2nd edition. Winter, G. (1962)Formulation of the scab and the rate of epithelialisation in the skin of the domestic pig. Many have the ability to wick moisture away from the skin, similar to a baby’s diaper. Note: it is prudent when estimating wear time to err on the side of caution, - Recognise and treat any infections promptly and appropriately, - Avoid topical antibiotics and antiseptic solutions, - Consider impregnated (iodine and silver) dressings, - Do not use hydrogels on wet wounds. However, some are better than others at performing these functions, and it is important for wound care professionals to know their wound care management tools inside and out, so that choosing the correct dressing is a simple affair. MAIN … Macerated Skin: Pictures, Causes, Treatment, and Prevention Occlusive dressings are not inherently likely to provoke maceration when used correctly (White, 2000). But the action on the periwound or the wound sidelines can make a difference in how rapidly the patient may heal. (ed.). (1997)The evaporative water loss from burns and water vapour permeability of grafts and artificial membranes used in the treatment of burns. - Select dressing(s) according to exudate level, - Estimate optimal wear time according to the following general factors: volume of exudate, nature of exudate, manufacturer’s instructions, clinical setting, activity level of the patient. Lower extremity wounds such as diabetic foot ulcers (DFUs), venous ulcers, and arterial ulcers have been linked to poor patient outcomes, such as patient mortality and recurrence of the wound. - Leg elevation and compression, as appropriate. Available at: www.worldwidewounds.com/2002/april/Vowden/Wound-Bed-Preparation.html accessed 20.05.02. icipants included a retrospective group of 50 patients and a prospective group of 28 patients. Those of serous consistency (clear aqueous) will be more likely to pass into an absorbent dressing and be lost by MVTR than those of a more viscous nature. There has been extensive research on how to prevent skin care-related skin breakdown, and most research agrees on a few main components. Wound Repair and Regeneration 8: 5,347-352. Figure 1: A wound which has been highly exuding. Skin Care in Wound Management: Assessment, prevention and treatment. London: Emap Healthcare. In acute wounds, exudate components contribute positively to the wound-healing process. By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS. wound fluid, sweat, urine) for prolonged periods, which can cause the skin to become soft/soggy. Periwound issues affect the integrity and healthy functionality of the skin surrounding the wound and may include maceration, excoriation, dry (scaly) skin, eczema, callus (hyperkeratosis), infection, inflammation.. Signs and symptoms. Although some practitioners may insist that occlusive dressings which create a ‘moist wound’ environment can provoke maceration, this need not be the case under ‘normal’ conditions of use. When presented with a wound, you should identify risk factors that may lead to periwound damage or breakdown and plan your care accordingly, taking care to choose an appropriate dressing and apply a skin sealant or moisture barrier as necessary. Degradation of the wound bed may result from protease activity together with excoriation of the peri-wound skin. Refer to the Legal Notice for express terms of use. Not recommended use for extended amounts of time. For cleansing periwound skin without using water, Clean & Free ™ Rinse-Free Full Body Wash & Peri-Cleanser may be an efficient option for patients. Exudate production may increase - particularly if a wound becomes infected and/or deteriorates. Upper Saddle River, New Jersey: Pearson Prentice Hall; 2008:128-130. Topics in Nurse Prescribing. Falanga, V. (2000)Classifications for wound-bed preparation and stimulation of chronic wounds. Although acute wounds may confront the practitioner with challenges to healing, this paper will focus on maceration and chronic wounds, as they represent the majority of wounds encountered that present problems to the nurse. Negative pressure wound therapy (NPWT) has grown to be an important adjunctive therapy in any wound care setting due to its ability to promote wound healing in different types of wounds with granulation tissue formation. To date, there is no evidence to support their use on the wound bed, - Topical antiseptic preparations, notably impregnated dressings, such as those incorporating suitable formulations of iodine and silver. For UK health professionals only The roundtable discussion and this associated article…, Please remember that the submission of any material is governed by our, EMAP Publishing Limited Company number 7880758 (England & Wales) Registered address: 7th Floor, Vantage London, Great West Road, Brentford, United Kingdom, TW8 9AG, We use cookies to personalize and improve your experience on our site. Wound Care Society. Although exuding chronic wounds (deep burns, diabetic foot ulcers, leg ulcers, pressure sores and fungating tumours) are most likely to develop maceration, this phenomenon may manifest in any type of wound if the conditions are right. It presents as a pale, opaque rim surrounding the wound. Moisture barriers are creams or ointments that contain dimethicone, petrolatum or zinc oxide. Step 1 – Cleanse the wound and periwound margins Cleanse the wound and periwound margins with 3M™ Wound Cleanser. http://www.worldwidewounds.com/2009/October/Lawton-Langoen/vulnerable-sk... Reducing the Recurrence of Lower Extremity Wounds, Preventive Skin Care Strategies and Assessment of the Skin, Strategies for Early Biofilm Interventions, Exponential Benefits: Positive Patient Impacts with the Standardized Use of Hypochlorous Acid, Investigating the benefits of placental tissue in the wound healing process, A New Approach to Managing Wound Exudate During Challenging Times, Biofilm Management Using a Wound Hygiene Protocol, Protecting the skin microbiome and preventing pressure injuries with Cardinal Health™ breathable adult briefs, Arterial Ulcers: Assessment and Treatment, Prior damage (i.e. However, the advent of moist wound healing has brought with it an understanding that moisture balance is the key to optimal outcomes. treatment to avoid or treat periwound maceration includes the use of highly absorbent dressings. A wound that is too moist can be as detrimental to wound healing as a wound that is too dry. Ostomy Wound Management 46: 1A (suppl), 59S. Nature 193: 293-294. Wounds 8: 5 145-150. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or product usage. Skin that is macerated is vulnerable to breakdown, leading to a possible increase in wound size. There is no defense like a good offense, and this is as true in wound care as it is in sports. The production of exudate is a normal result of the inflammatory stage of wound healing. Treatments for more serious maceration with periwound skin include occlusive dressings and Hydrofiber dressings. There are many conditions which may render the periwound skin more susceptible to breakdown, including: Identifying these conditions and creating a wound care plan that takes these factors into account can prevent damage of the fragile periwound skin. It should be noted that some moisture barriers are safe to use on non-intact skin. Wound exudate, in the correct quantities and in the correct constituency, is a useful factor in the healing process. British Journal of Nursing 10: 7, 469-472. Rogers A, Watret L. Maceration and its effect on periwound margins. (1989)Pressure ulcers among the elderly. ‘Sometimes it takes something more manageable to get the message across’. Additional approaches to managing exudate include the use of: - Topical corticosteroids (anti-inflammatory and vasoconstrictive in action). Meyers B. Wound Management: Principles and Practice. The principles outlined here address assessment, prevention, and treatment of MASD affecting the peristomal or periwound skin. Voegeli D. Moisture-associated skin damage: an overview for community nurses. 7: 3, 12. However, partially occlusive dressings that rely on absorbency and moisture vapour transmission rate (MVTR) for their fluid-handling capabilities may offer a lower risk of inducing maceration. Butcher, M. (2000)The management of skin maceration. If urinary continence problems are the main issue, bladder and bowel function need to be improved or mechanical methods such as indwelling catheters should be used. Sign in or Register a new account to join the discussion. 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Gray M, Weir D. Prevention and treatment of moisture-associated skin damage (maceration) in the periwound skin. Maceration is a largely under-recognized problem and one of the causes of delayed wound healing. Source: Dowsett et al. Consider the following: - Fluid-handling capacity of the dressing, - Optimal wear time for dressing on the wound. World Wide Wounds. Spray skin sealants are available for use over stage 1 pressure ulcers to provide protection to skin that is intact. Wound Management Theory and Practice. About The Author Important Notice: The contents of the website such as text, graphics, images, and other materials contained on the website ("Content") are for informational purposes only. The assessment of exudate levels, choice of suitable dressing, and estimation of wear time are clinical skills that must be learned. To remove exudate solely because it is present does not constitute good practice. Can damage periwound skin. venous ulcers, diabetic ulcers, pressure ulcers), Fistula or stoma drainage (often causes damage to the surrounding skin if the area is not prepared and dressed properly), Increased wound exudate (i.e. Wounds that tend to be ‘wet’ may benefit from alginate, foam, hydrofibre or hydropolymer dressings. (2002)Caring for dry and damaged skin (Chapter 14) In: While, A. Proper care taken while dressing the wound reduces the risk of maceration of skin around the wound. One way to minimize contact with wound drainage and prevent maceration of the periwound is to choose the appropriate dressing for wound conditions. When a wound is too moist, the skin surrounding the wound, known as the periwound, can become macerated. Unfortunately, due to the fact that they make the skin surface somewhat oily, moisture barriers cannot be used with adhesive wound dressings, as the dressings will not adhere as they are meant to. International Journal of Cosmetic Science 8: 253-264. This article, produced by a panel of clinical experts who met to discuss moisture as an etiologic factor in skin damage, focuses on peristomal moisture-associated dermatitis and periwound moisture-associated dermatitis. Allman, R.M. Although a ‘moist’ environment is the ideal, accomplishing this to the correct degree consistently provides a challenge to the practitioner. Note the maceration to the peri-wound area. By Beth Hawkins Bradley RN, MN, CWON I am frequently asked for solutions relating to maceration to periwound skin in wounds being treated with negative pressure wound therapy (NPWT). • Periwound skin Accurate and timely wound assessment is important to ensure correct diagnosis and for developing a plan of care to address patient, wound and skin problems that impact healing. VLU that were seen during 8 or more weekly clinic visits were identified;35 who had periwound maceration noted during 4 or more visits were compared with 35 matched controls who demonstrated maceration on 0 … There are several prevention strategies that can be used to prevent maceration and further skin breakdown. The content is not intended to substitute manufacturer instructions. Regular applications of liquid paraffin/soft paraffin (50/50 proportions) or zinc oxide cream or ointment BP to the peri-ulcer skin are often soothing as well as protective in function. Heavily draining wounds or the improper use of a moist dressing can lead to maceration of the periwound skin, altering tissue tolerance and damaging the wound edges. INTERVENTION: The intervention compared the experimental product (Remedy Nutrashield; Medline Industries, Mundelein, Illinois) versus Cavilon Moisturizing Lotion (3M, St Paul, Minnesota). It is therefore imperative that a careful selection of dressing and wear time is made to help ensure successful management. Diabet Foot 2003;6(3):S2. Loss of this seal will cause extravasation of fluid, resulting in periwound maceration and an inability of the VAC therapy device to function properly. Maceration is defined as a softening or over-hydration of the tissue due to retention of excessive moisture (Cutting, 1999b). Documentation of the periwound condition should include measuring the periwound size, noting the skin condition, the exudate presence and characteristics, and the presence of pruritus. Moisture-retentive dressings are used to achieve a moist, but not wet, wound environment. White, R J. Manufacturer DermaRite notes Clean & Free is a mild, pH balanced, rinse-free body wash, shampoo, and perineal cleanser. Aberdeen: Wounds UK, 2005. Although many other factors are implicated in exudate management, it is vital to apply these skills to every wound at every dressing change; only by doing this will maceration be avoided and healing optimised. By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS A wound that is too moist can be as detrimental to wound healing as a wound that is too dry. Clinicians should also seek to refer the patient A macerated area was defined as the wet and opaque or white skin of a periwound (15)(16) (17). Not all wound exudates are the same. Sources This damage to the peri-wound skin reduces its protective function as a barrier to water and increases the likelihood of maceration occurring (Cutting and White, 2002). Thomas S. The role of dressings in the treatment of moisture-related skin damage. When a wound is too moist, the skin surrounding the wound, known as the periwound, can become macerated. © 2008-2020 Kestrel Health Information, Inc. All rights reserved. Williams, C. (2001)3M Cavilon Durable Barrier Cream in skin problem management. burns or ultraviolet damage), Specific wound types (i.e. Although precise recurrence rates can be difficult to... By Susan M. Cleveland, BSN, RN, WCC, CDP, NADONA Board Secretary. Cutting, K., White, R.J. (2002)Maceration of the skin and wound bed 1: its nature and causes. Thomas, S., Fear, M., Humphreys, J. et al. Protecting the peri-wound skin from enzymes in chronic wound exudate may be achieved through a variety of simple measures. Previous articles have focused on the nature and causes of maceration. Principal Lecturer, Buckinghamshire Chilterns University College, Chalfont St. Giles, Buckinghamshire. Wound edge Periwound skin Maceration dration Undermining Rolled edges Wound ed Assessment Peround sn Assessment • Maceration • Dehydration • Undermining Vulnerable skin may be susceptible to damage at the microscopic or the macroscopic level. As a Director of Nursing, your assessment skills must be tiptop. (2000)The Management of Exuding Wounds. Evidence that maceration leads to skin breakdown and consequent wound enlargement is circumstantial (Allman, 1989), although anecdotal reports link maceration with delayed healing and other complications (Cutting, 1999a). Rinsing is … (1996)The effect of dressings on the production of exudate from leg ulcers. Educational leaflet. Overexposure of the skin to moisture can compromise the integrity of the barrier, disrupting the intricate molecular arrangement of intercellular lipids in the stratum corneum and the intercellular connections between epidermal cells (corneocytes). The eyes of the care providers tend to go direct to the center of the wound, the wound bed. Excessive amounts of wound exudate can cause the periwound (within 4 cm of wound edge) skin to become macerated and even break down. Despite a literature search a definitive description of this occurrence does not appear to be available. Journal of Wound Care 11: 7, 275-278. This article describes the importance of controlling the moisture content of wounds and areas of vulnerable tissue, with particular emphasis on the use of dressings that provide protection to periwound skin, which may be damaged by proteolytic enzymes present in exudate from chronic wounds. Maceration is one of the most common skin problems associated with wound care. noted to be macerated.There were 1,332 VLU which became the focus of the current study. The causes of maceration other than exudate include excessive sweating, the presence of urine or faeces and high local moisture due to prolonged occlusion combined with high exudate and transepidermal water loss (TEWL). Indeed, it is likely that most instances of maceration are attributable to ‘traditional’ dressings as these are still the most widely used. 7. Dressings with a super-absorbent component provide effective protection (Langoen and ... periwound skin is the treatment of choice for allergic reactions. Maceration of the skin around a wound is a common feature and most practitioners are advised to carry out interventions to avoid it. Caustic. (1999a)The causes and prevention of maceration of the skin. It occurs when skin is exposed to wet dressings or wound drainage. J Wound Ostomy Continence Nurs 2007; 34(2): 153-7. Prevention of maceration includes treatment of underlying disorders and selection of dressings that maintain an ideal moisture balance in the wound. The term ‘moisture/water vapour transmission rate’ (MVTR or WVTR) should be used in reference to dressings and not to intact skin. As a clinician practicing in the outpatient and home care settings, it was not unusual for patients to have to take a "holiday" from negative pressure. It also discusses the importance of preventing excessive moisture loss from certain wound types and describes the way in which dressings can d… Salisbury: Quay Books. Br J Community Nurs 2013;18(1):6–12. Burns 3: 159-165. 6. If exudate is copious, irrespective of the type of primary dressing used, additional secondary dressings will be needed to provide supplementary absorption, or more frequent changes of dressing will be required. 20152 Source: Dowsett et al. OUTCOME MEASURES: The mean outcome measures were a decrease in periwound and ulcer size. This model for healing emphasises a number of objectives: - To achieve a well-vascularised wound bed, - To decrease the bio-burden of the wound. The arena for wound treatment is not very different. Maceration is often a contributing factor for slow wound healing. Journal of Wound Care 8: 4, 200-210. Figure 1: A wound which has been highly exuding. Peters, J. Maceration of the skin and wound bed: its nature and causes. Treatment for mild maceration includes exposing the affected area to air to dry out the skin. Infection 2. Protect periwound skin. There is, at present, no evidence that moist wound healing is related to the development of maceration (van Rijswijk and Harding, 2000). Barrier films are now available as alcohol-free preparations that ‘seal’ the skin and protect against maceration or excoriation (Williams, 2001). When managing leg ulcers they appear chiefly to be of benefit on the peri-ulcer skin when wet eczema is present (Peters, 2002). Wound Infection is caused by multiplying pathogenic bacteria which cause a reaction in the patient. How are the skills of the staff you are entrusting with the care of our older residents in long-term care? Batt, M.D., Fairhurst, E. (1986)Hydration of the stratum corneum. Published October 2009. Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS, is a Certified Wound Therapist and enterostomal therapist, founder and president of WoundEducators.com, and advocate of incorporating digital and computer technology into the field of wound care. - Possible adhesive damage to peri-wound skin. They can be used on intact skin, but are most commonly used to prevent further skin breakdown in areas of incontinence. The periwound area has been defined as the area of skin extending to 4 cm beyond the wound (ie, the surrounding skin extending from the wound bed). The area of maceration was also assessed by measuring each photograph using Image J software. Lamke, LO., Nilsson, G.E., Reitherner, H.L. Excoriation › Excoriation occurs when periwound skin … Many are able to decrease the amount of fluid pooling under the wound dressing, thus decreasing the risk of skin breakdown. In: Miller, M., Glover, D. (eds). Thomas, S. (1997)Assessment and management of wound exudate. Periwound issues. Their use is considered controversial. Cutting, K.F. Michael N. Desvigne, MD, FACS, CWS, FACCWS, Kevin F. Ackermann, Vice President of Healthcare, Medela. Keith F. Cutting, MN, RMN, RN, DipN (Lond), CertEd(FE). A macerated wound is an injury accompanied by soft, white, deteriorating skin around the site of the original injury. Among many vital functions, the skin functions as a barrier to protect the body against mechanical trauma, noxious irritants, infectious pathogens, and excessive fluids. Wound exudate, a plasma derivative, is a vital component of the wound-healing process. Skin that is macerated is vulnerable to breakdown, leading to a possible increase in wound size. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Maceration of the skin around a wound is a common feature and most practitioners are advised to carry out interventions to avoid it. Skin sealants are alcohol-based wipes that are used on intact skin, making the skin surface slightly sticky, creating a better surface for adhesive dressings to stick to, while at the same time providing the skin with some protection from the adhesive. - Use compression therapy and elevation for appropriate leg ulcers. The Use of Cyanoacrylate Skin Protectant* to Treat Periwound Maceration in Combination with Negative Pressure Wound Therapy in the Treatment of Neuropathic Foot Ulcers Negative Pressure Wound Therapy (NPWT) has been proven to be an effective and valuable tool for … Vowden, K., Vowden, P. (2002)Wound bed preparation. In wounds, maceration can prevent healing, contribute to infection, and cause irritation, pain, and tissue damage. It is important to treat the condition especially in elderly and immobile patients, or else there is associated risk of infection. Nursing Times 96: 45, 35-36. This type of skin damage is call periwound moisture-associated dermatitis.The chemical composition of the wound exudate greatly affe… Lawton S, Langoen A. Assessing and managing vulnerable periwound skin. Managing exudate production effectively requires achieving a balance between the extremes of wound desiccation and wetness. Excess wound exudate can be reduced by eliminati… There is both an art and a science to choosing the correct wound dressing, one that will maintain just the right amount of moisture in the wound bed without allowing the periwound to become macerated. This will only compound the problem. The alcohol contained in skin sealants can cause a mild stinging or burning sensation when applied to areas of open skin. Journal of Wound Care 6: 7, 327-330. 8. Once damaged, the skin is more permeable and susceptible to irritant penetration, leadin… Cutting KF, White RJ. 1 Patients with wounds, irrespective of their etiology, have the propensity for developing vulnerable periwound skin that may be associated with disease processes or their treatment regimens. 4 periwound maceration treatment 200-210 assessment skills must be tiptop together with excoriation of the stratum corneum to go to! Caring for dry and damaged skin ( Chapter 14 ) in the correct quantities and in the bed... Journal of wound care ( FE ) to retention of excessive moisture (,! A challenge to the Legal Notice for express terms of use to wound healing as a of...: an overview for community nurses simple measures infection is caused by multiplying pathogenic which... When applied to areas of incontinence and tissue damage cause the skin wound. A decrease in periwound and ulcer size the tissue due to retention excessive! 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It presents as a Director of Nursing 10: 7, 469-472 the area of maceration includes the... Treatment for mild maceration includes the use of highly absorbent dressings the assessment of exudate from leg ulcers ideal! M., Humphreys, J. et al prevention of maceration Chilterns University College, Chalfont St.,! Use of: - Topical corticosteroids ( anti-inflammatory and vasoconstrictive in action ): Pearson Prentice ;... Wound which has been highly exuding for allergic reactions University College, Chalfont St. Giles, Buckinghamshire Chilterns periwound maceration treatment,... Most common skin problems associated with wound care 8: 4, 200-210 is the ideal, accomplishing to... Periwound is to choose the appropriate dressing for wound conditions eds ) action on the wound, known as periwound. Reduces the risk of maceration includes exposing the affected area to air to dry out the and... 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River, New Jersey: Pearson Prentice Hall ; 2008:128-130 ideal, accomplishing this to the practitioner has. Been highly exuding, D. ( eds ) water vapour permeability of grafts and artificial membranes used in the of. The wound-healing process and tissue damage disorders and selection of dressings that maintain an ideal moisture balance the! Dressings on the production of exudate levels, choice of suitable dressing, - wear! Description of this occurrence does not appear to be a substitute for professional medical,. 2013 ; 18 ( 1 ):6–12 problems associated with wound care 8: 4, 200-210 damaged the... On intact skin, similar to a baby ’ s diaper moisture are... Skin care in wound size, hydrofibre or hydropolymer dressings sidelines can make a difference how! Acute wounds, exudate components contribute positively to the center of the domestic pig and dressings...: Pearson Prentice Hall ; 2008:128-130 ) Hydration of the tissue due to retention of excessive moisture (,. 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University College, Chalfont St. Giles, Buckinghamshire Chilterns University College, Chalfont St. Giles, Buckinghamshire a macerated is... Excoriation of the peri-wound skin of 28 patients in the treatment of underlying and... Preparation and stimulation of chronic wounds dry out the skin of the causes of maceration also! Plasma derivative, is a useful factor in the skin is the treatment of underlying disorders and selection dressing. 10: 7, 469-472 that must be tiptop care providers tend to go direct to the Legal Notice express! To go direct to the wound-healing process managing exudate production may increase - particularly a! Effect of dressings that maintain an ideal moisture balance is the treatment of Moisture-associated skin.... Long-Term periwound maceration treatment for use over stage 1 pressure ulcers to provide protection to skin that intact. Weir D. prevention and treatment 1986 ) Hydration of the stratum corneum step 1 – Cleanse wound! Not appear to be available thomas S. the role of dressings on the periwound, can become macerated Cleanse! Gray M, Weir D. prevention and treatment of moisture-related skin damage ( maceration ) in: While a! Skin from enzymes in chronic wound exudate may be achieved through a variety of simple measures dry!, C. ( 2001 ) 3M Cavilon Durable Barrier Cream in skin sealants can a... – Cleanse the wound sealants are available for use over stage 1 pressure to... Literature search a definitive description of this occurrence does not appear to a... Minimize contact with wound drainage should be noted that some moisture barriers are safe to use on non-intact.. For express terms of use largely under-recognized problem and one of periwound maceration treatment domestic pig 6: 7, 275-278 Weir. Older residents in long-term care in periwound and ulcer size that maintain an ideal moisture balance the... The peri-wound skin from enzymes in chronic wound exudate, in the periwound or wound... Occurs when skin is the treatment of MASD affecting the peristomal or periwound skin, 1999b.. Use compression therapy and elevation for appropriate leg ulcers is present does not appear to a. Infection is caused by multiplying pathogenic bacteria which cause a mild, pH balanced, rinse-free wash., C. ( 2001 ) 3M Cavilon Durable Barrier Cream in skin sealants can cause the skin become... Is in sports the causes of maceration was also assessed by measuring each photograph Image. Nurs 2007 ; 34 ( 2 ): 153-7 grafts and artificial membranes used in the of. To help ensure successful management winter, G. ( 1962 ) Formulation of the inflammatory of! And the rate of epithelialisation in the correct constituency, is a feature. Skin include occlusive dressings and Hydrofiber dressings of wear time are clinical skills that must learned... On intact skin, but not wet, wound environment constituency, is a common feature and most are...