What moisture-associated skin damage is

Skin is not built to stay wet for hours. Moisture-associated skin damage, or MASD, is the inflammation and breakdown that follows when urine, stool, sweat, wound drainage or another body fluid sits on the skin too long. Moisture-associated skin damage care means finding the source of the moisture, protecting the skin and looking after any open areas.

Wet skin softens and its outer barrier weakens, so rubbing from sheets, briefs or skin against skin can strip it away. Urine and stool add irritants, and warm, damp skin lets yeast and bacteria grow.

Gateway arranges care for this kind of wound across the region. See wound care in St. Louis for how visits at home and in facilities are set up.

The main types of moisture damage

Clinicians group MASD by where the moisture comes from.

  • Incontinence-associated dermatitis is caused by urine or stool. It affects the buttocks, groin, genital area and inner thighs. Skin looks red or darker than usual, may be shiny or raw, and often burns or stings.
  • Skin fold moisture damage (intertrigo) happens where skin touches skin and sweat is trapped: under the breasts, under the abdomen, in the groin and between the toes.
  • Periwound moisture damage affects the skin around a wound when drainage soaks it. The skin turns pale or white, soft and wrinkled, and the wound’s edges can break down.
  • Skin damage around a stoma comes from leaking output. An ostomy nurse usually leads that care.

How it differs from a pressure injury

Moisture damage on the buttocks is often mistaken for a pressure injury (bed sore), and the two call for different plans.

A pressure injury is caused by pressure and shear. It usually sits over a bone, such as the tailbone, hip or heel, has a defined shape and can extend deep into the tissue. Moisture damage is caused by wetness. It is shallow, spread over a wider area with uneven edges, and found wherever the moisture reaches, including creases and folds.

Turning schedules and cushions relieve pressure but do not fix moisture, and barrier products do not relieve pressure. Wet skin is also easier for pressure to injure, so both problems can occur in the same spot.

What the treating clinician assesses

The treating clinician looks at the skin and at what is keeping it wet:

  • The location, pattern and depth of the damage
  • The source of moisture and how long skin stays in contact with it
  • Signs of yeast or bacterial infection
  • Continence, toileting routines and the absorbent products in use
  • For periwound damage, how well the current dressing handles the drainage

What a care plan for moisture damage includes

Most care plans have the same parts, adjusted by the clinician for each person:

  1. Gentle cleansing. How the skin is cleaned, how often and with what.
  2. Skin protection. A barrier product, chosen by the clinician, that shields skin from moisture.
  3. Managing the source. A continence plan, a different absorbent product, a way to keep skin folds dry, or a dressing matched to the drainage.
  4. Treating infection if present. The clinician decides whether medicine is needed.
  5. Rechecking. Skin that is not improving on the plan needs another look.

Gateway arranges the supplies the clinician orders and helps get the written plan to caregivers and facility staff. Our guide to managing incontinence and skin protection lists questions to ask, and our page on dressing selection and changes explains how dressings are matched to drainage.

Changes to report to the clinician

Tell the treating clinician if you see:

  • Red or discolored skin that becomes open, raw or bleeding
  • Small red bumps or spots spreading beyond the edge of a rash
  • Skin that looks purple, maroon or black, or feels firm or mushy (these can point to pressure damage)
  • Drainage soaking through a wound dressing before the next change
  • Fever, spreading redness or warmth, pus or a new foul odor

Call 911 for confusion, fainting, trouble breathing, or a high fever with rapidly spreading redness. Gateway is not an emergency service.

How Gateway arranges moisture-associated skin damage care

Gateway connects patients and families in Greater St. Louis and the Metro East with partner clinicians who see people at home and in skilled nursing, assisted living and memory care. In facilities, facility wound rounds keep the treating clinician and nursing staff working from one plan. When pressure is part of the problem, we can also coordinate the pressure injury prevention steps the clinician orders.

Call 314-325-0126 or request care with a name and phone number. Whether visits are available depends on the location and care setting. Benefits depend on the treating provider, the plan and the care needed.

Common questions

Is moisture-associated skin damage the same as a bed sore?

No. A bed sore, or pressure injury, comes from pressure, usually over a bone. Moisture damage comes from skin staying wet and is usually shallow and spread out. They can look alike and can happen together, so a clinician should examine the area before anyone decides which it is.

Can adult diaper rash turn into an open wound?

It can. Skin exposed to urine and stool again and again may go from red and sore to raw, weeping patches. Open skin hurts and is easier to infect. Redness that is not improving, or any broken skin, is a reason to ask for a clinician’s assessment.

Why is the skin around my wound white and wrinkled?

That is usually a sign of too much moisture, called maceration. Wound drainage is soaking the nearby skin, much as fingers wrinkle in a long bath. Tell the treating clinician, who may change the dressing plan. Our guide on keeping skin healthy around a wound explains more.

Does a red rash in a skin fold mean a yeast infection?

Not always. Trapped sweat and rubbing can cause redness on their own. Yeast is common in warm, damp folds, and clinicians suspect it when the rash is bright red, itchy and has small spots scattered beyond its edge. The clinician decides what it is and whether medicine is needed.

Related pages

General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.