What is standard wound care for moisture-associated skin dermatitis of the buttocks?

Standard Wound Care for Moisture-Associated Skin Damage of the Buttocks

Standard wound care for moisture-associated skin damage (MASD) of the buttocks should focus on gentle cleansing, moisture barrier application, and addressing the underlying cause of excessive moisture exposure.

Assessment and Identification

• Assess for characteristic signs:

  • Inflammation of the skin (erythema)
  • With or without erosion or secondary cutaneous infection
  • Possible maceration (whitish, soggy appearance)
  • May be painful, itchy, or burning

• Identify the source of moisture:

  • Incontinence (urine/stool)
  • Perspiration
  • Wound exudate
  • Other body fluids

Treatment Protocol

Step 1: Cleansing

• Clean the affected area gently with a mild skin cleanser 1
• Avoid harsh soaps or detergents that can further irritate the skin
• Pat dry thoroughly or allow to air dry (do not rub) 1, 2
• For incontinence-related MASD, cleanse after each incontinent episode 2

Step 2: Barrier Protection

• Apply a moisture barrier product containing dimethicone or zinc oxide paste 1, 2
• For moderate to severe cases, consider:
  • Zinc oxide paste (if easy to remove prior to next cleansing) 1
  • Dimethicone-based barrier products 2
  • Barrier creams with humectants 1

Step 3: Dressing Selection (if needed)

• For moist desquamation or erosive areas:
  • Apply hydrophilic dressings after cleansing 1
  • Consider anti-inflammatory emulsions such as trolamine or hyaluronic acid cream for symptomatic relief 1
  • Avoid adhesive dressings directly on damaged skin

Step 4: Infection Management

• Monitor for signs of infection:
  • Increased redness, warmth, odor
  • Worsening pain
  • Purulent drainage
• If infection is suspected:
  • Consider swabbing the area for identification of infectious agent 1
  • Use topical antibiotics only when infection is confirmed, not prophylactically 1

Prevention Strategies

• Implement a structured skin care regimen:

  • Regular cleansing with mild products
  • Thorough but gentle drying
  • Consistent application of barrier products 1, 2

• Address the underlying cause:

  • For incontinence: implement appropriate continence management
  • For excessive perspiration: consider moisture-wicking fabrics and frequent position changes
  • For wound exudate: manage primary wound appropriately

• Avoid common pitfalls:

  • Do not use products in jars (risk of contamination) 1
  • Use tube-packaged moisturizers instead 1
  • Avoid products containing potential allergens (fragrances, preservatives) 1
  • Do not use harsh cleansers or alcohol-based products 1

Special Considerations

• For nighttime management: consider applying moisturizer followed by loose protective coverings to create an occlusive barrier 1
• For severe cases: consider the "soak and smear" technique - soak the affected area in plain water for 20 minutes and immediately apply moisturizer to damp skin 1
• For recalcitrant cases: consider consultation with a wound care specialist or dermatologist 1

Follow-up and Monitoring

• Assess skin condition daily
• Document changes in appearance, size of affected area, and patient symptoms
• Adjust treatment approach based on improvement or deterioration
• Continue preventive measures even after resolution to prevent recurrence

By following this structured approach to MASD management, clinicians can effectively treat the condition while improving patient comfort and preventing complications that could impact morbidity and quality of life.