Treatment of Moisture-Associated Skin Damage
The cornerstone of treating moisture-associated skin damage (MASD) is implementing a structured skin care regimen consisting of gentle cleansing, barrier protection, moisture control, and addressing the underlying moisture source. 1, 2
Core Treatment Principles
The treatment approach must address multiple pathophysiologic factors simultaneously, as MASD results from prolonged moisture exposure combined with chemical irritants, pH alterations, mechanical friction, and potential secondary infection 3.
Essential Treatment Components
Structured Skin Care Regimen:
- Gentle cleansing with pH-neutral (pH 5) cleansers and tepid water to remove irritants without further damaging the skin barrier 4
- Pat skin dry rather than rubbing to minimize mechanical trauma 4
- Avoid hot water, excessive soap use, and harsh cleansers that cause dehydration 4
Barrier Protection and Moisturization:
- Apply barrier creams or ointments to protect skin from moisture and irritants 1, 2
- Use hypoallergenic, fragrance-free moisturizing creams or ointments at least once daily 4
- Petrolatum-based products are effective for creating an occlusive barrier that prevents moisture evaporation 4, 5
- Zinc oxide preparations help protect and dry oozing/weeping areas 5
- Avoid greasy creams that may facilitate folliculitis development 4
Moisture Control:
- Keep affected areas as dry as possible 4
- Use absorbent materials and change them frequently 1, 2
- Ensure proper air circulation to affected areas 2
Treatment by Severity
Mild MASD (Grade 1):
- Continue structured cleansing and barrier protection regimen 1, 2
- Apply moisturizers and barrier creams twice daily 4
- Monitor for progression 2
Moderate MASD (Grade 2):
- Intensify barrier protection application frequency 4
- Consider topical low-to-moderate potency corticosteroids (e.g., prednicarbate cream 0.02% or hydrocortisone 1%) for inflammatory components 4
- Apply topical steroids under supervision to avoid perioral dermatitis and skin atrophy 4
- Reassess after 2 weeks 4
Severe MASD (Grade 3):
- Short-term systemic corticosteroids (prednisone 0.5-1 mg/kg for 7 days with weaning over 4-6 weeks) for severe inflammation 4
- Obtain bacterial cultures if secondary infection suspected 4
- Initiate appropriate antibiotics based on culture sensitivities for at least 14 days 4
Managing Secondary Infection
When infection is present or suspected (indicated by failure to respond to treatment, painful lesions, yellow crusts, or discharge):
- Obtain bacterial swabs for culture 4
- Start calculated antibiotic therapy covering Staphylococcus aureus (most common pathogen) 4
- Continue antibiotics for minimum 14 days based on sensitivities 4
- Incise and drain abscesses to prevent sepsis 4
Addressing the Moisture Source
Critical to treatment success is controlling the underlying cause 1, 2, 6:
- Manage incontinence appropriately
- Control wound exudate with appropriate dressings
- Address excessive perspiration in intertriginous areas
- Optimize peristomal appliance fit
Special Considerations
Avoid these interventions that may worsen MASD:
- Hot showers or baths 4
- Excessive soap use 4
- Alcohol-containing lotions or gels 4
- Manipulation or picking at affected skin 4
- Tight-fitting clothing or shoes 4
For occlusive therapy (nighttime treatment):
- Apply moisturizer followed by cotton or loose plastic gloves to create occlusive barrier 4
- Water-based moisturizers are safe under all glove types 4
- Oil-based moisturizers should not be used under latex or rubber gloves as they compromise glove integrity 4