MOIST OINTMENT IMEME SKIN

After exudate has been managed, the skin should be allowed to progress to healing. Liquid, ointment, or cream-based skin protectants offer a range of protection for the periwound skin from maceration. This can mean anything from absorptive or windowed dressings to external collection devices or negative pressure wound therapy in extreme cases. The first step in treatment of periwound moisture-associated dermatitis is managing the excessive exudate. Apply a barrier film or skin protectant to the periwound skin when appropriate.Manage wound exudate with dressings chosen for proper absorbency.Monitor the wound area routinely for changes in skin condition.

The following precautions can help minimize the risk of developing periwound moisture-associated dermatitis in at-risk patients and to minimize complications in patients already exhibiting symptoms: Wound infection will also greatly increase the risk of periwound maceration, as it increases the exudate production. The following wounds are more prone to developing periwound moisture-associated dermatitis:

Damage may be focused on the dependent area of the wound in extremities, due to pooling of wound exudate.įigure 1: Example of periwound maceration Risk Factors The individual may report experiencing pain, burning or itching as a result of the skin damage.

Wounds with more viscous exudate are more prone to periwound maceration, as the moisture is less likely to be lost by evaporating through the dressing. Periwound moisture-associated dermatitis is marked by erythema (which may be harder to discern in persons with darkly pigmented skin), maceration (white, pale, or gray skin that is softened and/or wrinkled), and irregular or diffuse edges (as opposed to pressure ulcers which typically have distinct edges). Another factor affecting the occurrence of periwound maceration is damage to skin by aggressive removal of adhesive wound dressings, which affect the integrity of the skin barrier by stripping away parts of the epidermis. Specifically, exudate from chronic wounds has been found to contain a higher concentration of proteolytic enzymes as compared to exudate from acute wounds. The presence of bacteria, specific proteins, or proteolytic enzymes, as well as the volume of wound exudate greatly reduce the barrier function of the skin and can lead to maceration. The chemical composition of the wound exudate greatly affects the potential damage that can be wrought. This type of skin damage is call periwound moisture-associated dermatitis. Excessive amounts of wound exudate can cause the periwound (within 4 cm of wound edge) skin to become macerated and even break down. However, the advent of moist wound healing has brought with it an understanding that moisture balance is the key to optimal outcomes. The production of exudate is a normal result of the inflammatory stage of wound healing. Periwound Moisture-Associated Dermatitis Etiology The four specific types of moisture-associated skin damage that will be discussed here are periwound moisture-associated dermatitis, peristomal moisture-associated dermatitis, incontinence-associated dermatitis, and intertriginous dermatitis. When exposed to excessive amounts of moisture, the skin will soften, swell, and become wrinkled, all of which make the skin more susceptible to damage from one of the complicating factors mentioned above. The moisture barrier of the skin plays a critical role in maintaining homeostasis within the body, mainly by concurrently slowing the movement of water out of the body ( transepidermal water loss, or TEWL) and regulating the absorption of water and solutes from outside the body. Possibilities include mechanical factors (friction), chemical factors (irritants contained in the moisture source), or microbial factors (microorganisms). It is proposed that for MASD to occur, another complicating factor is required in addition to mere moisture exposure. Moisture-associated skin damage (MASD) is the general term for inflammation or skin erosion caused by prolonged exposure to a source of moisture such as urine, stool, sweat, wound drainage, saliva, or mucus.

Moist ointment imeme