Tips for Differentiating Between Pressure Injuries and Moisture Associated Skin Damage (MASD)
When it comes to staging pressure injuries (PI) and identifying moisture-associated skin damage (MASD) it can be challenging. Both types of wounds have similar presentation and show up consistently on the same parts of the body.
Pressure Injury Basics
Pressure injuries (PI) result when prolonged pressure impairs blood flow to an area by compressing tissues/vessels. These injuries are found over bony prominences in the body such as the coccyx, sacrum, scapula, and heels. Medical devices or other foreign objects that put pressure against the body can also cause a pressure-related injury. Common culprits for medical device-related pressure injuries are nasal cannulas, gastric tubes, and indwelling catheters. Other factors such as moisture and nutrition also play a big part in the formation and treatment of pressure-related wounds.
Pressure Injuries Stages
- Stage I: Skin is still intact with non-blanchable redness or erythema. The area may be painful, soft, warmer or cooler than the rest of the body.
- Stage II: Partial thickness loss of dermis presenting as a shallow open ulcer with red and/or pink wound bed. The wound bed is without slough. It may also present as intact or open serum-filled blister.
- Stage III: Full thickness tissue loss in which subcutaneous fat may be visible but bone, tendon, or muscle are not exposed. Slough may be present, but the visible slough does not obscure depth. May include undermining and tunneling at this stage.
- Stage IV: Full thickness tissue loss with exposed bone, tendon, and/or muscle. Slough or eschar may be present on some parts but not enough to cover the wound bed. This stage often has undermining and/or tunneling.
- Deep Tissue Injury: Purple or maroon localized area of discolored intact skin. Could also be seen as a blood-filled blister due to damage or underlying soft tissue from pressure and/or shear. Ultimately the skin is still intact, and the depth is unknown at this point in time.
- Unstageable: There is full thickness tissue loss in which the base of the ulcer is covered by at least 50% slough and/or eschar. Most of the wound bed cannot be seen and therefore cannot yet be staged.
Moisture Associated Skin Damage Basics
MASD develops when the top layer of skin is damaged first. Top-down skin injury (outer layers of skin are damaged first): The inflammation and erosion of the skin is caused by prolonged exposure to moisture. The sources of moisture may include urine or stool perspiration, wound exudate, mucus, or saliva. The moist and often macerated skin is in a weakened state that is easily damaged by friction. MASD is common between skin folds, around stomas and peri-wounds, and to the peri-region in incontinent patients.
Comparison of Pressure Injuries and Moisture Associated Skin Damage
MASD and PIs can be easily confused with one another. It is common for MASD to contribute to the formation of a pressure injury since the tissue has become compromised. A pressure injury with a lot of drainage can also lead to MASD to the peri-wound. While it may be hard to decipher between the two types of skin injuries, here is a quick reference to refer to during an assessment that can help a nurse decide.
Moisture Associated Skin Damage
- Cause, Prevent, Treatment: Too much moisture has compromised the skin and led to breakdown. Find a way to control the source of moisture that is damaging the tissues.
- Location: Diffusely distributed over an area. Wound margins are often irregular.
- Color: Pink or red but is still blanchable.
- Depth: Partial thickness tissue loss. Blisters with serous fluid might be present.
- Necrosis: None.
- Pain: Pain is common. The patient may also complain of burning or itching.
Pressure Injuries
- Cause: Pressure is the cause, and the priority is to offload the area or to remove the source of pressure.
- Location: Usually over a bony prominence or from a medical device. Wound edges are well circumscribed.
- Color: Wound bed may be red, blue, or purple. The wound bed could also be obscured by slough or eschar which would be yellow, white, tan, brown, or black.
- Depth: Partial or full thickness depth. Blisters may be present over pressure areas or from equipment or devices. Blisters could be filled with either serous fluid or blood.
- Necrosis: May potentially have slough or eschar.
- Pain: May or may not be present. Some wounds may not have much feeling if the wound is too deep, and the nerve endings are damaged.