What is the best plan of care for moisture-associated dermatitis?

Management of Moisture-Associated Dermatitis

The best plan of care for moisture-associated dermatitis (MAD) includes identifying and eliminating the moisture source, implementing a structured skin care regimen with gentle cleansers, applying barrier products, and using moisturizers to repair the skin barrier. 1

Initial Assessment and Identification

• Determine the specific type of moisture-associated skin damage (MASD), which may include incontinence-associated dermatitis, periwound skin damage, intertriginous dermatitis, or peristomal moisture-associated dermatitis 2
• Assess the severity, location, and extent of skin damage to guide appropriate treatment selection 2
• Identify and address the underlying cause of excessive moisture exposure (e.g., incontinence, wound exudate, perspiration) 3

Core Treatment Approach

Step 1: Moisture Management

• Implement measures to prevent excessive contact of skin with moisture, which is the primary intervention for preventing MASD 3
• For incontinence-associated dermatitis, establish an effective continence management plan with appropriate absorbent products 4
• For periwound moisture, use appropriate wound dressings that manage exudate effectively 2
• For intertriginous dermatitis, keep skin folds clean and dry 4

Step 2: Skin Cleansing

• Use gentle skin cleansers instead of harsh soaps that can further damage the skin barrier 1
• Clean affected areas promptly after moisture exposure, particularly following episodes of incontinence 3
• Avoid hot water for washing as it can exacerbate irritation 1

Step 3: Barrier Protection

• Apply a liquid barrier product that provides long-lasting protection against moisture and irritants 3
• For moderate to severe cases, use barrier products that create a protective film on the skin surface 2
• Products packaged in tubes rather than jars are preferred to minimize contamination 1

Step 4: Anti-inflammatory Treatment

• For inflamed areas, apply mid-potency topical corticosteroids (such as triamcinolone 0.1%) twice daily for acute flares 1
• Use the minimal effective amount of topical corticosteroids to control symptoms 1
• For facial lesions, consider lower potency steroids or topical calcineurin inhibitors to minimize side effects 1

Step 5: Skin Repair and Maintenance

• Apply moisturizers after cleansing to repair the skin barrier 1
• For nighttime treatment of hands, consider the "soak and smear" technique - soak in plain water for 20 minutes followed by immediate application of moisturizer to damp skin 1
• For ongoing maintenance, implement a proactive approach with regular application of moisturizers and barrier products 5

Special Considerations

• For persistent cases, consider twice weekly application of topical corticosteroids or topical calcineurin inhibitors to previously affected areas to prevent flares 5
• For patients with moderate-to-severe MASD and signs of secondary bacterial infection, consider antiseptic treatments such as diluted sodium hypochlorite (bleach) baths 5
• Educational interventions should be incorporated into the treatment plan to improve patient outcomes and adherence 5

Common Pitfalls to Avoid

• Failure to identify and remove the causative moisture source will result in persistent dermatitis 1
• Overuse of topical corticosteroids can lead to skin thinning and other adverse effects 1
• Over-reliance on barrier creams without addressing the underlying cause may give a false sense of security 1
• Neglecting to differentiate MASD from other conditions like pressure injuries can lead to inappropriate treatment 2

By following this structured approach to managing moisture-associated dermatitis, clinicians can effectively treat existing damage and prevent recurrence, ultimately improving patient comfort and quality of life.