How can you tell if skin breakdown in the buttock region is moisture-associated skin damage (MASD) from incontinence, versus a pressure injury?

MASD is the irritation or erosion of the skin secondary to exposure to a moisture source. Ammonia from urine and enzymes from stool can disrupt the pH of the skin, causing it to become irritated and break down. 

MASD from incontinence covers a large surface area, usually including both buttocks. The area is not isolated to a bony prominence. The edges are irregular and not well confined to a pressure point. The skin can appear irritated and raw, and may have superficial denuded areas within. The red, irritated skin will be blanchable. If the area has a red raised rash with satellite lesions, suspect a fungal infection. 

Skin damage from moisture may increase the risk of pressure injuries. The presence of moisture changes the mechanical properties of the skin, making it more susceptible to the strains of pressure and shearing forces.

If a pressure injury is forming within the MASD, the red skin will not be blanchable. Denuded skin from MASD stays superficial, with a red/pink wound bed. If a pressure injury is starting to form within the denuded area, it will have granulation, slough and/or eschar tissue. A pressure injury will be a localized area within the MASD, typically over a bony prominence. 

To prevent MASD, use toileting schedules to minimize or eliminate incontinence episodes. Ensure the incontinence brief has adequate absorption and wicks the urine away from the skin. Use petroleum and/or silicone-based barrier ointments to protect the skin from moisture, but ensure they are compatible with the brief. If the resident is having loose stools, an assessment should be completed. Involve the dietary department to ensure appropriate diet and fiber.