Pathway for the treatment of skin that is damaged and excoriated by moisture







First Line management should be good skin care with Emollients i.e Hydromol.
This pathway is to be used as a step up after primary emollient therapy has been proved to be
ineffective.
These guidelines are secondary to establishing and addressing the cause of the incontinence /
excoriation
Do not use soap to cleanse skin in this area, use Hydromol as a soap substitute.
Continence pads must be worn on the body, not laid underneath the patient.
Do not use blue incontinence sheets for moisture prevention.
The creams below are indicated for use with continence products and do not block the pad
absorbability.
Skin Type
Clinical intervention
Product
Patient has
incontinence or has an
excessive sweating
problem.
Healthy, intact skin but
patient has been
assessed as ‘at risk’ of
skin damage secondary
to moisture.
No erythema.
Prevention :
 Maintain skin hygiene
and emollients
 Replace pads when
indicated.
 Establish & address
the cause of the
incontinence.
 Only consider barrier
product if patient has
been assessed as at
risk.
MEDI DERMA S
barrier cream 2g
Sachet (x20)
Tube 90g
Skin is moist with
diffuse erythema.
There is Superficial skin
damage present.
This is not associated
with pressure.
 1st line -Cleanse using
hydromol as a soap
substitute after every
episode of
incontinence.
Medi derma S
barrier film
1ml & 3ml foam
applicators
Large surface
areas and painful
moisture lesions
use Medi derma S
spray 50mls
(see guidance )
If this fails to work:
 2nd line -apply barrier
preparation after
every 3rd wash
 Manage cause of skin
breakdown.
 If unable to manage
incontinence seek
advice and support
from bladder &bowel
service
 Refer to TV to aid
management of skin.
Pathway for the treatment of skin that is damaged and excoriated by moisture by moisture/tissue
Viability/Jan’16/V4

Peri wound skin is
white waterlogged
/macerated due to
poor management of
exudate




Spreading erythema.
Extensive excoriation.
Up to 50% of affected
skin is broken.
Oozing / bleeding may
be present.
High bacterial load is
usually present.
There may be fungal
involvement.
Deeper ulceration
which has not been
managed by above
treatments OR complex
patient and wound
factors which cannot be
resolved and has the
potential to
deteriorate.

Address underlying
causes such as
oedema or infection
Check appropriate
absorbent pad is
being used (for mod
to high levels of
exudate this should
be Sorbion S )
Consider frequency of
dressing changes
Apply barrier film at
every dressing change
after the limb has
been washed
Medi derma S
Barrier film
Foam applicators
1ml and 3ml sizes
Skin has been
assessed as
excoriated due to
urine /faeces
Skin is in an
inflammatory stage or
has a high bacterial
load but not infected
Medihoney
barrier cream
Sachets –2g
Tube -50g
(Indicated for
treatment of mild
fungal infection).
N.B.If peri wound
skin is excoriated
due to high
bacterial load then
consider
Medihoney barrier
cream
If gross fungal
infection consider
antifungals.


Do as above
Exclude any issue
with pressure damage
Proshield Plus
PIP-359-8760
Ensure you use
the Proshield
foam and spray
cleanser
(pip-359-87520)
for the removal of
proshield plus
(Proshield is on
the restricted
formulary please
contact TV for
support).
Pathway for the treatment of skin that is damaged and excoriated by moisture by moisture/tissue
Viability/Jan’16/V4