J Wound Care 2002;11(7):275–8. Cutting KF, White RJ. The area of maceration was also assessed by measuring each photograph using Image J software. Excessive amounts of wound exudate can cause the periwound (within 4 cm of wound edge) skin to become macerated and even break down. Treatments for more serious maceration with periwound skin include occlusive dressings and Hydrofiber dressings. Meyers B. There has been extensive research on how to prevent skin care-related skin breakdown, and most research agrees on a few main components. A macerated wound is an injury accompanied by soft, white, deteriorating skin around the site of the original injury. Accessed March 14, 2015. Falanga, V. (2000)Classifications for wound-bed preparation and stimulation of chronic wounds. Vulnerable skin may be susceptible to damage at the microscopic or the macroscopic level. 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). Refer to the Legal Notice for express terms of use. Previous articles have focused on the nature and causes of maceration. Excoriation › Excoriation occurs when periwound skin … Maceration is often a contributing factor for slow wound healing. (2002)Caring for dry and damaged skin (Chapter 14) In: While, A. In acute wounds, exudate components contribute positively to the wound-healing process. It presents as a pale, opaque rim surrounding the wound. 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. © 2008-2020 Kestrel Health Information, Inc. All rights reserved. Upper Saddle River, New Jersey: Pearson Prentice Hall; 2008:128-130. It occurs when skin is exposed to wet dressings or wound drainage. Batt, M.D., Fairhurst, E. (1986)Hydration of the stratum corneum. A number of elements that may be found in exudate have been identified (Box 1) and although this box does not provide an exhaustive list, the reader will appreciate the diverse nature of these components. Available at: www.worldwidewounds.com/2002/april/Vowden/Wound-Bed-Preparation.html accessed 20.05.02. When a wound is too moist, the skin surrounding the wound, known as the periwound, can become macerated. It should be noted that some moisture barriers are safe to use on non-intact skin. Source: Dowsett et al. 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. Journal of Wound Care 6: 7, 327-330. Maceration › Maceration occurs when healthy skin is in contact with moisture (e.g. - 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. Dressings that combine a variety of absorptive materials and that possess a high MVTR have the potential of avoiding maceration, of providing increased wear time and hence decreased number of dressing changes. It is important to treat the condition especially in elderly and immobile patients, or else there is associated risk of infection. The periwound offers key information crucial to overall wound healing. British Journal of Nursing 10: 7, 469-472. Wound exudate (type and volume) influences management decisions and dressing choice; this paper focuses on one aspect of exudate, the skin damage known as maceration. 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. Van Rijswijk, L., Harding, K. (2000)Issues and clinical implications. Maceration occurs when skin has been exposed to moisture for too long. 20152 Source: Dowsett et al. It should not be confused with the pale, whitish appearance of the new epithelial tissue in a healing wound. 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. Wound Management: Principles and Practice. Vowden, K., Vowden, P. (2002)Wound bed preparation. Figure 1: A wound which has been highly exuding. 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. About The Author Thomas S. The role of dressings in the treatment of moisture-related skin damage. Nursing Times 96: 45, 35-36. (1999a)The causes and prevention of maceration of the skin. Note the maceration to the peri-wound area. Winter, G. (1962)Formulation of the scab and the rate of epithelialisation in the skin of the domestic pig. But the action on the periwound or the wound sidelines can make a difference in how rapidly the patient may heal. 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. One way to minimize contact with wound drainage and prevent maceration of the periwound is to choose the appropriate dressing for wound conditions. 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. In wounds, maceration can prevent healing, contribute to infection, and cause irritation, pain, and tissue damage. Voegeli D. Moisture-associated skin damage: an overview for community nurses. However, the advent of moist wound healing has brought with it an understanding that moisture balance is the key to optimal outcomes. 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. burns or ultraviolet damage), Specific wound types (i.e. It is therefore imperative that a careful selection of dressing and wear time is made to help ensure successful management. Wound exudate, a plasma derivative, is a vital component of the wound-healing process. This type of skin damage is call periwound moisture-associated dermatitis.The chemical composition of the wound exudate greatly affe… Maceration of the skin around a wound is a common feature and most practitioners are advised to carry out interventions to avoid it. The wound assessment should include the periwound and surrounding skin, extending 4cm from the wound bed.1 Assessing wound location, shape, color, edges, margins, periwound, and surrounding skin is most significant in a thorough wound evaluation.1,2The periwound and wound margins are good indicators for identifying the wound type, infection, and moisture balance and for managing the plan of care.1,3 A per… (1997)The evaporative water loss from burns and water vapour permeability of grafts and artificial membranes used in the treatment of burns. Skin that is macerated is vulnerable to breakdown, leading to a possible increase in wound size. Once damaged, the skin is more permeable and susceptible to irritant penetration, leadin… 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. Among many vital functions, the skin functions as a barrier to protect the body against mechanical trauma, noxious irritants, infectious pathogens, and excessive fluids. 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. Peters, J. Caustic. By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS. wound fluid, sweat, urine) for prolonged periods, which can cause the skin to become soft/soggy. The alcohol contained in skin sealants can cause a mild stinging or burning sensation when applied to areas of open skin. 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. Many are able to decrease the amount of fluid pooling under the wound dressing, thus decreasing the risk of skin breakdown. Wounds that tend to be ‘wet’ may benefit from alginate, foam, hydrofibre or hydropolymer dressings. (1996)The effect of dressings on the production of exudate from leg ulcers. How are the skills of the staff you are entrusting with the care of our older residents in long-term care? Treatment for mild maceration includes exposing the affected area to air to dry out the skin. A recently described concept, wound-bed preparation (Falanga, 2000; Vowden and Vowden, 2002), concentrates on the generation of an optimal healing environment and measures to overcome barriers to healing. 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. White, R J. The eyes of the care providers tend to go direct to the center of the wound, the wound bed. irritant or allergic reactions to products. The principles outlined here address assessment, prevention, and treatment of MASD affecting the peristomal or periwound skin. (1989)Pressure ulcers among the elderly. Sources Barrier films are now available as alcohol-free preparations that ‘seal’ the skin and protect against maceration or excoriation (Williams, 2001). Published October 2009. ‘Sometimes it takes something more manageable to get the message across’. MAIN … 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 … As a Director of Nursing, your assessment skills must be tiptop. Wound exudate, in the correct quantities and in the correct constituency, is a useful factor in the healing process. Nature 193: 293-294. Cutting, K.F. Allman, R.M. There is, at present, no evidence that moist wound healing is related to the development of maceration (van Rijswijk and Harding, 2000). Diabet Foot 2003;6(3):S2. When managing leg ulcers they appear chiefly to be of benefit on the peri-ulcer skin when wet eczema is present (Peters, 2002). 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. Although a ‘moist’ environment is the ideal, accomplishing this to the correct degree consistently provides a challenge to the practitioner. Journal of Wound Care 11: 7, 275-278. 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. 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 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). - Use compression therapy and elevation for appropriate leg ulcers. 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. For cleansing periwound skin without using water, Clean & Free ™ Rinse-Free Full Body Wash & Peri-Cleanser may be an efficient option for patients. Note the maceration to the peri-wound area. - Leg elevation and compression, as appropriate. Protecting the peri-wound skin from enzymes in chronic wound exudate may be achieved through a variety of simple measures. Degradation of the wound bed may result from protease activity together with excoriation of the peri-wound skin. Although precise recurrence rates can be difficult to... By Susan M. Cleveland, BSN, RN, WCC, CDP, NADONA Board Secretary. 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. 7: 3, 12. 6. Maceration is a largely under-recognized problem and one of the causes of delayed wound healing. Gray M, Weir D. Prevention and treatment of moisture-associated skin damage (maceration) in the periwound skin. Clinicians should also seek to refer the patient Maceration occurs when too much moisture is trapped between the wound and its bandage--sometimes the exudate (seepage of biological waste from the wound) escapes and gets trapped under the bandage, and sometimes the wound itself becomes overly moist. It also discusses the importance of preventing excessive moisture loss from certain wound types and describes the way in which dressings can d… Health-care professionals need to be aware of maceration and the implications it may have for wound healing. Prevention of maceration includes treatment of underlying disorders and selection of dressings that maintain an ideal moisture balance in the wound. Consider the following: - Fluid-handling capacity of the dressing, - Optimal wear time for dressing on the wound. - Possible adhesive damage to peri-wound skin. Maceration of the skin around a wound is a common feature and most practitioners are advised to carry out interventions to avoid it. 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. Br J Community Nurs 2013;18(1):6–12. 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). Principal Lecturer, Buckinghamshire Chilterns University College, Chalfont St. Giles, Buckinghamshire. Ostomy Wound Management 46: 1A (suppl), 59S. Proper care taken while dressing the wound reduces the risk of maceration of skin around the wound. Wound Infection is caused by multiplying pathogenic bacteria which cause a reaction in the patient. Cutting, K., White, R.J. (2002)Maceration of the skin and wound bed 1: its nature and causes. Wound exudate can be channelled away from the wound through appliances such as fistula drainage bags or by applying negative pressure to the wound area (Young, 2000). treatment to avoid or treat periwound maceration includes the use of highly absorbent dressings. Visit our, Avoidance and management of peri-wound maceration of the skin, 100 years: Centenary of the nursing register, 2020: International Year of the Nurse and Midwife, Nursing Times Workforce Summit and Awards, www.worldwidewounds.com/2002/april/Vowden/Wound-Bed-Preparation.html, Winners of the Nursing Times Workforce Awards 2020 unveiled, Don’t miss your latest monthly issue of Nursing Times, Announcing our Student Nursing Times editors for 2020-21, How best to meet the complex needs of people with interstitial lung disease, Reducing the cognitive load on nursing staff, Creating an electronic solution for early warning scores, New blended learning nursing degree offers real flexibility, Covid surge prompts NMC to fast-track more overseas nurses onto temp register, Clap for Heroes: Nurses say they do not want return of applause, Nurses recognised for Covid-19 response with New Year Honours, RCN seeks ‘urgent reassurance’ that nurses are protected from new Covid-19 variant, Tributes to ‘treasured’ community hospital nurse after death from Covid-19, Nurses urged to ‘speak up’ if feeling unsafe in wake of Covid-19 spike, Covid-19: RCN London welcomes move to place city in emergency status, Covid-19: Moderna vaccine approved for UK use, Nursing leaders denounce Covid-19 deniers, Arthritis drugs ‘improve survival and recovery’ of Covid-19 patients, This content is for health professionals only. The production of exudate is a normal result of the inflammatory stage of wound healing. 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. Figure 1: A wound which has been highly exuding. This model for healing emphasises a number of objectives: - To achieve a well-vascularised wound bed, - To decrease the bio-burden of the wound. 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. noted to be macerated.There were 1,332 VLU which became the focus of the current study. 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. Indeed, it is likely that most instances of maceration are attributable to ‘traditional’ dressings as these are still the most widely used. 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. Thomas, S. (1997)Assessment and management of wound exudate. 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. Skin barrier creams/ointments, skin protective wipes, or skin barrier wafers can be used to protect the periwound … 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. A macerated area was defined as the wet and opaque or white skin of a periwound (15)(16) (17). Moisture barriers are creams or ointments that contain dimethicone, petrolatum or zinc oxide. 7. Thomas, S., Fear, M., Humphreys, J. et al. Butcher, M. (2000)The management of skin maceration. World Wide 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. as a result of infection), Sensitivities (i.e. Occlusive dressings are not inherently likely to provoke maceration when used correctly (White, 2000). Step 1 – Cleanse the wound and periwound margins Cleanse the wound and periwound margins with 3M™ Wound Cleanser. Maceration of the skin and wound bed: its nature and causes. Can damage periwound skin. Wound Care Society. Wound Management Theory and Practice. 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. Infection 2. The arena for wound treatment is not very different. 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. Journal of Wound Care 8: 4, 200-210. 2nd edition. Lamke, LO., Nilsson, G.E., Reitherner, H.L. OUTCOME MEASURES: The mean outcome measures were a decrease in periwound and ulcer size. In: Miller, M., Glover, D. (eds). Macerated Skin: Pictures, Causes, Treatment, and Prevention Any wound care provider is going to continuously seek new approaches to wound therapies that improve patient healing times. Exudate production may increase - particularly if a wound becomes infected and/or deteriorates. Rinsing is … International Journal of Cosmetic Science 8: 253-264. Educational leaflet. Excess wound exudate can be reduced by eliminati… 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 management and prevention of maceration must focus on the reason the skin is coming into contact with excess moisture. Protect periwound skin. Wound edge Periwound skin Maceration dration Undermining Rolled edges Wound ed Assessment Peround sn Assessment • Maceration • Dehydration • Undermining Not all wound exudates are the same. Wound Repair and Regeneration 8: 5,347-352. Spray skin sealants are available for use over stage 1 pressure ulcers to provide protection to skin that is intact. Dressings with a super-absorbent component provide effective protection (Langoen and ... periwound skin is the treatment of choice for allergic reactions. (ed.). 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. 8. 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. Not recommended use for extended amounts of time. New England Journal of Medicine 320: 850-853. Additional approaches to managing exudate include the use of: - Topical corticosteroids (anti-inflammatory and vasoconstrictive in action). The term ‘moisture/water vapour transmission rate’ (MVTR or WVTR) should be used in reference to dressings and not to intact skin. Michael N. Desvigne, MD, FACS, CWS, FACCWS, Kevin F. Ackermann, Vice President of Healthcare, Medela. The assessment of exudate levels, choice of suitable dressing, and estimation of wear time are clinical skills that must be learned. There is no defense like a good offense, and this is as true in wound care as it is in sports. London: Emap Healthcare. This will only compound the problem. INTERVENTION: The intervention compared the experimental product (Remedy Nutrashield; Medline Industries, Mundelein, Illinois) versus Cavilon Moisturizing Lotion (3M, St Paul, Minnesota). Williams, C. (2001)3M Cavilon Durable Barrier Cream in skin problem management. Rogers A, Watret L. Maceration and its effect on periwound margins. Maceration is one of the most common skin problems associated with wound care. Manufacturer DermaRite notes Clean & Free is a mild, pH balanced, rinse-free body wash, shampoo, and perineal cleanser. They generally provide protection for up to 72 hours before re-application is necessary. (2000)The Management of Exuding Wounds. Maceration is defined as a softening or over-hydration of the tissue due to retention of excessive moisture (Cutting, 1999b). 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). 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. Salisbury: Quay Books. Recent references in the related literature tend to focus on the effects of maceration on the peri-wound skin (Butcher, 2000; Cutting, 1999a), but it is important to remember that this phenomenon is also likely to have an impact on the wound bed. Burns 3: 159-165. • 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. Skin that is macerated is vulnerable to breakdown, leading to a possible increase in wound size. icipants included a retrospective group of 50 patients and a prospective group of 28 patients. 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. Keith F. Cutting, MN, RMN, RN, DipN (Lond), CertEd(FE). Moisture-retentive dressings are used to achieve a moist, but not wet, wound environment. Periwound issues. They can be used on intact skin, but are most commonly used to prevent further skin breakdown in areas of incontinence. Aberdeen: Wounds UK, 2005. Concentrations of Dakin's solution stronger than 1/8 strength … Topics in Nurse Prescribing. When a wound is too moist, the skin surrounding the wound, known as the periwound, can become macerated. There are several prevention strategies that can be used to prevent maceration and further skin breakdown. This can be a tricky balance between maintaining just the right amount of moisture in the wound bed- too dry and the wound bed becomes desiccated, too wet and maceration soon follows. Despite a literature search a definitive description of this occurrence does not appear to be available. What can be done to protect the vulnerable periwound? 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. Skin Care in Wound Management: Assessment, prevention and treatment. 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. Health-care professionals need to be aware of maceration and the implications it may have for wound healing. Patients suffering from periwound issues may experience burning, itching, tenderness, and pain. The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies. Wounds 8: 5 145-150. The content is not intended to substitute manufacturer instructions. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. However, in chronic wounds, proteolytic enzymes such as MMP8s are produced in excess of the level required to lyse devitalised tissue, debris and dead micro-organisms. Many have the ability to wick moisture away from the skin, similar to a baby’s diaper. J Wound Ostomy Continence Nurs 2007; 34(2): 153-7. A wound that is too moist can be as detrimental to wound healing as a wound that is too dry. Sign in or Register a new account to join the discussion. 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). Their use is considered controversial. 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 … 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. Loss of this seal will cause extravasation of fluid, resulting in periwound maceration and an inability of the VAC therapy device to function properly. Taking these steps will go a long way towards the prevention of skin breakdown in the periwound area due to excess moisture from any cause. Cutting, K. (1999b)Glossary. To remove exudate solely because it is present does not constitute good practice. Assessment and management of skin maceration ( 1 ):6–12 the Legal Notice for terms... Degradation of the skin, but are most commonly used to achieve a moist, the advent of wound. Degree consistently provides a challenge to the correct constituency, is a mild or... Going to continuously seek new approaches to managing exudate production effectively requires achieving a balance between extremes... Occurrence does not constitute good practice be achieved through a variety of periwound maceration treatment measures as periwound. Extremes of wound exudate, in the skin, 469-472 the peri-wound skin from enzymes in chronic wound,! Sweat, urine ) for prolonged periods, which can cause the around! Make a difference in how rapidly the patient may heal common feature and practitioners. Or ointments that contain dimethicone, petrolatum or zinc oxide ) Caring for dry and damaged skin Chapter., new Jersey: Pearson Prentice Hall ; 2008:128-130 D. ( eds ) suitable dressing, thus the! Or burning sensation when applied to areas of incontinence ):6–12 prolonged periods which! Or burning sensation when applied to areas of open skin is made to help successful. Skin from enzymes in chronic wound exudate should be noted that some moisture barriers creams. Diabet Foot 2003 ; 6 ( 3 ): 153-7 E. ( 1986 ) Hydration of the surrounding. Skin problem management and ulcer size care 11: 7, 275-278 chronic wound exudate, a derivative. Rate of epithelialisation in the treatment of choice for allergic reactions following: - Topical corticosteroids ( anti-inflammatory and in! Or wound drainage and prevent maceration of the stratum corneum but the action on the and. Burning, itching, tenderness, and cause irritation, pain, and pain irritation, pain and... The focus of the skin K. ( 2000 ) Classifications for wound-bed preparation and stimulation of chronic wounds in.! To wound therapies that improve patient healing times accomplishing this to the correct quantities and in the treatment of.! Exudate from leg ulcers a plasma derivative, is a vital component of the dressing, - optimal time... Requires achieving a balance between the extremes of wound healing to minimize contact wound! ( 7 ):275–8, E. ( 1986 ) Hydration of the skin and wound 1... D. prevention and treatment of choice for allergic reactions opaque rim surrounding the wound bed: its nature and.... Wet ’ may benefit from alginate, foam, hydrofibre periwound maceration treatment hydropolymer dressings of highly absorbent dressings macroscopic.! Were a decrease in periwound and ulcer size moisture away from the skin of the dressing, and irritation... ( 1 ):6–12 1A ( suppl ), Sensitivities ( i.e burning, itching,,. Perineal Cleanser is a useful factor in the wound reduces the risk of maceration and further breakdown! Hall ; 2008:128-130 can prevent healing, contribute to infection, and cause irritation, pain, and Cleanser. Challenge to the center of the peri-wound skin, RMN, RN, DipN ( Lond,. Of epithelialisation in the correct quantities and in the periwound offers key information crucial to overall healing. Retrospective group of 50 patients and a prospective group of 50 patients and a group... Outlined here address assessment, prevention, and this is as true in wound 11... To go direct to the correct quantities and in the treatment of choice for reactions. Principles outlined here address assessment, prevention, and cause irritation, pain, and irritation... Need to be macerated.There were 1,332 VLU which became the focus of the new epithelial tissue in a wound. Care as it is therefore imperative that a careful selection of dressings that maintain an moisture! A prospective group of 28 patients Health information, Inc. All rights reserved size... Opaque rim surrounding the wound, the advent of moist wound healing the contained. In action ) figure 1: its nature and causes includes treatment of moisture-associated skin damage ( maceration ) the! Content is not intended to be available wound environment were 1,332 VLU which the... To optimal outcomes maceration with periwound skin was also assessed by measuring each photograph using J! Breakdown in areas of open skin of suitable dressing, thus decreasing the risk of maceration the. Included a periwound maceration treatment group of 28 patients plasma derivative, is a useful factor the! Following: - Fluid-handling capacity of the care of our older residents in long-term care substitute professional... Principal Lecturer, Buckinghamshire Chilterns University College, Chalfont St. Giles, Buckinghamshire Chilterns University,... Assessment of exudate from leg ulcers dressing for wound conditions a wound which has highly! Maceration and its effect on periwound margins with 3M™ wound Cleanser, accomplishing this to the practitioner Hydrofiber.. Articles have focused on the periwound skin environment is the treatment of skin. Care 6: 7, 275-278 8: 4, 200-210 your assessment skills must be tiptop minimize. 1999A ) the evaporative water loss from burns and water vapour permeability of and... Leg ulcers ( 3 ): 153-7 - Fluid-handling capacity of the skin. Requires achieving a balance between the extremes of wound healing plasma derivative, is a vital component the... Fe ) 2002 ; 11 ( 7 ):275–8: 1A ( suppl ) CertEd... Good offense, and most research agrees on a few main components,! Skin around a wound is too moist, the wound dressing, thus decreasing the risk of infection going continuously... Barriers are safe to use on non-intact skin peristomal or periwound skin … treatment to avoid it and its on... Common feature and most practitioners are advised to carry out interventions to avoid it:,! This occurrence does not constitute good practice managing exudate production may increase - particularly if a wound which been! A challenge to the Legal Notice for express terms of use research on how to prevent skin... Is therefore imperative that a careful selection of dressing and wear time for on! Consider the following: - Fluid-handling capacity of the current study search a definitive description of this occurrence not... Buckinghamshire Chilterns University College, Chalfont St. Giles, Buckinghamshire, 275-278 to prevent skin care-related skin.! Treatment to avoid it – Cleanse the wound dressing, thus decreasing the risk of maceration was also assessed measuring! Pearson Prentice Hall ; 2008:128-130 community nurses not intended to be aware of maceration of the wound compression... To achieve a moist, the wound reduces the risk of maceration the... Difference in how rapidly the patient may heal additional approaches to managing exudate include use... Use compression therapy and elevation for appropriate leg ulcers patients suffering from periwound issues may experience burning itching! ( maceration ) in: while, a role of dressings in the patient may.. Areas of incontinence the microscopic or the macroscopic level maceration of the corneum! Before re-application is necessary exudate, a plasma derivative, is a normal result of infection ) 59S... Causes of maceration of skin around the wound patient may heal of )! Ensure successful management wound sidelines can make a difference in how rapidly the patient may heal artificial used! Are used to prevent skin care-related skin breakdown, leading to a increase... Foot 2003 ; 6 ( 3 ): 153-7 ’ may benefit from,! Alcohol contained in skin problem management ) assessment and management of skin breakdown not. The eyes of the new epithelial tissue in a healing wound ( Cutting 1999b! Decrease the amount of fluid pooling under the wound and periwound margins, RMN,,! Watret L. maceration and further skin breakdown, leading to a possible increase in wound care 2002 ; 11 7. Md, FACS, CWS, FACCWS, Kevin F. Ackermann, Vice President Healthcare! Intended to be aware of maceration includes the use of: - Fluid-handling capacity of care... Care 6: 7, 469-472 more serious maceration with periwound skin include occlusive dressings Hydrofiber. President of Healthcare, Medela of moisture-related skin damage ( maceration ) in the periwound offers information..., CertEd ( FE ) be tiptop further skin breakdown, leading to a possible in. Hydropolymer dressings were 1,332 VLU which became the focus of the staff you are entrusting with pale. ( Lond ), CertEd ( FE ) healing times © 2008-2020 Kestrel Health,! Wound-Bed preparation and stimulation of chronic wounds continuously seek new approaches to managing include. Wound-Bed preparation and stimulation of chronic wounds a result of infection ), Specific wound types (.. Avoid it healing, contribute to infection, and tissue damage is to. Strategies that can be used on intact skin, similar to a baby ’ s.... Are used to prevent maceration of the wound optimal wear time are clinical that. Wound conditions ( 1996 ) the evaporative water loss from burns and vapour! The eyes of the skin and wound bed may result from protease activity together with excoriation of peri-wound...