Maceration — the Effects of Long-Term Fluid Exposure

Maceration develops when large amounts of fluid remain in contact with the skin for long periods. In some cases, this happens when a wound leaks fluid. Maceration may also occur as a result of perspiration, urine, and many other liquids. This exposure can cause wounds to deteriorate, heal slower than normal, and possibly become infected.

Wrinkled, soggy skin is an earlyearly sign of maceration and indicate that the skin is over-hydrated. The skin may also become pale and extremely soft. Some individuals develop bedsores or venous ulcers, and pain, itching, and burning sensations are also common. Wounds may begin to swell irregularly and release a foul-smelling discharge if opportunistic organisms infect the area.

Anything from a small bandage on a paper cut to professional wrapping of larger wounds can lead to maceration. It is most common during occlusive therapy: using materials that are completely air- and water-tight to prevent microbes from entering a wound. Unless there is regular changing of the dressing, fluid cannot evaporate and therefore accumulates on the skin, and maceration may occur.

Maceration may also develop in people with urinary incontinence and low mobility. Following urine leakage, clothes and bedding need cleaning and changing. If this does not occur, prolonged exposure can trigger skin maceration and ulcers. These situations most commonly affect older adults, who also have thinner and more sensitive skin and reduced blood circulation.

Some people sweat more than the typical amount. This condition, hyperhidrosis, is common and often nothing more than an annoyance. However, the excess perspiration can cause maceration in certain circumstances. For example, sweat can be trapped in socks and shoes, leading to severe maceration of the feet. In other cases, fluid may accumulate in skin folds, joints, bandages, or tight-fitting clothing.

In most situations, maceration resolves once the skin is dry. However, skin with significant damage may not recover without professional care. Experts will sometimes refer to this as moisture-associated skin damage (MASD). Treatment begins by removing irritants and then protecting against future exposure. Barrier ointments or films can help defend the skin, and catheters can help in cases of incontinence. Wounds that leak fluid may require highly absorbent bandages.

Maceration can worsen and develop several dangerous complications. Among these, some of the most severe involve ulcers and lesions. These wounds leak substances that break down the skin, allowing serious infections to develop. As these infections progress, they may lead to issues like cellulitis. In extreme circumstances, maceration can result in tissue death or necrosis.

Infections that result from maceration can become systemic and spread to the bloodstream, triggering some life-threatening issues. This is sepsis, and if the following symptoms are not recognized and treated, it can be fatal.

• Confusion
• Dizziness
• Fatigue
• Fever
• Flushed or red skin
• Low body temperature
• Shivering
• Inability to urinate
• Difficulty breathing or shortness of breath

Experts have attempted to discover when levels of hydration in the skin become damaging and cause maceration, but they have yet to reach a consensus. Because of this, they recommend regularly changing out bandages and dressings, especially if fluid has begun to accumulate. Additionally, practicing proper hygiene and washing clothing and bedding regularly can prevent maceration.

Most cases of maceration resolve without issue once the skin is dry. People with hyperhidrosis, urinary incontinence, or diabetes should visit a doctor if a wound appears to heal poorly or slowly. Speak with a doctor immediately if experiencing any of the symptoms of an infection or sepsis. Once the maceration is resolved, most people lead typical lives.