A systematic approach to the assessment of MASD helps with early recognition of whether a patient is at increased risk of complications. It also helps health care practitioners identify when prevention strategies should be put into place. (Ousey et al., 2012)

Loss of skin integrity can have a significant impact on the patient, including pain and discomfort, anxiety and distress, alongside a loss of dignity (AWTVNF, 2014). An assessment of the patient’s skin and hygiene should be a fundamental part of their care. By monitoring the skin, signs of skin damage can be noted, and the relevant steps can be taken.

A comprehensive skin assessment should be part of the holistic assessment, and this, along with the potential risk factors, must be taken into consideration when formulating and implementing a management plan (always refer to local policy and complete all relevant documentation). Include the patient, where able, in decisions about treatment and involve/educate the patient and/or carers on the use of products and devices.

Incontinence associated dermatitis (IAD)

  • Determine the cause of IAD e.g. urine and/or faeces.
  • Clean the skin promptly after each incontinence episode with a pH neutral skin cleanser. Avoid the use of soap as this can alter the skin’s pH, acid mantle with the potential to dehydrate and irritate the skin (AWTVNF, 2014).
  • Keep skin clean and dry, apply barrier products.
  • Treat any areas of cutaneous candidiasis (thrush) with appropriate antifungal.
  • Consider the use of appropriate products or devices to divert urine or stool.
  • Address and treat the cause of incontinence.
  • Reduce the exposure to irritants.

(Adapted from Dowsett, 2013; Zulkowski, 2017; BCPNSWC, 2019)

Intertriginous dermatitis (ITD)

  • Examine entire area of skin folds, including the base. Use assistance where appropriate to gently lift the fold without exacerbating the area.
  • Note the tissue type and the treatment aim when considering treatment options.
  • Clean vulnerable skin with a gentle cleanser with minimal rubbing. Avoid the use of soaps with an alkaline pH (Woo et al., 2017).
  • Ensure careful drying of the skin fold.
  • Protect affected area from further breakdown or maceration.
  • Avoid use of occlusive barriers such as petrolatum.
  • Avoid products containing chlorhexidine gluconate, alcohol or perfumes, as these can be absorbed by damaged skin (Dowsett, 2013).
  • Use a moisture wicking fabric in affected skin folds to reduce moisture and prevent skin-on-skin friction.
  • Encourage patients to wear light, loose clothing made from natural fibres and quick-drying material.

Adapted from (Dowsett, 2013; Zulkowski, 2017; Woo et al., 2017)

Periwound moisture associated skin damage

  • As part of the full assessment, the exudate, colour, consistency, odour, and amount should be documented and address the cause/source of the exudate.
  • Consider the levels of exudate when selecting a dressing and choose an appropriate dressing for the exudate level that will help reduce further maceration and damage.
  • Be aware of the potential of a wound infection.
  • If the wound is not healing and/or progressing, reassess both patient and wound to establish whether co-morbidities or changes with the patient are contributing to the delay in healing and address accordingly.
  • Protect the periwound area from further breakdown/maceration using a barrier product.
  • Consider increasing the frequency of dressing changes to manage the exudate level.
  • Regular wound assessments to monitor the progress.

(Adapted from Dowsett, 2013; BCPNSWC, 2019)

Peristomal moisture associated skin damage

  • Use water rather than cleansers to cleanse peristomal skin.
  • Avoid products (unless recommended by a specialist) or other irritants on the peristomal skin.
  • Ensure that the most suitable appliance/bag/system has been selected and that size and fit are correct.
  • Protect peristomal, surrounding skin area from further maceration and consider using barrier products (please refer to local policy) to prevent further breakdown.

Adapted from (Dowsett, 2013)