PRESSURE INJURY VS MOISTURE ASSOCIATED SKIN DAMAGE

There is often confusion between a pressure ulcer/injury and a moisture lesion due to the presence of moisture, which may be as a result of incontinence of urine and/or faeces (EPAUP, 2014).

Moisture lesions are often reported as Category/Stage 2 pressure damage
It is important to identify the cause of any skin damage, as the treatment and management of pressure damage and moisture associated skin damage may differ (Yates, 2012).

Clinicians must be clear that if moisture lesions are not treated correctly, they can worsen, and the patient may develop secondary pressure damage and ulceration.

The following table provides an overview of the causes, likely location and clinical presentation of moisture lesions.

	Pressure Ulcer	Moisture Lesion
Causes	Pressure and/or shear must be present.	Moisture must be present (e.g. wet skin caused by incontinence, urine or diarrhoea.
Location	A wound not over a bony prominence or under a medical device is unlikely to be a pressure ulcer.	Moisture lesions may occur over a bony prominence. Pressure and shear should be excluded as causes, and moisture should be present. A lesion that is limited to the anal cleft and has a linear shape is likely to be a moisture lesion. Peri-anal redness/skin irritation is most likely to be a moisture lesion due to faeces.
Shape	If the lesion is limited to a single spot, it is likely to be a pressure ulcer. Circular wounds or wounds with a regular shape.	Diffuse, different superficial spots are more likely to be moisture lesions.
Depth	Partial-thickness skin loss up to full-thickness skin loss.	Moisture lesions are superficial, partial-thickness skin loss. However, in some cases moisture lesions may become infected, the depth and extent of the lesions can become large.
Necrosis	Necrosis can be present.	No necrosis present in a moisture lesion.
Edges	If the wound has distinct edges, it is likely to be a pressure ulcer.	Moisture lesions often have diffuse or irregular edges.
Colour	Red skin – if redness non-blanchable, it is most likely a pressure ulcer. Red in wound – red tissue in wound bed indicates granulation, likely to be stage 2, 3 or 4 pressure ulcer. Black in wound indicates necrotic tissue and indicates a pressure ulcer.	Red skin - if the redness is not uniformly distributed, the lesion is likely to be a moisture lesion. Pink or white surrounding the skin, is maceration due to moisture.

Adapted from (Beldon, 2008; Fletcher, 2008)

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