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What Is Skin Maceration?

Medically Reviewed by Dan Brennan, MD on April 25, 2021

Have you ever come out of a pool or bath and noticed your fingertips were whitish and shriveled-looking? That’s a mild version of skin maceration. 

Skin maceration happens when the skin is exposed to moisture for a prolonged period of time, and it can have a serious impact on your health. 

What Causes Skin Maceration?

Showering and keeping ourselves clean using water is part of everyday life. But what if your skin was subjected to moisture 24 hours a day, seven days a week? Excessive exposure to moisture can cause maceration, a serious problem for your skin. 

Skin maceration happens when your skin is broken down by moisture on a cellular level. Once this damage occurs, your skin is much more vulnerable to other types of problems and complications. 

Moisture-associated skin damage (MASD) is an umbrella term for four types of skin problems caused by prolonged exposure to moisture: 

  • Incontinence-associated dermatitis (IAD)
  • Intertriginous dermatitis (ITD)
  • Periwound skin damage
  • Peristomal MASD‌

MASD often happens to people who sweat excessively or come into contact with urine or feces for a long time due to incontinence. It can also happen to people who have larger wounds that expel fluid, or exudate, when the wound isn’t kept clean and dry. 

Symptoms of Skin Maceration

Cases of skin maceration are becoming more common in the world of healthcare, mainly due to an increase in the aging population. People who suffer from moisture-related skin damage can experience the following symptoms: 

  • Pain
  • Tenderness in the area
  • A burning sensation
  • Extremely itchy skin, also known as pruritus

People who suffer from skin maceration are also prone to developing other complications around the area. Bacterial or fungal infections can develop in macerated skin because these microbes flourish in a dark, damp environment. ‌

Painful pressure ulcers, also known as bedsores, can happen on macerated skin. Dermatitis is a painful, irritating skin condition that can also be caused or promoted by macerated skin. 

Other factors that can cause or worsen MASD are: 

  • Incontinence
  • Poor hygiene
  • Excessive stress on the skin, such as friction or pressure
  • The presence of yeast or fungus
  • Humidity 
  • Chemical or biological skin irritants 

Skin Maceration and Incontinence

Urinary and fecal incontinence can be a sensitive topic. It’s not known exactly how many people suffer from it because it can be difficult or embarrassing to talk about. 

From what we do know, urinary incontinence can affect about 19% of women aged 45 and younger and 29% of women aged 80 and up. It’s not as well-studied in men, but we know it affects 5-15% of men who live in retirement communities. 

Incontinence is strongly associated with skin maceration. Because incontinence can cause an environment full of moisture, the skin can become macerated if it’s left for an extended period of time. 

When the skin is macerated, its protective barriers are broken down. This leaves the door open for bacterial and other infections to take hold. 

Urine and feces are not only irritants for the skin, but feces especially can contain bacteria that worsen cases of skin maceration. Incontinence-related maceration can develop in as little as four days. 

It usually shows up in the skin folds, inner thighs, and buttock areas. 

Treatment for Skin Maceration

Since skin maceration comes from constant moisture, keeping skin clean and dry can help speed up the recovery process. 

When dealing with skin maceration, the first step is to clean the skin thoroughly to remove bacteria. In incontinence-related cases, consider using a no-rinse, pH-balanced cleanser.

Next, an ointment should be applied to the skin to act as a protective barrier. Keep skin clean and dry, and if maceration is incontinence-related, change soiled clothes immediately.  

Other ways you can help skin maceration heal is by reducing friction and pressure. That might mean repositioning yourself or your loved one every 1-2 hours to relieve pressure on the area. You might consider supportive cushioning to help relieve tender areas.

Proper changing of bandages isn’t the only way to promote healing. Getting proper nutrition, especially protein, will give your body the nutrients it needs to start repairing itself. Drinking the recommended amount of water will also help speed healing. 

‌You’ll need proper circulation of the blood to heal fully. Avoid smoking tobacco. Smoking hinders your blood circulation and makes the healing process slower. 

If you think you have skin maceration, speak to your doctor as soon as possible. If left alone, it can fester and get worse. 

WebMD Medical Reference

Sources

SOURCES: 

Advances in Skin & Wound Care: “Diagnosing and Treating Moisture-Associated Skin Damage,”

‌“Management of Moisture-Associated Skin Damage: A Scoping Review.”

‌University of Virginia: “Wound Care: The Basic.”

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