Overview of Skin Maceration

Skin maceration can occur due to prolonged skin exposure to moisture. It can happen if the skin is underwater for a long time (bathing, swimming) or if moisture can't escape from the skin, such as after wearing a bandage for too long.

While maceration can be often harmless, it may lead to complications in the elderly, in people with wounds, or those recovering from surgery. If left untreated, maceration can cause a bacterial or fungal skin infection that can progress to an all-body, systemic infection. Poor hygiene adds to the risk.

Prevention of skin maceration is important when there's a risk. Infections or extensive skin maceration need treatment with antibiotics, antifungals, or specialized wound care treatments.

Symptoms and Causes

Wrinkled skin is the first and most obvious sign of skin maceration. Most of us are familiar with the wrinkled appearance of our hands and feet after a long bath. Maceration will also cause the skin to be extremely soft and take on whitish coloration.

Maceration can occur in situations such as:

• Over-soaking in the bath or swimming pool
• Sweating excessively (hyperhidrosis)
• Working or wading in water without protective gear
• Encasing the skin in non-breathable materials like latex
• Not changing wound dressings regularly
• Urinary incontinence

The excessive buildup of tissue moisture, either through perspiration, urine, or other fluids, is often referred to as hyper hydration.

Diabetic foot ulcers, leg ulcers, bed sores, and fungal lesions are susceptible to maceration. The fluids from these wounds contain enzymes that actively break down proteins in the skin, which prevents skin healing and allows excess fluid to build up.

Occlusive Therapy

One of the most common causes of skin maceration in a medical setting is occlusive therapy. This involves the use of films and other non-porous materials to ensure that a wound dressing is completely air- and water-tight. A protective dressing prevents infectious organisms from entering skin cuts and wounds, and it can also promote the absorption of medications into tissues.

Unless the bandage is regularly changed, perspiration and leakage from the wound can rapidly accumulate. Within a short period of time, bacteria can contaminate the wounds and cause an infection.

If this occurs, symptoms may include:

• Pale and visibly wrinkled skin
• Erythema (patches of redness)
• A moist, "spongy" wound
• Irregular swelling along the edges of the wound
• A foul-smelling, thickened discharge
• Pain, itching, or burning

If the wound is opened, it will be moist and raw with swollen, inflamed tissue.

Urinary Incontinence

People who are incontinent can also experience skin maceration. Unless the urine-soaked clothing and bedding are changed regularly, prolonged exposure can lead to skin ulcers, particularly in skin folds or where the skin is compressed against the mattress. The damage will generally be centered around the area of urine pooling around the skin.

Elderly people are most vulnerable due to skin thinning. Reduced blood circulation and a weak immune system lower the body's ability to fight infection.

Maceration will also accelerate the formation of bed sores, and prevent them from healing.

Complications

With skin maceration, any skin that is broken, has poor circulation, or experiences prolonged hyperhydration may be vulnerable to injury or infection. This is called moisture-associated skin damage (MASD).

Skin infections caused by maceration can progress, leading to cellulitis (a serious skin infection that spreads to deeper layers of skin) necrosis (tissue death).

On rare occasion, an infection can become systemic, meaning that it moves from the site of the initial infection into the bloodstream. Referred to as septicemia, the infection is life-threatening.

Symptoms include:

• Confusion
• Delirium
• Dizziness
• Fatigue
• Fever
• Flushing
• Inability to urinate
• Low body temperature
• Rapid heart rate and respiration
• Shivering
• Shortness of breath

Without immediate hospitalization and treatment, death may occur. Septicemia is most often associated with a systemic bacterial infection (bacteremia).

A weak immune system is a risk factor for complications. Advanced HIV or having an organ transplant are risk factors for systemic fungal infections. Post-operative infections are often bacterial and caused by Staphylococcus aureus or Pseudomonas aureginosa.

Treatment and Prevention

Most cases of skin maceration are treated by keeping the skin clean and dry. Once a scab has formed, the air around the wound is usually better than keeping it tightly bandaged. You may want to keep the wound covered while at work or doing manual labor, and your healthcare provider might advise you to keep it uncovered and place antibiotic ointment at other times.

Treating Skin Wounds

If you have had a serious skin wound or have undergone an operation, you need to follow your healthcare provider's instructions on how and when to change the wound dressing. This is especially important if you're using an occlusive bandage.

Managing Urinary Incontinence

To prevent skin maceration in incontinent adults, always use disposable, absorbent undergarments and change them the moment they are soiled. Avoid caffeinated beverages later at night, which promote urination (but never deprive an elderly adult of fluids to avoid bedwetting).

If an accident does occur, wash and dry the skin gently with soap and water. Moreover, check for bed sores or any signs of skin breaks or infection.

Bed sores require intensive management. This may involve a saline solution to remove any dead cells and an appropriate moisturizer to keep the skin soft. Depending on the size of the sore, your healthcare provider may prescribe a zinc paste bandage, zinc oxide paste, or other types of dressings and medications to aid in the healing.

Pain

Treatment for pain can be complicated with ulcerative sores. Tylenol (acetaminophen) is often helpful for pain. A lidocaine ointment may also help ease the pain.

Beta-blockers, corticosteroids, and nonsteroidal anti-inflammatory drugs (NSAIDs) can all interfere with healing.

When to See a Healthcare Provider

If you follow wound care instructions but still have a spongy or "weepy" wound, speak to your healthcare provider. Depending on the amount of seepage you're experiencing, your practitioner may recommend that you change to a hydrofiber dressing (which wicks the fluid discharge away from the wound) or an alginate dressing (a carbohydrate-based biofilm designed to absorb heavy wound discharge).

If an infection develops, call your healthcare provider immediately. Signs include fever, pain, heavy discharge, or a foul smell.

Treatment of an infection can include:

• Depending on the severity of the infection, you may need a course of topical or oral antibiotics.
• Iodine-infused gauze pads and dressing may also be used if there is heavy discharge.
• Leg ulcers are usually treated with elevation and compression stockings.
  

Septicemia requires hospitalization and emergency care. Treatment may involve intravenous fluids, antibiotics, norepinephrine (to control low blood pressure), and corticosteroids (to reduce inflammation).

A Word From Verywell

If you have a cut or burn, follow the basic first aid guidelines, ensuring the wound neither gets dirty nor becomes overly moist. Getting proper nutrition, especially having enough protein, will give your body the nutrients to start the healing process. Be sure to drink the recommended amount of water to also help speed up the healing process.

If a wound isn't healing or if you have pain, fever, chills, or any signs of infection, speak with your healthcare provider. You could have an infection, circulatory disorder, or chronic condition (like diabetes) in need of special attention.