The skin of human beings when is exposed to moisture for a long period of time, the skin becomes soft and breaks down. In the year, 1877 Jean Martin Charcot was the first person to describe it. When large quantity of liquid stays in surface of the skin or the surface of the wound for long period of time. On the surface of the skin wrinkles appear. Wrinkles appearing on the skin means the skin is more than hydrated than that is normally required. Skin which is macerated becomes very soft and has a white colored appearance and looks sagged and wrinkled. This white colored skin is different from the pale white appearance of a new epithelial tissue, when a wound is healed. Majority of time maceration of the skin is cured when that part of the skin is allowed to dry and is in contact with fresh air. No medicine or any expertise of a doctor or nurse is required. But when the surface of the skin is subjected to a very long period of moisture again and again, then the skin may be exposed to the possibility of having bacterial and fungal infection. If it becomes infected then it may become itchy and have a very bad smell.
Maceration on the skin occurs due to contact with moisture for a long period of time. It happens when one uses bandage on the skin. Putting bandage on the skin for any kinds of wounds like a paper cut on a finger to larger wounds that require treatment from the professional experts, maceration happens. Anyone wearing a plastic that is non – breathable or a latex rubber gloves, can have maceration. As these non - breathable materials trap in moisture in the skin and causes the skin to retain the moisture for a long time. It can also occur during treatment of wounds because the surface of the skin under the dressing or bandage slowly starts retaining moisture and becomes wet. This wetness can occur due to urine, other bodily fluids and perspiration, which gets retained in the surface of the skin. This moisture when retained causes hyper - hydration.
Taking bath for a long time or swimming for a long time means keeping the surface of the skin in contact with water for a long period of time. This prevents the moisture to escape from the skin. People who are older and has got wounds or are recovering from any kind of surgery gets maceration. If this maceration is not treated it can lead to skin infection that can spread to the entire body causing systemic infection. Sometimes poor hygiene causes this and this leads to the risk. In extreme cases antibiotics, antifungals and specialized wound care treatment is required. Wrinkles appear on the hand and feet after taking a long bath or after swimming for long time. It happens when the skin is over soaked in the bath or swimming pool. Sometimes it happens due to sweating excessively. People who work in water or wad in water without protective gear gets maceration. Sometimes due to injury to the body, a particular part of the body is wrapped in bandage then maceration occurs. Encasing the skin in non – breathable materials like latex. Unable to change the dressings of the wound at regular interval. Some old people are unable to control the leakage of urine. This is called urinary incontinence (UI). This also leads to maceration. All of these causes build – up of tissue moisture. This is called as hyper hydration.
Sometimes the most common causes of skin maceration in a medical set up is occlusive therapy. This involves the use of films and other non – porous materials to make sure that the wound dressing is completely water tight as well as air tight. This is done to prevent microbes from entering the breaks in the skin. This is also done to help in better absorption of medications into the tissues. This dressing or bandage needs to be changed at regular interval. Perspiration and leakage from the wound can get accumulated and after a few time it would cause bacteria to colonize and lead to infection. If this happens, then the person will have pale and highly wrinkled skin. The skin will have red patches called erythema. The wound may be spongy and moist, the symptom of maceration. The symptoms may have irregular swelling along the edges of the wound. Another symptom can be a discharge of pus, which is thick and have a bad smell. The symptoms can be having a burning sensation, itching and having pain. When the dressing of the wound will be opened, it would be raw and swollen and moist with inflamed tissue.
Some old people have problem in leakage of urine. Their clothing and bedding is soaked in urine and that needs to be changed at regular interval. Continuous exposure to these causes painful and eruptive skin ulcers, mainly in the skin folds or places where the skin is pressed against the mattress. This leads to the formation of bed sores. These causes obstructions in the healing process despite intense therapy. This damage is concentrated around the area of pooling. Elder people are most affected as with age they have thin skin and less of blood circulation, this later hinders the ability of the body to fight local infection.
Once the skin is dry maceration is no longer there. But any skin that is broken will have poor circulation and will have hyper hydration , which will be objected to infection and injury. This is referred to as moisture – associated skin damage (MASD). It is problematic when treating diabetic foot ulcers, bed sores, fungal lesions and leg ulcers. The wounds contains enzymes that actively breaks down peptide and proteins bonds in the skin. Instead of healing the wound, it hurts it. Infections and other complications may happen when efforts are made to manage the wounds. Skin infections due to maceration can cause more harm, if not treated. This can cause cellulitis, which is a post - operative infection, usually happening in the lower leg and sometimes death of tissue occurs. That death of tissues is called cutaneous necrosis.
When a wound is very moist that can act as hindrance to the healing of the wound. The skin surrounding the wound is known as periwound and that can become macerated. Skin that is macerated is prone to breakdown, leading to a chance of increase in wound size. The correct dressing needs to be put so that it maintains just the perfect amount of moisture in the wound bed without allowing the periwound to become macerated. Moisture – retentive dressings are used to achieve a moist, but not wet, wound environment. Many are able to decrease the amount of fluid pooling under the wound dressing, hence reducing the risk of skin breakdown. Some dressings have the ability to absorb away the moisture from the skin, which is similar to the diaper of baby. Skin sealants and alcohol – based wipes are used on intact skin, making the surface of the skin slightly sticky. This creates a better surface for adhesive dressings to stick to, simultaneously providing the skin with some protection from the adhesive. Spray skin sealants are used over stage 1 pressure ulcers to provide protection to skin that is intact. Creams and ointments that has dimethicone, zinc oxide and petrolatum are used as moisture barriers. They can be used on intact skin, but are commonly used to prevent further break down in areas of incontinence.
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