Whitehead F, Giampieri S, Graham T, Grocott P, et al.
Journal of wound care. Date of publication 2017 Apr 2;volume 26(4):159-165.
1. J Wound Care. 2017 Apr 2;26(4):159-165. doi: 10.12968/jowc.2017.26.4.159.
Identifying, managing and preventing skin maceration: a rapid review of the
clinical evidence.
Whitehead F(1), Giampieri S(2), Graham T(2), Grocott P(3).
Author information:
(1)Postgraduate Student Diploma in Adult Nursing, King's College London,
Florence Nightingale Faculty of Nursing and Midwifery, 57 Waterloo Road, London,
SE1 8WA, UK.
(2)Research Associate, King's College London, Florence Nightingale Faculty of
Nursing and Midwifery, 57 Waterloo Road, London, SE1 8WA, UK.
(3)Professor of Nursing Technology and Innovation, King's College London,
Florence Nightingale Faculty of Nursing and Midwifery, 57 Waterloo Road, London,
SE1 8WA, UK.
OBJECTIVE: To identify the clinical empirical evidence for identifying, managing
and preventing skin maceration in human subjects.
METHOD: A rapid review of the current literature was undertaken between 5
September and 19 September 2016 using the electronic databases CINAHL, MEDLINE,
PUBMED and Cochrane, with the key words: skin macerat*, wound macerat*, moisture
associated skin damage, wound exudate and hyper-hydration of skin, Results: Of
526 papers found using an electronic database search, four were identified as
fitting the search parameters, and a further two were retrieved from a manual
search of reference lists. There were three themes that emerged: how to identify
and measure maceration, how to manage and reduce maceration once it has already
occurred, and how to prevent skin maceration. Hyper-hydration can reach greater
skin depths than previously thought, thus engendering more extensive damage
potential, which in turn can impact on treatments and healing time.
Realistically, the deeper the hyper-hydration issue, the more extensive the
damage and it will take longer to recover-a problem compounded if the
hyper-hydration is due to incontinence and skin is also exposed to urine and/or
faeces. In relation to wound management, the authors advocate the removal of
moisture away from the wound or skin, either through superabsorbent dressings,
or by allowing the excess moisture to evaporate through semi-permeable dressings
to reduce maceration, enhance patient comfort and encourage healing. However, we
found no evidence regarding the limits of hydration of the dermis and epidermis
and thereby the optimal conditions for managing exuding wounds and promoting
skin health. Each of the six papers in this review calls for further research to
help identify, treat and prevent maceration.
CONCLUSION: Maceration causes patients' discomfort and pain as well as
prolonging healing time and deserves more focused research. This rapid review
highlights how limited the clinical empirical research is on identifying and
managing skin maceration from an early stage so that health professionals may be
better equipped to prevent it. Further clinical research is also needed to
determine when levels of hydration in the skin become damaging. The small number
of studies within this review show that skin maceration can be avoided, but
clearer guidance is needed.
DOI: 10.12968/jowc.2017.26.4.159
PMID: 28379098 [Indexed for MEDLINE]
