![]() When the skin is overhydrated, the brick and mortar structure of the skin puffs up and gaps between skin cells and the lipid profile, thereby causing a loss of skin surface stability. The compromised condition of MASD-affected skin can also result in an increased susceptibility of the skin to MARSI. This can result in infection, pain, and delayed healing. When moisture or trauma damages the epidermis or outer layer of the skin, the body's protective barrier is compromised. Loss of Skin Protective Barrier in Moisture-Associated Skin Damage Once again, the best approach to prevention includes continuing accurate skin assessments and maintaining an effective skin care regimen. This in turn creates the perfect storm leading to bacterial overgrowth and possible infection. In individuals with diabetes mellitus the increased glucose levels combined with these other factors lead to an imbalance in the normal flora. 3 Combined with moisture, the chemical onslaught of incontinence, obesity, skin folds, and friction with skin-to-skin contact increase the susceptibility of the skin to bacterial overgrowth. Risk Factors for Incontinence-Associated Dermatitisįactors that increase the risk of IAD in addition to incontinence include fragile skin, decreased mobility, decreased cognitive ability, poor personal hygiene or decreased capacity to perform personal hygiene, pain, poor nutritional status, and critical illness. Use of appropriate products to cleanse, protect, and treat the skin will help diminish pain as well. Treatment of this condition begins with interventions that address the moisture and fungus, such as 2% miconazole nitrate. ![]() Steps should include continuing to assess the skin care regimen for the proper use of skin cleansers, using moisturizers, avoiding occlusive products, managing moisture with absorptive products that will wick the fluid away from the skin, and using antifungal products. 2 Understanding the epidemiology of Candida colonization in these situations may guide assessment and prevention strategies for these patients. The development of Candida infection often results in increased morbidity and extended length of stay. These lesions are typically pruritic, and painful. Candida infection clinically manifests as a bright red maculopapular rash spreading out from the central contact area, with associated distant satellite lesions. Forty-three percent of the incontinent patients in the study developed a perianal Candida infection. ![]() Candida Infection in Incontinence-Associated DermatitisĪccording to a study by Campbell and colleagues, 1 Candida albicans, which is the most prevalent human fungal commensal organism, is also the most frequent organism responsible for infection related to incontinence-associated dermatitis or IAD. Today our focus is to discuss each of these complications of MASD in more detail and address some of the most common issues leading to their development. These can occur individually or overlap, which can make them even more difficult to manage. If left untreated or not treated appropriately, moisture-associated skin damage or MASD can lead to further complications such as Candida infections, bacterial overgrowth, pressure injuries, and medical adhesive-related skin injury (MARSI). When we ask what causes skin damage we should consider the conditions that can harm the skin, including excessive moisture and overhydration, altered pH of the skin, the presence of fecal enzymes and pathogens, and characteristics of incontinence such as the volume and frequency of the output and whether the output is urine, feces, or both. Best practice in skin care focuses on the prevention of skin breakdown and the treatment of persons with altered skin integrity.
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