Moisture-associated Skin Damage Research Articles

Management of chronic peri-stomal dermatitis with hypergranulation: moisture associated skin damage (MASD) of a colostomy in a rural setting

Management of chronic peri-stomal dermatitis with hypergranulation: moisture associated skin damage (MASD) of a colostomy in a rural setting

Treatment of chronic peristomal moisture associated skin damage with a combination of hyaluronic acid and silver sulfadiazine

Treatment of chronic peristomal moisture associated skin damage with a combination of hyaluronic acid and silver sulfadiazine

Device-related pressure injury: the management of chronic peristomal dermatitis and moistureassociated skin damage (MASD) in a urostomy in a rural setting

Device-related pressure injury: the management of chronic peristomal dermatitis and moistureassociated skin damage (MASD) in a urostomy in a rural setting

Peristomal Moisture-Associated Skin Damage Treatment: Use of Cyanoacrylate Liquid Skin Protectant: A Case Series.

Despite recent advances in ostomy care, the incidence of stoma and peristomal skin complications including peristomal moisture-associated skin damage (MASD) remains as high as 80% of patients living with ostomies. We evaluated a cyanoacrylate liquid skin protectant (CLSP) for the treatment and healing of peristomal MASD in patients with an ileostomy, ileal conduit, or colostomy. Five patients (24-85 years old) with peristomal MASD related to an ileostomy (n = 2), ileal conduit (n = 2), or colostomy (n = 1) were evaluated in this case study. All were treated with a CLSP in an attempt to reduce peristomal MASD caused by effluent leakage, which resulted in painful denudation of the peristomal skin. All patients received 1 to 2 applications of the CLSP prior to replacement of the pouching system. Prior to CLSP application, patients underwent assessment focusing on the causes of ostomy pouching system undermining and leakage. Interventions to prevent recurrent undermining and leakage, usually focused on modifications of the pouching system, were completed when indicated. For these 5 patients, complete resolution of peristomal MASD was observed at 2 to 8 days following CLSP treatment. More severe peristomal MASD cases required 7 to 8 days for complete resolution while less severe peristomal MASD resolved within 2 to 3 days. Patients showed less frequent pouching system changes, healing of peristomal skin, and reduced peristomal MASD associated with the CLSP treatment and addressing underlying etiology. On a pain scale of 0 to 10, patients reported less pain with an average of more than 7 out of 10 prior to the CLSP treatment and less than 4 out of 10 after treatment.

Dependency-related skin lesions in the prone critical patient. Incidence study

ObjectiveTo determine the incidence of dependence-related skin lesions (DRSL) in patients in prone position (PP) and to identify the predisposing factors. MethodFollow-up study in two polyvalent intensive care units. Patients undergoing invasive mechanical ventilation and PP with no skin lesions on admission were included. We recorded the 3 types of DRSL: (pressure ulcers [PU], moisture-associated skin damage [MASD] and friction injuries [FI]), demographic variables, diagnosis, length of stay, PP episodes, postural changes, APACHE II (Acute Physiology and Chronic Health Disease Classification System), prealbumin level on admission, body mass index (BMI), diabetes, hypertension, smoking, peripheral vascular disease (PVD), vasoactive drugs, Braden scale and mortality. Bivariate analysis: chi-square test, t-test or Mann–Whitney U test. Multivariate analysis: logistic regression. ResultsForty nine patients were included and 170PP were performed.Forty-one DRSL appeared in 22 patients with a cumulative incidence of 44.9% (95%CI: 31.6–58.7). PU accounted for 63.4% (73.1% facial; 76.9% stage II), 12.2% were MASD (60% inguinal; 60% stage II) and 24.4% were FI (50% thoracic; 70% stage III).The median age of the lesion group (LG) was 66.5 [61.8−71.3] vs. 64 [43−71] years old in the non-lesion group (NLG), p=0.04. Eighty percent of the LG had PVD vs. 20% of the NLG, p=0.03. The median total hours on PP of the LG was 96.9 [56.1−149.4] vs. 38.2 [18.8−57] of the NIG, p<0.001. Multivariate analysis selected total PP hours (OR=1.03; 95%CI:1.01–1.05) and PVD (OR=8.9; 95%CI:1.3–58.9) as predisposing factors for developing DRSL. ConclusionsThere is a high incidence of skin lesions related to prone decubitus dependence, mostly pressure lesions, although of low severity.The accumulated hours in probe position and peripheral vascular disease favor their development.

Lesiones cutáneas relacionadas con la dependencia en el paciente crítico pronado. Estudio de incidencia

ObjectiveTo determine the incidence of dependence-related skin lesions (DRSL) in patients in prone position (PP) and to identify the predisposing factors. MethodFollow-up study in two polyvalent intensive care units. Patients undergoing invasive mechanical ventilation and PP with no skin lesions on admission were included. We recorded the 3 types of DRSL:(pressure ulcers (PU), moisture-associated skin damage (MASD) and friction injuries (FI)), demographic variables, diagnosis, length of stay, PP episodes, postural changes, APACHE II (Acute Physiology and Chronic Health Disease Classification System), prealbumin level on admission, body mass index (BMI), diabetes, hypertension, smoking, peripheral vascular disease (PVD), vasoactive drugs, Braden scale and mortality. Bivariate analysis: Chi-square test, t-test or Mann-Whitney U test. Multivariate analysis: logistic regression. ResultsForty nine patients were included and 170 PP were performed. Forty-one DRSL appeared in 22 patients with a cumulative incidence of 44.9% (95% CI: 31.6-58.7). PU accounted for 63.4% (73.1% facial; 76.9% stage II), 12.2% were MASD (60% inguinal; 60% stage II) and 24.4% were FI (50% thoracic; 70% stage III). The median age of the lesion group (LG) was 66.5 (61.8-71.3) vs 64 (43-71) years old in the non-lesion group (NLG), P=.04. Eighty percent of the LG had PVD vs 20% of the NLG, p=0.03. The median total hours on PP of the LG was 96.9 (56.1-149.4) vs 38.2 (18.8-57) of the NIG, P<.001. Multivariate analysis selected total PP hours (OR: 1.03; 95% CI: 1.01-1.05) and PVD (OR: 8.9; 95% CI: 1.3-58.9) as predisposing factors for developing DRSL. ConclusionsThere is a high incidence of skin lesions related to prone decubitus dependence, mostly pressure lesions, although of low severity. The accumulated hours in probe position and peripheral vascular disease favor their development.

(043) Genital Tucking Practices in Trans Individuals and Anogenital Implications

Abstract Introduction Genital tucking is a practice performed by some transgender women and gender nonconforming individuals to reduce or conceal the contour of the penis and testicles. A variety of genital tucking techniques exist that are used to achieve an individual’s desired appearance. The penis and scrotum may be moved into the perineal area or between the buttocks. Some individuals may additionally reposition the testicles upward into the inguinal canals. Typically, these techniques are reinforced through the use of compression underwear, a specialized supportive undergarment termed a gaff, or adhesive tape. Despite the important role genital tucking plays in gender expression and affirmation, little, if any, research currently exists on the prevalence of tucking practices, the techniques employed, and its effects on anogenital health. Dermatological injury due to genital tucking encompasses a broad range of complications and may be largely avoidable if correct anogenital care and tucking methods are implemented. Objectives The purpose of this study is to present key findings generated from a review of available literature on anogenital dermatological conditions and their association with genital tucking. Data are presented on genital tucking techniques, associated health risks with emphasis on dermatological considerations, as well as suggested physician preventative counseling. Methods PubMed was searched for publications corresponding to the areas of interest (moisture-associated skin damage, medical adhesive-related skin injury, anogenital care techniques). Research from primary publications, consensus statements, and literature reviews were included. Findings were synthesized and applied to the context of genital tucking practices. Results As certain tucking practices expose the anogenital skin to excessive moisture, friction, and adhesive products, dermatological complications are a significant concern. Individuals who tuck may experience medical adhesive-related skin injury which includes mechanical injury (e.g., skin tears, blistering), dermatitis (e.g., hypersensitivity reactions), and other injuries such as maceration and folliculitis. Moreover, genital tucking may predispose individuals to intertriginous dermatitis, an inflammatory skin condition that occurs due to friction and trapped moisture within skin folds. Predisposing risk factors to skin injury that may disproportionately affect transgender individuals who tuck include dehydration, exposure to estrogen hormone therapy, and immunodeficiency. Prevention of adverse outcomes related to tucking should include counseling and regular surveillance of the anogenital area. Patients should be counseled on the selection and use of absorbent, natural fabrics as well as the safest and most effective adhesive tapes. Applying barrier and drying agents before tucking and employing proper adhesive removal techniques should be recommended to further reduce risk of anogenital skin injury and infection. Conclusions This review was the first of our knowledge to discuss the practice of genital tucking, the associated dermatological risk factors, and the critical role physicians play in caring for and counseling patients on tucking practices. Genital tucking preventative counseling and routine examination of the affected area may improve anogenital health of individuals who engage in this practice. Disclosure No.

Exploring the learning needs of clinicians in Belgium and Sweden regarding prone positioning and skin damage prevention: A qualitative study

IntroductionDuring the coronavirus pandemic (COVID -19), the use of prone positioning in critically ill patients with acute respiratory distress syndrome (ARDS) increased substantially. As a result, clinicians had to (re)learn how to treat the patient in the prone position while preventing adverse events such as pressure ulcers, skin tears and moisture-associated skin damage. AimThe purpose of the study was to determine participants' learning needs related to patients in the prone position and the prevention of skin damage, such as pressure ulcers, and what they perceived as a positive or negative learning experience. DesignThis study used a qualitative methodological framework and employed an exploratory design. ParticipantsA purposive sample of clinicians (n = 20) with direct or indirect work experience with prone ventilated patients was recruited in Belgium and Sweden. MethodsIndividual semi-structured interviews were conducted in Belgium and Sweden between February and August 2022. Data were analysed thematically using an inductive approach. The COREQ guideline was utilised to comprehensively report on the study. FindingsTwo themes were identified: ‘Adapting to a crisis’ and ‘How to learn’, with the latter having two subthemes: ‘balancing theory and practice’ and ‘co-creating knowledge’. Unexpected circumstances necessitated a personal adaption, a change in learning methods and a pragmatic adaptation of protocols, equipment and working procedures. Participants recognised a multifaceted educational approach which would contribute to a positive learning experience regarding prone positioning and skin damage prevention. The importance of poising theoretical teaching with practical hands-on training was highlighted with an emphasis on interaction, discussion, and networking between peers. ConclusionsThe study findings highlight learning approaches which may help inform the development of befitting educational resources for clinicians. Prone therapy for ARDS patients is not limited to the pandemic. Therefore, educational efforts should continue to ensure patient safety in this important area.

Management of peri-stomal dermatitis (moisture-associated skin damage) of a post-acute ileostomy in a rural setting

Management of peri-stomal dermatitis (moisture-associated skin damage) of a post-acute ileostomy in a rural setting

Construction and validation of the perioral moisture-related skin damage (PMASD) risk prediction model in patients with colorectal cancer.

This study aims to analyse the risk factors of Peristomal Moisture-Associated Skin Damage (PMASD) in colorectal cancer patients, construct a prediction model, and verify its effect. A total of 375 patients who underwent rectal cancer stoma surgery at the Liaoning Cancer Hospital between January and December 2020 were selected according to the inclusion and exclusion criteria. The clinical data were retrospectively analysed for modelling and internal validation (modelling group). According to the same criteria, the clinical data of 242 patients from January and June 2021 were retrospectively analysed for external validation (validation group). Baseline patient data were recorded. Patients in the modelling group were divided into those with and without PMASD based on the occurrence of PMASD during hospitalisation. Logistic regression analysis was used to examine the factors of PMASD and the PMASD nomogram model of colorectal cancer. Internal model validation was performed with the Bootstrap method, using the ROC and H-L goodness of fit test to evaluate the differentiation and calibration of the model. Last, external validation of the model was performed. In the modelling group, 212 patients with colorectal cancer developed PMASD. According to the results of the logistic regression analysis, high fasting plasma glucose and fasting blood glucose (FPG), a history of radiotherapy, the height of the stoma opening (i.e., flat or lower than the skin surface), and skin folds around the stoma are risk factors for PMASD (OR > 1, P < 0.05). The stool shaping and colostomy are protective factors for PMASD in patients with colorectal cancer (OR < 1, P < 0.05). To establish the prediction of colorectal cancer, patient development of PMASD line, graph model, and internal verification was carried out using the Bootstrap method: H-L test P=0.846, area under curve, area under the ROC curve (0 > 0.75, 95% CI: 0.778-0, AUC=0.820). The external validation included the H-L test (P=0.137, AUC [0.862] > 0.75, 95% CI: 0.815-0.909), with the maximum value of the Youden index as the best cut-off value for the model. The ROC curve had a Youden index of 0.559, a sensitivity of 0.877, and a specificity of 0.657. The prompt model area showed good calibration and discrimination. The PMASD in patients with colorectal cancer is affected by defecation traits, the stoma opening height, stoma type, FPG, skin folds around the stoma, and previous radiotherapy history. The nomogram model can provide an effective means to reasonably predict the risk of PMASD in patients with colorectal cancer.

A sebkörnyéki szövődmények megelőzése és kezelése a krónikus nem gyógyuló lábszársebek kezelésében

Chronic non-healing lower extremity ulcers represent a significant burden for the patient and society. Periwound breakdown delays wound healing, worsens patients’ quality of life, and increases the costs of wound treatment. Damage to the periwound area may result from moisture-associated skin damage, medical-adhesive related skin injury, contact dermatitis, and infections. Essential elements of preventing periwound complications are identifying predisposing risk factors for periwound damage, regular assessment of the condition of the periwound area, proper wound treatment technique, and exudate control. Timely detection and rapid multidisciplinary treatment of complications are necessary

Application of structured nursing plan for patients with moisture-associated skin damage caused by ileostomy stoma chassis leakage

Application of structured nursing plan for patients with moisture-associated skin damage caused by ileostomy stoma chassis leakage

Moisture-associated skin damage: The basics

Learn how to identify, prevent, and manage MASD.

Moisture-associated skin damage: a framework to guide decision making.

Moisture-associated skin damage: a framework to guide decision making.

Impact of prolonged PPE use on Canadian health professionals.

To explore the impact that prolonged use of personal protective equipment (PPE) has on the skin integrity of Canadian health professionals. A descriptive, pan-Canadian, cross-sectional, online survey was carried out to explore the type and prevalence of PPE-related skin injury among Canadian health professionals. Convenience sampling was used to disseminate the online survey link to health professionals. There were responses from 757 health professionals. Masks worn included surgical masks (90%), a combination of surgical or N95/KN95 masks (7.7%) and an N95/KN95 mask alone (2.7%). Responses showed 84.6% of providers always wear a mask while at work with 38.5% wearing the same mask all shift; 90% of participants wore protective eye wear. Complications included soreness or pressure injuries behind the ears (70%), new or worsening acne (52%), a runny nose or sneezing (45%), itching (39%), and dry skin (37%). Hand issues included dry skin (53%), red skin (30%), itching (26%), broken skin (20%), rash (16%), and dermatitis (11%) - 51% of respondents did not moisturise their hands. Complications related to gown use included itching (6%), moisture-associated skin damage (5.5%), feeling claustrophobic (4.5%), and new or worsening acne (3%). Increased perspiration due to PPE was experienced in 87.5% of respondents. Some 43% of respondents noted their mental health became worse due to wearing PPE for prolonged periods. These findings should be used in the development of guidelines to prevent and manage PPE-related skin injuries among health professionals. Education for professionals should focus on skin protection, prevention of PPE-related skin complications and support for mental health issues.

Perianale Hauterkrankungen – Diagnostik und Therapie

In addition to bleeding or pain, itching, burning and weeping are the most frequently expressed complaints in proctological consultations. A large proportion of these patients present with skin changes in the peri/anal region. These changes can be an important symptom of diseases of the anus or the intestines, since the sensitive skin of the perianal region and the anoderm can be damaged by secretions. Furthermore, due to the special anatomical situation of an intertriginous space with moisture retention, patients with moisture-associated skin damage in the anal region often present with characteristic changes. Anal eczema, which can be classified into three different forms, is the most common dermatoproctological condition. In addition to the frequent anal eczema, other dermatological diseases such as psoriasis or lichen sclerosus also manifest in the perianal region. Physicians should be aware of these diseases as well as rarer dermatoses of the perianal skin and cutaneous infections in the perianal region.

Moisture-Associated Skin Damage: Expanding Practice Based on the Newest ICD-10-CM Codes for Irritant Contact Dermatitis Associated With Digestive Secretions and Fecal or Urinary Effluent From an Abdominal Stoma or Enterocutaneous Fistula.

Moisture-associated skin damage (MASD) occurs when skin is repeatedly exposed to various sources of bodily secretions or effluents, often leading to irritant contact dermatitis, characterized by inflammation with or without denudation of affected skin. In 2020, the Wound, Ostomy and Continence Nurses Society commissioned an initiative that led to the addition of multiple International Classification of Diseases, Tenth Revision, Clinical Modification codes (ICD-10-CM) for irritant contact dermatitis caused by various forms of MASD for use in the United States. In a recent issue of the Journal of Wound, Ostomy and Continence Nursing, a clinical practice alert identifying the various new codes was published that summarized each of the new codes and provided highlights of the descriptions for each of these codes. This is the second in a series of 2 follow-up articles providing a more detailed description of the MASD conditions to which the newest irritant contact dermatitis ICD-10-CM codes apply. Specifically, this article reviews the clinical manifestations and assessment, pathophysiology, epidemiology, prevention, and management of irritant contact dermatitis associated with digestive secretions from a stoma or fistula, and fecal or urinary effluent from an abdominal stoma or enterocutaneous fistula.

A new approach with a novel silicone adhesive stoma bag: a clinical study on peristomal skin and quality of life.

The care of peristomal skin is a major challenge for people living with a stoma, as well as stoma care nurses. Peristomal skin complications include medical adhesive-related skin injuries/skin stripping, moisture-associated skin damage and contact dermatitis. There is also a limited choice of hydrocolloid adhesive stoma bags. This article reports on the introduction of Genii™, a new stoma bag that sticks with a unique breathable silicone adhesive. The study investigated the experiences of 61 colostomates over a 6-week period, examining the effect on their peristomal skin and their quality of life, in terms of sleep, self-image, social confidence and exercise, and overall product performance. The majority of study participants reported a positive experience when using the stoma bag.

Getting Ready for Wound Certification: Promoting Skin Health and Preventing Injuries.

Getting Ready for Wound Certification: Promoting Skin Health and Preventing Injuries.

Moisture-Associated Skin Damage: Expanding and Updating Practice Based on the Newest ICD-10-CM Codes.

Moisture-associated skin damage (MASD) occurs when skin is repeatedly exposed to various sources of bodily secretions or effluents, often leading to irritant contact dermatitis with inflammation, with or without denudation of affected skin. In 2020, the Wound, Ostomy and Continence Nurses Society took an initiative that led to the addition of multiple International Classification for Diseases codes for irritant contract dermatitis caused by various forms of MASD for use in the United States (ICD-10-CM). In the last issue of the Journal of Wound, Ostomy and Continence Nursing, a clinical practice alert identifying the various new codes was published that summarized each of the new codes and provided highlights of the descriptions of each of the these codes. This is the first in a series of 2 articles providing a more detailed description of the newest irritant contact dermatitis codes linked to MASD. Specifically, this article reviews the clinical manifestations and assessment, pathophysiology, epidemiology, prevention, and management of irritant contact dermatitis due to saliva, respiratory secretions, and fecal or urinary incontinence.