Moisture-Associated Skin Damage

Abstract

Moisture-associated skin damage (MASD) occurs when skin is repeatedly exposed to various sources of bodily secretions or effl uents, often leading to irritant contact dermatitis, characterized by infl ammation 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 Classifi cation of Diseases, Tenth Revision, Clinical Modifi cation 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. Specifi cally, 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 fi stula, and fecal or urinary effl uent from an abdominal stoma or enterocutaneous fi stula.

Nursing Management of Abdominal Wound Dehiscence of an Infant With Severe Undernutrition and Peristomal Moisture-Associated Dermatitis After Ileostomy Closure

“…11 Patients with intestinal ostomies are susceptible to erosion and secondary infection of peristomal skin caused by the liquid fecal stoma effluent rich in digestive enzymes and intestinal bacteria. 4,12 Maintenance of peristomal skin health relies on a pouching system that ensures continuous contact between the skin barrier and the skin around the stoma. 7 In this case, Baby Q was not managed using a pouching system and was exposed to a large amount of exudate on the peristomal skin.…”

“…3 Peristomal moisture-associated skin damage (MASD), a form of irritant contact dermatitis that occurs when the peristomal skin is exposed to effluent from an intestinal ostomy or urostomy, is particularly prevalent. 4 It affects 34% of people with ileostomies. 5 One study revealed those living with an ileostomy were more likely to experience peristomal MASD than those with a colostomy.…”

Skin complications in patients with an intestinal stoma

“…• uszkodzenia skóry związane z wilgocią w okolicy stomii (peristomal moisture-associated skin damage -PMASD), • urazy skóry związane z przylepcem medycznym (peristomal medical adhesive-related skin injury -PMARSI) [12,15,16]. Zmiany z grupy PMASD powstają w wyniku podrażnienia przez utrzymującą się na skórze wokół stomii wilgoć.…”

“…1). W zależności od charakteru wydzieliny i czasu jej oddziaływania na skórę zmiana przybiera postać zaczerwienienia, nadżerek, częściowej utraty skóry z nieregularnymi granicami, utraty pełnej grubości skóry ze zwiększonym wysiękiem surowiczym i krwawieniem, którym towarzyszy uczucie swędzenia, pieczenia i bólu [12,15].…”

“…Należy pamiętać, że krem zmniejsza przyczepność worka. Jeśli stan się utrzymuje, należy skontaktować się z dermatologiem [15,20,21].…”