Best practices for preventing Moisture-Associated Skin Damage (MASD)

If you have an elderly parent or loved one who suffers from incontinence, you’re probably familiar with the expression MASD or moisture-associated skin damage. While your loved one’s healthcare providers will help identify and treat MASD initially, it is ultimately up to you – the at-home caregiver – to monitor and treat this condition over the long-term. Read on to learn more about MASD and what steps you can take to help nurse damaged skin back to health.

What is MASD?

The formal definition of MASD is: inflammation and erosion of the skin caused by prolonged exposure to moisture and its contents, including urine, stool, perspiration, wound exudate, mucus, or saliva, and the chemical combination of the moisture source, friction and microbial pathogens. Said more simply, MASD is skin breakdown caused when the skin is exposed to excessive wetness.

Skin starts out healthy

Before we can understand how to treat damaged skin, we need to understand what keeps skin healthy. The stratum corneum, the outermost protective layer of the skin, is responsible for the barrier that protects the skin and for maintaining moisture and hydration of the skin. Healthy skin is resilient, pliable, elastic, slightly moist and well hydrated. The skin is naturally populated with microorganisms such as staphylococcus aureus, staphylococcus epidermis and some forms of streptococcus. Substances in sweat, sebum and the acid pH (4.5-5.5) of the skin help to prevent these organisms from becoming pathogenic. This is referred to the acid mantle. When the acid mantle is breached, often by one of the conditions listed below, MASD occurs.

Four conditions that cause MASD

  • Incontinence associated dermatitis (IAD)
  • Intertriginous dermatitis, also termed intertrigo (ITD)
  • Peristomal moisture-associated dermatitis
  • Periwound moisture-associated dermatitis

It’s important to remember that moisture from any source increases the skin’s permeability and decreases its barrier function.

Factors that intensify MASD and make it worse include:

  • Type and chemical composition of fluid: sweat, urine, stool, wound exudate
  • Friction: skin folds, clothing, adhesives/tape removal
  • Obesity: skin changes, pH, poor heat exchange
  • Microorganisms: skin flora, stool flora, cross contamination

Best practices for attaining healthy skin

Now that you know what causes MASD and what can make it worse, what can you do to treat it, or even better, prevent someone who is at risk from getting it?

  • Cleanse the skin gently with pH balanced cleansers
  • Apply a high-quality moisturizer daily or twice daily
  • Use skin barriers such as creams, ointments, pastes and film-forming skin protectants
  • Use a skin protectant (dimethicone, breathable cyanoacrylate protective film, petrolatum, or zinc oxide)
  • Use absorptive, polymer-based containment underpads/drypads designed to wick incontinence moisture away from the skin
  • Select an appropriate ostomy pouching system (if applicable) and accessory products such as skin barrier paste, skin barrier strips, convex barriers and belts
  • See a Certified Wound and Ostomy Care Nurse (CWOCN) or Certified Ostomy Care Nurse (COCN)

The right products can also help:

Disposable cloths

  • Use combined, single-step, no-rinse products – disposable washcloths that incorporate cleansers, moisturizers and skin protectants into a single product
  • Use smoothly woven, disposable cloths
  • Use absorptive, polymer-based underpads/drypads


  • Choose loose-fitting clothing and use bed linens made from microfiber, polyester fabric designed to reduce friction and wick perspiration away from the skin and to the fabric surface where it evaporates


  • Choose topical dressings based on fluid handling, avoiding both excessive dryness and excessive moisture in the wound bed
  • Use a more absorbent dressing
  • Change the dressing more frequently
  • Utilize window dressings and/or external collection devices (pouching systems) when indicated



Gray M, Black J, Baharestani M, Bliss D, et al. Moisture –Associated Skin Damage. JWOCN. 2011; 38 (3): 233-241

Black J, Gray M, Bliss D, Kennedy-Evans K, et al. MASD Part 2: Incontinence-Associated Dermatitis and Interiginous Dermatitis. JWOCN. 2011; 38 (4): 359-370

Colwell J, Ratliff C, Goldberg M, Baherestani M, et al. MASD Part 3: Peristomal Moisture Associated Dermatitis and Periwound Moisture-Associated Dermatitis. JWOCN. 2011; 38 (5): 541-553

Gray M. Incontinence-related skin damage: essential knowledge. Ostomy Wound Manage 2007;53(12):28-32 WOCN. Guideline for Prevention and Management of Pressure

Ulcers. Glenview, IL. The Wound Ostomy Continence Nurse’s Society