title: Identifying, managing and preventing skin maceration: a rapid review of the clinical evidence.
abstract: OBJECTIVE
  To identify the clinical empirical evidence for identifying, managing and preventing skin maceration in human subjects.
  
  
  METHODS
  A rapid review of the current literature was undertaken between 5 September and 19 September 2016 using the electronic databases CINAHL, MEDLINE, PUBMED and Cochrane, with the key words: skin macerat*, wound macerat*, moisture associated skin damage, wound exudate and hyper-hydration of skin, Results: Of 526 papers found using an electronic database search, four were identified as fitting the search parameters, and a further two were retrieved from a manual search of reference lists. There were three themes that emerged: how to identify and measure maceration, how to manage and reduce maceration once it has already occurred, and how to prevent skin maceration. Hyper-hydration can reach greater skin depths than previously thought, thus engendering more extensive damage potential, which in turn can impact on treatments and healing time. Realistically, the deeper the hyper-hydration issue, the more extensive the damage and it will take longer to recover-a problem compounded if the hyper-hydration is due to incontinence and skin is also exposed to urine and/or faeces. In relation to wound management, the authors advocate the removal of moisture away from the wound or skin, either through superabsorbent dressings, or by allowing the excess moisture to evaporate through semi-permeable dressings to reduce maceration, enhance patient comfort and encourage healing. However, we found no evidence regarding the limits of hydration of the dermis and epidermis and thereby the optimal conditions for managing exuding wounds and promoting skin health. Each of the six papers in this review calls for further research to help identify, treat and prevent maceration.
  
  
  CONCLUSIONS
  Maceration causes patients' discomfort and pain as well as prolonging healing time and deserves more focused research. This rapid review highlights how limited the clinical empirical research is on identifying and managing skin maceration from an early stage so that health professionals may be better equipped to prevent it. Further clinical research is also needed to determine when levels of hydration in the skin become damaging. The small number of studies within this review show that skin maceration can be avoided, but clearer guidance is needed.
authors.affiliation: Postgraduate Student Diploma in Adult Nursing, King's College London, Florence Nightingale Faculty of Nursing and Midwifery, 57 Waterloo Road, London, SE1 8WA, UK.
authors.forename: F
authors.initials: F
authors.lastname: Whitehead
authors.affiliation: Research Associate, King's College London, Florence Nightingale Faculty of Nursing and Midwifery, 57 Waterloo Road, London, SE1 8WA, UK.
authors.forename: S
authors.initials: S
authors.lastname: Giampieri
authors.affiliation: Research Associate, King's College London, Florence Nightingale Faculty of Nursing and Midwifery, 57 Waterloo Road, London, SE1 8WA, UK.
authors.forename: T
authors.initials: T
authors.lastname: Graham
authors.affiliation: Professor of Nursing Technology and Innovation, King's College London, Florence Nightingale Faculty of Nursing and Midwifery, 57 Waterloo Road, London, SE1 8WA, UK.
authors.forename: P
authors.initials: P
authors.lastname: Grocott
mesh_terms: D041342:Absorbent Pads; D001458:Bandages; D055317:Evidence-Based Practice; D006801:Humans; D017592:Skin Care; D012871:Skin Diseases / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D014549:Urinary Incontinence / Q000150:complications; D014947:Wounds and Injuries / Q000517:prevention & control* / Q000628:therapy
keywords: moisture associated skin damage; rapid review; skin maceration; skin moisture management