Moisture-Associated Skin Damage

Abstract

Moisture-associated skin damage (MASD) occurs when skin is repeatedly exposed to various sources of bodily secretions or effluents, often leading to irritant contact dermatitis with inflammation, with or without denudation of affected skin. In 2020, the Wound, Ostomy and Continence Nurses Society took an initiative that led to the addition of multiple International Classification for Diseases codes for irritant contract dermatitis caused by various forms of MASD for use in the United States (ICD-10-CM). In the last issue of the Journal of Wound, Ostomy and Continence Nursing, a clinical practice alert identifying the various new codes was published that summarized each of the new codes and provided highlights of the descriptions of each of the these codes. This is the first in a series of 2 articles providing a more detailed description of the newest irritant contact dermatitis codes linked to MASD. Specifically, this article reviews the clinical manifestations and assessment, pathophysiology, epidemiology, prevention, and management of irritant contact dermatitis due to saliva, respiratory secretions, and fecal or urinary incontinence.

Moisture-Associated Skin Damage

“…The location of MASD reflects areas where skin is exposed to the underlying moisture source; its borders will follow the flow of effluent from the stoma or fistula and its borders are indistinct when compared to partial- or full-thickness pressure injuries. Symptoms include burning and itching of inflamed skin 1,3,4. While the L24B0 code may be used for initially characterizing MASD of an unspecified source, the WOC or ostomy or wound care nurse's assessment will focus on determining the stoma type, anatomic location of the fistulous tract, character of effluent, and underlying factors leading to irritant contact dermatitis to determine a more specific diagnosis and guide treatment (Table).…”

“…The likelihood and presentation of irritant contact dermatitis varies based on the characteristics of stoma or fistula effluent, its pH, and its microbiologic biome. 1 In comparison to gastrostomy or fistula effluent, the effluent from a colostomy is closer to that of a person with an intact gastrointestinal tract,…”

“…Symptoms include burning and itching of inflamed skin. 1,3,4 While the L24B0 code may be used for initially characterizing MASD of an unspecified source, the WOC or ostomy or wound care nurse's assessment will focus on determining the stoma type, anatomic location of the fistulous tract, character of effluent, and underlying factors leading to irritant contact dermatitis to determine a more specific diagnosis and guide treatment (Table ).…”

“…In the first article in this 2-part series, Gray and colleagues2 summarized the history of a roundtable discussion that identified the overarching concept of MASD and its multiple manifestations, each presentation based on the type and chemical constitution of the moisture source (bodily secretion of effluent), and its effects on the skin. That discussion led to the publication of a series of 3 articles that reviewed clinical manifestations and the pathophysiology of MASD along with 4 prevalent forms: incontinence-associated dermatitis, intertriginous dermatitis, peristomal MASD, and periwound MASD 1,3,4. The third article in the series reviewed clinical manifestations and the pathophysiology of MASD focused on peristomal MASD and periwound MASD 4…”

Practice Alert

“…Moisture-associated skin damage develops from prolonged exposure of the skin to various sources of moisture and irritants such as urine, feces, digestive secretions, mucus, saliva, perspiration, and wound drainage, resulting in irritant contact dermatitis. 1 Th erefore, each of the new ICD-10-CM diagnosis codes were added under the category of Contact Dermatitis. Because of the variability of MASD etiologies, the new International Classifi cation of Diseases, Tenth Revision ( ICD-10 ) codes are essential for accurate reporting of specifi c types of MASD in a consistent manner.…”