Maceration

How It's Caused & Treated

Dressing a patient’s wound.
Dressing a patient’s wound. Science Photo Library/Getty Images

Maceration is a skin condition that occurs when fluid or moisture is in contact with the skin for extended periods of time, particularly with wound dressing. The skin softens, turns white and can easily become infected with bacteria or fungi.

Causes of Maceration

Maceration is caused by urinary incontinence and sweat, but the primary cause is prolonged exposure to fluid or moisture. Maceration often occurs as the result of a wound.

A wound produces healing fluids, but if it's not properly cared for it can cause the skin to deteriorate.

Maceration is often a side effect of several different chronic wounds, including bedsores, diabetic foot ulcers, leg ulcers and fungating lesions. The fluids these chronic wounds create contain proteases: enzymes that break down proteins and peptides. In other words, proteases break down even healthy skin tissue.

Those who have urinary incontinence or are on bed rest are at a greater risk of developing bedsores on the lower back and buttocks. In fact, there's a causal relationship between bedsores and maceration. It's an environment in which maceration thrives: bedsores become bigger, painful and can cause serious damage to the skin.

The normal wound healing process begins when damaged cells release histamine, which causes blood vessels to leak plasma. As a result, nearby skin tissue begins to swell, a condition clinically known as edema.

Fluid starts to accumulate. At first it's clear, but it later becomes thicker and more opaque.

As a wound deteriorates and heals, there may be an increase in the amount of fluid it produces. The wound may start to smell different or break and leak open upon friction. The amount of fluid produced varies depending on the wound.

For example, a wound that is not properly cared for could produce greater levels of fluid, thus creating an environment that encourages bacteria growth.

Treatment & Prevention of Maceration

There are two types of wound dressings used to treat maceration: occlusive dressings and hydrofibers. An occlusive dressing is a wax-coated wound covering that provides an air- and water-tight seal. Hydrofiber dressings, like sterile gauze pads, absorb moisture and promote healing. Some gauze pads contain iodine, which further prevents a wound from macerating nearby skin.

Coincidentally the things that are used to treat maceration are also what cause maceration. It comes down to how well the wound is dressed and cared for. For example, a gauze pad can only absorb so much fluid. It's important that it be replaced as needed. If it isn't, maceration can occur.

Minor cuts and scrapes can be treated at home, but a larger laceration or lesion that produces a significant amount of fluid is a reason to see a doctor.

Even larger injuries can be treated at home, but it's important to consult with a doctor who can provide you with a treatment regimen that includes products you can find at the drugstore first.

Maceration can be avoided with proper care, but it can occur with any type of wound, whether large (like a burn on your arm) or small (a cut on your finger), so it's very important to closely follow a doctor's or product's instructions. Additionally, excessive moisture weakens the skin and causes it to break down, so keep the affected skin as clean and dry as possible.

Sources:

http://www.nursingtimes.net/the-causes-and-prevention-of-maceration-of-the-skin/199668.fullarticle

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