Skin Maceration Explained

By: Nathan Chandler

We've all had raisin-like skin wrinkles after sitting too long in a hot bath. This is technically known as skin maceration.
We've all had raisin-like skin wrinkles after sitting too long in a hot bath. This is technically known as skin maceration.
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It's the wrinkly toes and fingers we witness after a long hot bath drags on too long. And it's the super-soft skin that results when you've left a bandage on too tight, for too many hours. It's called skin maceration, and although it's a relatively harmless manifestation of excess moisture in the skin, you should know how to treat it.

Skin maceration occurs when skin is wet for extended periods of time, and you've undoubtedly experienced maceration many times in your life. Maceration often occurs when you apply a bandage to everything from a paper cut on your finger to much larger wounds that require professional treatment. And you may have noticed maceration after wearing non-breathable plastic or latex rubber gloves, which trap moisture against the skin.

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Maceration often occurs during treatment of wounds because the skin under the bandage becomes wet due to perspiration, urine or other bodily fluids. The excess moisture is sometimes called hyperhydration.

Wrinkles are the first sign that the skin is over-hydrated. In addition, macerated skin becomes extremely soft and takes on a whitish appearance. However, this white skin should not be confused with the pale, whitish appearance of the new epithelial tissue in a healing wound.

Although most maceration clears up quickly once the skin is exposed to fresh air and allowed to dry, sometimes skin that experiences long periods of maceration is vulnerable to fungal and bacterial infection. As opportunistic organisms affect the area, it may become itchy or develop a foul odor.

What's more, because the skin is so much softer, it's also more susceptible to injury from rubbing or friction. Keep reading to see how you can prevent skin maceration and keep it from snowballing into bigger problems.

 

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Preventing Skin Maceration

Bandages often trap excess moisture next to the skin, causing maceration.
Bandages often trap excess moisture next to the skin, causing maceration.
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Maceration is often considered the first sign of worse things to come. If not treated properly in elderly or immobile people, maceration may signal that pressure wounds or wounds caused by friction are imminent.

Maceration has also been linked to slower wound healing. Proper care of wounds and informed bandage application will greatly reduce maceration and prevent more serious complications.

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You've already witnessed what happens to your macerated skin once you finally get out of your long soak in the bathtub. Your skin slowly but surely returns to normal without any intervention from you.

However, in some instances, this condition is harder to resolve. Maceration often occurs in elderly, bedridden people struggling with incontinence. Bedding traps moisture next to the skin, and because the person lays immobile in bed for much of the day, the skin becomes macerated and prone to bed sores and infection. Thus, moisture levels must be reduced and monitored.

If the maceration is occurring near a bandaged wound, you may need to review your bandaging tactics. Because healing wounds all ooze fluid (called exudate), the wound area may be moist. In significant wounds, the exudate may flow into the bandage faster than the bandage can allow for air to provide helpful evaporation.

In this case, maceration may accelerate and begin to cause complications. The situation may call for more frequent changing of the bandage to keep moisture to a minimum.

If the bandage covers a large portion of skin, it may also cause heat buildup, which subsequently triggers the body to try and cool itself through sweating. That sweat may also be trapped by an overly aggressive bandage. A smaller or more frequently changed bandage may help.

Reducing moisture levels also keeps bacterial colonization to a minimum. As a result, the macerated area is much less likely to develop an infection. The ultimate result is a wound that heals faster and without further skin damage.

For more medical curiosities, head on over to the next page.

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Sources

  • Blagg, Margaret Kitterman. "Preventing Pressure Ulcers." Rehab Management. November/December 2009. (Oct. 7, 2010)http://www.rehabpub.com/issues/articles/2009-11_03.asp
  • Butcher, Martyn. "The Management of Skin Maceration." NursingTimes.net. Nov. 9, 2000. (Oct. 7, 2010)http://www.nursingtimes.net/nursing-practice-clinical-research/the-management-of-skin-maceration/206024.article
  • Infection Control Today. "Protecting the Epidermis and the Bottom Line." Oct. 29, 2007. (Oct. 7, 2010)http://www.infectioncontroltoday.com/articles/2007/10/protecting-the-epidermis-and-the-bottom-line.aspx
  • Sardina, Donna. "Wound Watch: Winning the Battle Against Maceration Due to Incontinence." Lippincott's NursingCenter.com. November/December 2007. (Oct. 7, 2010)http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=768838
  • Thomas, Stephen. "The Role of Dressings in the Treatment of Moisture-Related Skin Damage." World Wide Wounds. March 2008. (Oct. 7, 2010)http://www.worldwidewounds.com/2008/march/Thomas/Maceration-and-the-role-of-dressings.html
  • 3M. "Skin Injuries -- Maceration." 2010. (Oct. 7, 2010)http://solutions.3m.com/wps/portal/3M/en_US/SH/SkinHealth/solutions/dressing-device-secural/injuries-maceration/

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