultaneously maintains hydration levels while blocking external moisture and irritants.

References

    1. Gray M, Black JM, Baharestani MM, et al. Moisture-associated skin damage: overview and pathophysiology. J Wound Ostomy Continence Nurse 2011;38(3):233-41.
    1. Woo KY, Coutts PM, Price P, Harding K, Sibbald RG. A randomized crossover investigation of pain at dressing change comparing 2 foam dressings. Adv Skin Wound Care 2009;22:304-10.
    1. Jones JE, Robinson J, Barr W, Carlisle C. Impact of exudate and odour from chronic venous leg ulceration. Nurs Stand 2008;22(45):53-4, 56, 58 passim.
    1. Bianchi J. Causes and strategies for moisture lesions. Nurs Times 2012;108(5):20-2.
    1. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol 2005;8:19-32.
    1. Baatenburg de Jong H, Admiraal H. Comparing cost per use of 3M Cavilon No Sting Barrier Film with zinc oxide oil in incontinent patients. J Wound Care 2004;13(9):398-400.
    1. Beeckman D, Verhaeghe S, Defloor T, Schoonhoven L, Vanderwee K. A 3-in-1 perineal care washcloth impregnated with dimethicone 3% versus water and pH neutral soap to prevent and treat incontinence-associated dermatitis: a randomized, controlled clinical trial. J Wound Ostomy Continence Nurs 2011;83(6):627-34.
    1. Beguin AM, Malaquin-Pavan E, Guihaire C, et al. Improving diaper design to address incontinence associated dermatitis. BMC Geriatr 2010;10:86.
    1. Brunner M, Droegemueller C, Rivers S, Deuser WE. Prevention of incontinence-related skin breakdown for acute and critical care patients: comparison of two products. Urol Nurs 2012;32(4):214-9.
    1. Clever K, Smith G, Bowser C, Monroe K. Evaluating the efficacy of a uniquely delivered skin protectant and its effect on the formation of sacral/buttock pressure ulcers. Ostomy Wound Manage 2002;48(12):60-7.
    1. Cooper P, Gray D. Comparison of two skin care regimes for incontinence. Br J Nurs 2001;10(6 Suppl):S6, S8, S10 passim.
    1. Cooper P, Gray D, Ressell F. Comparing Tena Wash Mousse with Clinisan Foam Cleanser: the results of a comparative study. Wounds UK 2008;4(3):12-21.
    1. Fader M, Clarke-O’Neill S, Cook D, et al. Management of night-time urinary incontinence in residential settings for older people: an investigation into the effects of different pad changing regimes on skin health. J Clin Nurs 2003;12(3):374-86.
    1. Kerr A, Arrowsmith M, Young S, Jaimes H. Evaluation of a skin barrier cream for managing IAD in elderly patients using high-frequency ultrasound. Br J Community Nurs 2014;19(12):585-91.
    1. Lewis-Byers K, Thayer D. An evaluation of two incontinence skin care protocols in a long-term care setting. Ostomy Wound Manage 2002;48(12):44-51.
    1. Palese A, Carniel G. The effects of a multi-intervention incontinence care program on clinical, economic, and environmental outcomes. J Wound Ostomy Continence Nurs 2011;38(2):177-83.
    1. Park KH. The effect of a silicone border foam dressing for prevention of pressure ulcers and incontinence-associated dermatitis in intensive care unit patients. J Wound Ostomy Continence Nurs 2014;41(5):424-9.
    1. Park KH, Kim KS. Effect of a structured skin care regimen on patients with fecal incontinence: a comparison cohort study. J Wound Ostomy Continence Nurs 2014;41(2):161-7.
    1. Sugama J, Sanada H, Shigeta Y, Nakagami G, Konya C. Efficacy of an improved absorbent pad on incontinence-associated dermatitis in older women: cluster randomized controlled trial. BMC Geriatr 2012;12:22.
    1. Zehrer CL, Newman DK, Grove GL, Lutz JB. Assessment of diaper-clogging potential of petrolatum moisture barriers. Ostomy Wound Manage 2005;51(12):54-8.
    1. Hosseinpour M, Fazeli A, Agabeigi M. Efficacy of Acacia senegal for stoma care in children with colostomy. Eur J Pediatr Surg 2012;22(3):234-7.
    1. Milne CT, Saucier D, Trevellini C, Smith J. Evaluation of a cyanoacrylate dressing to manage peristomal skin alterations under ostomy skin barrier wafers. J Wound Ostomy Continence Nurs 2011;38(6):676-9.
    1. Brown-Etris M, Punchello M, O’Connor T. Use of a transparent absorbent acrylic dressing on stage II and III pressure ulcers. J Wound Ostomy Continence Nurs 2006:S53-4.
    1. Cameron J, Hoffman D, Wilson J, Cherry G. Comparison of two peri-wound skin protectants in venous leg ulcers: a randomised controlled trial. J Wound Care 2005;14(5):233-6.
    1. Coutts P, Queen D, Sibbald RG. Peri-wound skin protection: a comparison of a new skin barrier vs. traditional therapies in wound management. Wound Care Canada. 2003;1(1):19 . Last accessed August 30, 2017.
    1. Cutting KF. Managing wound exudate using a super-absorbent polymer dressing: a 53-patient clinical evaluation. J Wound Care 2009;18(5):200, 202-5.
    1. Durante CM, Greco A, Sidoli O, Maino C, Gallarini A, Ciprandi G. Evaluation of the effectiveness of a polyhexanide and propyl betaine-based gel in the treatment of chronic wounds. Minerva Chir 2014;69(5):283-92.
    1. Faucher N, Safar H, Baret M, Philippe A, Farid R. Superabsorbent dressings for copiously exuding wounds. Br J Nurs 2012;21(12):S22, S24, S26-8.
    1. Hunter SM, Langemo D, Thompson P, et al. Observations of periwound skin protection in venous ulcers: a comparison of treatments. Adv Skin Wound Care 2013;26(2):62-6.
    1. Jørgensen B, Price P, Andersen KE, et al. The silver-releasing foam dressing, Contreet Foam, promotes faster healing of critically colonised venous leg ulcers: a randomised, controlled trial. Int Wound J 2005;2(1):64-73.
    1. Lázaro-Martínez JL, García-Morales EA, Aragón-Sánchez FJ, Año-Vidales P, Allas-Aguado S, García-Alvarez Y. [Reducing skin maceration in exudative diabetic foot ulcers]. Rev Enferm 2010;33(3):9-14.
    1. Maume S, van de Looverbosch D, Heyman H, Romanelli M, Ciangherotti A, Charpin S. A study to compare a new self-adherent soft silicone dressing with a self-adherent polymer dressing in stage II pressure ulcers. Ostomy Wound Manage 2003;49(9):44-51.
    1. Münter KC, Beele H, Russell L, et al. Effect of a sustained silver-releasing dressing on ulcers with delayed healing: the CONTOP study. J Wound Care 2006;15(5):199-206.
    1. Reyzelman AM, Vayser D, Tam SW, Dove C. Initial clinical assessment of a novel wound management system: a case series. Adv Skin Wound Care 2011;24(6):256-60.
    1. Schuren J, Becker A, Sibbald RG. A liquid film-forming acrylate for peri-wound protection: a systematic review and meta-analysis (3M Cavilon no-sting barrier film). Int Wound J 2005;2(3):230-8.
    1. Vanscheidt W, Sibbald RG, Eager CA. Comparing a foam composite to a hydrocellular foam dressing in the management of venous leg ulcers: a controlled clinical study. Ostomy Wound Manage 2004;50(11):42-55.
    1. Hoggarth A, Waring M, Alexander J, Greenwood A, Callaghan T. A controlled, three-part trial to investigate the barrier function and skin hydration properties of six skin protectants. Ostomy Wound Manage 2005;51(12):30-42.
    1. Shannon RJ, Chakravarthy D. Effect of a water-based no-sting, protective barrier formulation and a solvent-containing similar formulation on skin protection from medical adhesive trauma. Int Wound J 2009;6(1):82-8.
    1. Woo KY. Health economic benefits of cyanoacrylate skin protectants in the management of superficial skin lesions. Int Wound J 2014;11(4):431-7.
    1. Woo KY, Chakravarthy D. A laboratory comparison between two liquid skin barrier products. Int Wound J 2014;11(5):561-6.
    1. Young DL, Chakravarthy D. A controlled laboratory comparison of 4 topical skin creams moisturizing capability on human subjects. J Wound Ostomy Continence Nurs 2014;41(2):168-74.
    1. Gray M, Bliss DZ, Doughty DB, Ermer-Seltun J, Kennedy-Evans KL, Palmer MH. Incontinence-associated dermatitis: a consensus. J Wound Ostomy Continence Nurs 2007;34(1):45-54; quiz 55-6.
    1. Woo KY, Sears K, Almost J, Wilson R, Whitehead M, VanDenKerkhof EG. Exploration of pressure ulcer and related skin problems across the spectrum of health care settings in Ontario using administrative data. Int Wound J 2017;14(1):24-30.
    1. Beeckman D, van Lancker A, van Hecke A, Vergaeghe S. A systematic review and meta-analysis of incontinence-associated dermatitis, incontinence, and moisture as risk factors for pressure ulcer development. Res Nurs Health 2014;37(3):204-18.
    1. Black JM, Gray M, Bliss DZ, et al. MASD part 2: incontinence-associated dermatitis and intertriginous dermatitis: a consensus. J Wound Ostomy Continence Nurs 2011;38(4):359-70; quiz 371-2.
    1. Sibbald RG, Kelley J, Kennedy-Evans KL, Labrecque C, Waters N. A practical approach to the prevention and management of intertrigo, or moisture-associated skin damage, due to perspiration: expert consensus on best practice. Wound Care Canada 2013;11(2):1-21.
    1. Kalra MG, Higgins KE, Kinney BS. Intertrigo and secondary skin infections. Am Fam Physician 2014;89(7):569-73.
    1. Mistiaen P, van Halm-Walters M. Prevention and treatment of intertrigo in large skin folds of adults: a systematic review. BMC Nurs 2010;9:12.
    1. Nagase H, Visse R, Murphy G. Structure and function of matrix metalloproteinases and TIMPs. Cardiovasc Res 2006;69(3):562-73.
    1. Ravanti L, Kahari VM. Matrix metalloproteinases in wound repair [review]. Int J Mol Med 2000;6(4):391-407.
    1. Price PE, Fagervik-Morton H, Mudge EJ, et al. Dressing-related pain in patients with chronic wounds: an international patient perspective. Int Wound J 2008;5(2):159-71.
    1. Colwell 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 2011;38(5):541-53; quiz 554-5.
    1. Ratliff CR. Early peristomal skin complications reported by WOC nurses. J Wound Ostomy Continence Nurs 2010;37(5):505-10.
    1. Stephen-Haynes J. The importance of peristomal skin care in the community setting. J Community Nurs 2013;27(4):73-4, 76-7.
    1. Rudoni C. Peristomal skin irritation and the use of a silicone-based barrier film. Br J Nurs 2011;20(16):S12, S14, S16 passim.
    1. Raitliff C, Scarano K, Donovan A, Colwell J. Descriptive study of peristomal complications. J Wound Ostomy Continence Nurs 2005;32(1):33-7.
    1. McMullen CK, Wasserman J, Altschuler A, et al. Untreated peristomal skin complications among long-term colorectal cancer survivors with ostomies: lessons from a study of family caregiving. Clin J Oncol Nurs 2011;15(6):644-50.
    1. Rahnemai-Azar AA, Rahnemaiazar AA, Naghshizadian R, Kurtz A, Farkas DT. Percutaneous endoscopic gastrostomy: indications, technique, complications and management. World J Gastroenterol 2014;20(24):7739-51.
    1. Kwiatt M, Tarbox A, Seamon MJ, et al. Thoracostomy tubes: a comprehensive review of complications and related topics. Int J Crit Illn Inj Sci 2014;4(2):143-55.
    1. Huffman B, Emam H, Stevens M. Tracheostomy with emphasis on perioperative nursing care. J Nurs Educ Pract 2014;4:13.
    1. Zulkowski K. Diagnosing and treating moisture-associated skin damage. Adv Skin Wound Care 2012;25(5):231-6; quiz 237-8.
    1. Borchert K, Bliss DZ, Savik K, Radosevich DM. The incontinence-associated dermatitis and its severity instrument: development and validation. J Wound Ostomy Continence Nurs 2010;37(5):527-35.
    1. Beeckman D, van den Bussche K, Alves P, et al. The Ghent Global IAD Categorisation Tool (GLOBIAD). 2017. . Last accessed September 18, 2017.
    1. Page AC. Two new tools for your ostomy practice. Ostomy Wound Manage 2009;55(12):10.
    1. Konya C, Sanada H, Sugama J, et al. Skin debris and micro-organisms on the periwound skin of pressure ulcers and the influence of periwound cleansing on microbial flora. Ostomy Wound Manage 2005;51(1):50-9.
    1. Woo KY, Sibbald RG. The ABCs of skin care for wound care clinicians: dermatitis and eczema. Adv Skin Wound Care 2009;22(5):230-6; quiz 237-8.
    1. Okan D, Woo K, Ayello EA, Sibbald G. The role of moisture balance in wound healing. Adv Skin Wound Care 2007;20(1):39-53; quiz 53-5.
    1. Gray M, Weir D. Prevention and treatment of moisture-associated skin damage (maceration) in the periwound skin. J Wound Ostomy Continence Nurs 2007;34(2):153-7.
    1. Voegeli D. Moisture-associated skin damage: aetiology, prevention and treatment. Br J Nurs 2012;21(9):517-8, 520-1.
    1. Fonder MA, Lazarus GS, Cowan DA, Aronson-Cook B, Kohli AR, Mamelak AJ. Treating the chronic wound: a practical approach to the care of nonhealing wounds and wound care dressings. J Am Acad Dermatol 2008;58(2):185-206.
    1. Hollinworth H. Challenges in protecting peri-wound skin. Nurs Stand 2009;24(7):53-4, 56, 58 passim.
    1. Kline A. Allergic contact dermatitis of the foot after use of Mastisol® skin adhesive: a case report. Foot Ankle J 2008;1(2):2.
    1. Hanifin JM, Klas PA. The spectrum of cutaneous patch-test reactions in patients with atopic dermatitis. Clin Rev Allergy Immunol 1996;14(2):225-40.
    1. Meikle A, Vaghadia H, Henderson C. Allergic contact dermatitis at the epidural catheter site due to Mastisol® liquid skin adhesive. Can J Anaesth 2012;59(8):815-6.
    1. Widman TJ, Oostman H, Storrs FJ. Allergic contact dermatitis from medical adhesive bandages in patients who report having a reaction to medical bandages. Dermatitis 2008;19(1):32-37.
    1. Worsnop F, Affleck A, Varma S, English J. Allergic contact dermatitis from Mastisol mistaken for cellulitis. Contact Dermatitis 2007;56(6):357-358.
    1. Campbell K, Woodbury MG, Whittle H, Labate T, Hoskin A. A clinical evaluation of 3M no sting barrier film. Ostomy Wound Manage 2000;46(1):24-30.
    1. Neander KD, Hesse F. The protective effects of a new preparation on wound edges. J Wound Care 2003;12(10):369-71.
    1. Egawa M, Oguri M, Kuwahara T, Takahashi M. Effect of exposure of human skin to a dry environment. Skin Res Technol 2002;8(4):212-8.
    1. Imhof RE, de Jesus ME, Xiao P, Ciortea LI, Berg EP. Closed-chamber transepidermal water loss measurement: microclimate, calibration and performance. Int J Cosmet Sci 2009;31(2):97-118.

Source: PubMed

3
Abonneren