Why Does Moisture Irritate My Skin and What Can I Do About It?
By Diane Mirlocca RN WOCN, IIWCC
Did you know that moisture can cause your skin to breakdown? Moisture can be caused by drainage from a wound or a stoma, from urine or fecal incontinence or by too much perspiration in the folds of your skin. This damage has a name: moisture-associated skin damage (MASD). MASD is defined as inflammation or skin erosion caused by prolonged exposure to moisture. The four types of MASD are specifically named based on the area of skin breakdown: peri-wound (caused by wound drainage); peristomal (drainage from your stoma), intertriginous (where two skin areas may touch or rub together) and incontinence (from urine or feces). Let’s take a more detailed look at each of these.
- Peri-wound Moisture-associated Skin Damage
All wounds have some drainage. Inflammation, a normal part of the healing process is the cause; however, some wounds have more drainage (also called exudate) due to infection or edema (swelling). Another reason for excessive drainage may be due to using a dressing that is not absorbing enough of the drainage causing the excessive drainage to sit on healthy skin causing it to breakdown.
The skin around the wound (peri-wound) may become reddened, may have an irregular edge or may become soft and boggy (called maceration). What is maceration? Think about sitting in a bathtub for a long relaxing soak and when you get out, your skin is puffy, white and rubs off easily. Around the wound this maceration may cause your skin to erode away.
How do you prevent this from happening? Manage the amount of drainage coming from the wound and protect the skin around it.
- Protect your skin by using a skin barrier that will keep the drainage from becoming an irritant. This can be achieved by using a commercially produced skin protectant such as Cavilon Durable Barrier Cream, Coloplast Skin Prep,or Hollister Skin Protectant.
- Check your wound regularly for signs of infection: redness, heat, swelling, increased drainage, or a change in your pain. If these signs are present consult a wound care specialist or your family doctor as soon as possible.
- Choosing the right dressing for what the wound needs. Your wound dressing needs to absorb the drainage rather than having it sit on your skin. There are many different dressings and a wound specialist will help you select the best one for you.
If the peri-wound skin breaks down the above suggestions will help prevent further breakdown and potentially reverse what has happened.
- Peristomal Moisture Associated Dermatitis
Excess moisture around your stoma can result in similar skin breakdown. Moisture could be from sweat, external moisture leaking under edge (extended swimming, showering) or leakage for stoma due to improper fit. The skin around a stoma may become reddened, warm, and macerated. Ostomy products are designed to help prevent moisture buildup.
How do you prevent this from happening and what do you do if it occurs?
- Make sure your ostomy appliance fits properly.
- Change your appliance as soon as possible if there is a leak
- Check the skin around your stoma with each appliance change.
- Wash and dry peristomal skin well.
- Apply stoma powder directly on the skin before placing your appliance to help absorb excess moisture.
- Choose a skin barrier (Flange) appropriate for your output.
- Skin protectants are helpful; make sure to check manufacturers’ recommendations before using them.
If your peristomal skin breaks down, treat it as you would a wound using the best dressing to promote healing. Consult a nurse specializing in ostomy and wound care.
- Intertriginous Dermatitis
Intertriginous Dermatitis (Intertrigo) is a rash that occurs in skin folds where there is excessive moisture. The most common areas where this may occur are beneath the breasts, in the armpits, between your toes, in the groin area, around your genitals and in the belly folds. Moisture in these areas isn’t able to evaporate resulting in the skin becoming reddened, raw, itchy, weepy, cracked, and/or crusted. A foul odour can be present. Because these areas are moist and dark it is common for a yeast/fungal infection to occur. You may see this on small children around the neck area caused by drooling or leakage when feeding.
How do you prevent this from happening and how to manage it?
- Keeping the areas at risk clean and dry: use pH balanced soap and pat area dry
- Wear 'wicking' material (e.g. bamboo, polypropylene, polyester, gore-tex, x-static) if possible, to reduce moisture build up
- Inspect your skin folds regularly
- Use skin protectant to prevent moisture buildup
- If you suspect any area is infected see your doctor for treatment
- Incontinence-Associated Dermatitis
Incontinence-Associated Dermatitis is defined as a chemical irritation from urine or stool coming in contact with the skin. Read more about this condition in our blog. One of the most effective ways in reducing risk of skin breakdown is to use the right fitted incontinent product.
Our skin is our body’s first line of defense and while our skin needs moisture to stay healthy, too much moisture can cause significant injury. Remember, prevention is always the best medicine. However, if your skin does breakdown early treatment will prevent further breakdown and potentially reverse what has happened.