What Is Macerated Skin: Causes and Treatment

What is macerated skin?

Maceration usually occurs when the skin comes in contact with moisture for a long period of time. Macerated skin appears white, wrinkly, and soggy. The skin also becomes soft, making it more susceptible to bacterial or fungal infections. In some cases, macerated skin can cause pain and exposes a layer of skin tissue. 

Macerated skin is often associated with wounds, particularly wound dressings that are not regularly changed. Maceration can also cause slower healing of wounds. 

Causes

It is normal for the skin to regularly come into contact with moisture, such as moisture from sweat and water. These sources of moisture can affect the skin's appearance. Another source of moisture is during the process of wound healing, in which discharged fluids and pus accumulate in the skin that surrounds the wound. 

Other examples of mild skin maceration include wearing a bandage, getting your feet wet while walking in the rain, or soaking in a bath. In most cases, mild skin maceration resolves on its own after the skin gets the chance to dry out. However, when the skin is always exposed to moisture, macerated skin cannot easily return to its normal appearance. 

The most common causes of skin maceration are:

1. Wound healing and wound dressings

Open wounds due to injuries usually trigger a response from the body's immune system. This trigger involves the release of the substance called histamine, which enables the widening of blood vessels for the release of plasma. 

Plasma and other fluids accumulate in the skin around the wound, causing it to swell. To prevent maceration and other complications, it is very important for wounds to be regularly cleaned, dressed, and dried. Maceration most likely happens when the wound is infected, slowly heals, or not healing properly. The production of pus and other fluids tend to increase when a wound is infected. 

The following are some of the common types of wounds that are more prone to maceration:

• Third-degree burns (full thickness burns)
• Diabetic foot and leg ulcers
• Decubitus ulcers or pressure ulcers (bed sores)
• Venous leg ulcers

2. Hyperhidrosis

In hyperhidrosis, people unpredictably and excessively sweat. This medical condition usually affects the palms of the hands, soles of the feet, and underarms. Even when at rest or in a cool temperature, people with hyperhidrosis may still sweat. 

It is normal and healthy for the body to produce sweat, but excessive sweating can cause mild maceration. The most prone to maceration is the feet since wearing shoes with socks make them more difficult to dry. When the feet remain wet or damp in an unsanitary condition for a long period of time, a painful feet condition called trench foot can develop.

3. Hygiene

The risk of developing skin maceration also increases when people have poor hygiene practices. Bedridden patients and people with incontinence are also more susceptible to skin maceration. When these patients are often in contact with damp bedsheets, incontinence pads, and urine-soaked clothing, bacterial or fungal infections and adult diaper rash may develop aside from maceration. 

Maceration can also develop even if you have good hygiene. Not properly drying your feet or applying too much moisturizer to your feet before wearing socks can also lead to a mild skin maceration. 

Treatment

Macerated skin treatment usually depends on the main cause and severity of maceration. Mild cases of maceration are often reversed by simply exposing the affected skin area to air. However, severe cases usually require treatment. 

There are specific types of dressings and bandages when it comes to treating macerated skin due to wounds. They are:

• Occlusive Dressings: These type of dressings are used to seal specific types of wounds from fluids, air, and other harmful microorganisms, such as bacteria, viruses, and fungi. They are wax-coated, nonabsorbent, and are both watertight and airtight. Thus, these dressings can provide maximum protection against moisture and bacteria. They also help in reducing wound pain and improve wound healing time. However, the quality of occlusive dressings also depends on certain factors, such as the type of wound, the condition of the area surrounding the wound, and the skill of the caregiver dressing the wound. 

• Hydrofiber Dressings: These dressings are soft, sterile gauze pads and bandages that are designed to absorb excess moisture during the wound healing process. There are also some Hydrofiber dressings that contain iodine, which helps minimize the risk of developing maceration. 

Your healthcare provider can help provide more information regarding the specific type of bandage to use for your wound. They can also show you how to properly put on the bandages as well as give instructions on how often to change the bandages. For extra protection and to prevent excess moisture around your wound, your healthcare provider might also prescribe topical medications. 

Complications

The skin is a barrier that protects the body's internal organs and tissues against external threats. However, when there is maceration, this barrier becomes weak, making the skin more prone to developing bacterial and fungal infections. Macerated skin also easily breaks down and can delay the healing of wounds. 

Aside from being more susceptible to developing infections, maceration can also cause pain and discomfort. When macerated skin is rubbed against footwear or clothing, a new wound can arise and can expose underlying skin tissues.

Contact your healthcare provider if you have a slow-healing wound. Your doctor may give you additional treatment to help prevent any infection and maceration. 

Prevention

The following are some preventive measures to help identify, manage, and prevent skin maceration:

• Reduce and monitor moisture levels in people who are bedridden, especially those who struggle with incontinence. Maceration can occur in these people since they are immobile and always on their bed. Beddings can trap moisture next to the skin, so bedridden people are more susceptible to developing infections and bed sores. 
• After soaking in a bath or getting your feet wet, give your skin enough time to dry out. 
• Regularly change undergarments, diapers, dressings, and other things that tend to retain moisture on your skin. 
• Apply topical medications to skin areas that are more prone to maceration. 
• Reverse mild maceration by exposing your skin to air. 
• If home remedies fail to work, make sure to consult your healthcare provider, especially if you have slow-healing wounds.