Ask Proactive – I struggle with identifying Moisture Associated Skin Damage (MASD) from some pressure injuries. How can MASD and pressure injury be differentiated?

Q:

I struggle with identifying Moisture Associated Skin Damage (MASD) from some pressure injuries. How can MASD and pressure injury be differentiated?

Differentiating between Moisture Associated Skin Damage (MASD) and pressure injuries can be challenging, even for experienced clinicians. Both conditions can present with redness, irritation, and skin breakdown, but their underlying causes, locations, and appearances are distinct. Accurately identifying whether skin damage is moisture-related or pressure-related is essential for providing the right treatment, preventing further complications, and ensuring regulatory compliance.

Key Differences Between MASD and Pressure Injuries

Cause

• • MASD: Caused by prolonged exposure to moisture (urine, stool, sweat, wound drainage, saliva). The moisture breaks down the skin barrier.
  • Pressure Injury: Caused by unrelieved pressure and/or shear over a bony prominence, impairing blood flow and leading to tissue damage.

Location

• • MASD: Found in moisture-exposed areas (buttocks, groin, skin folds, around stomas, under dressings). Usually not directly over a bony prominence.
  • Pressure Injury: Usually develops over bony prominences (sacrum, heels, hips, ankles, elbows).

Appearance

• • MASD:
    • Diffuse, irregular, and shallow skin breakdown
    • Redness, inflammation, burning or itching
    • May look like a superficial burn
    • Edges are irregular and not well-defined
  • Pressure Injury:
    • Localized, usually circular or oval
    • Can be non-blanchable redness (Stage 1) or open wound (Stage 2+)
    • Edges are more distinct and well-defined

Depth

• • MASD: Typically superficial (epidermis/dermis only). Rarely extends deep.
  • Pressure Injury: Can progress from superficial redness to full-thickness skin and tissue loss, sometimes exposing bone or muscle.

Contributing Factors

• • MASD: Incontinence, perspiration, wound drainage, poor perineal care, occlusive dressings.
  • Pressure Injury: Immobility, poor repositioning, friction/shear, unrelieved pressure.

Resident Experience

• • MASD: Often described as painful, burning, or itching in a broad area.
  • Pressure Injury: May be painful or tender at a specific spot, especially over bone.

Quick Tip for Staff:

• • If it’s over a bony prominence and related to immobility → Think Pressure Injury
  • If it’s in a moist area, diffuse, or irregular → Think MASD

Correctly distinguishing between MASD and pressure injuries is critical for guiding care, preventing worsening skin damage, and ensuring accurate documentation. By focusing on cause, location, appearance, and contributing factors, staff can better identify the underlying issue and implement the most effective interventions. Remember: pressure injuries are typically linked to immobility and occur over bony prominences, while MASD is associated with moisture and often appears in diffuse or irregular patterns. A clear assessment leads to more targeted treatment, improved resident comfort, and better outcomes.

References

Beeckman, D. (2017). A decade of research on Incontinence-Associated Dermatitis (IAD): Evidence, knowledge gaps and next steps. Journal of Tissue Viability, 26(1), 47–56. https://doi.org/10.1016/j.jtv.2016.02.004

Gray, M., Giuliano, K. K., Black, J. M., & Baharestani, M. M. (2011). Moisture-associated skin damage: Overview and pathophysiology. Journal of Wound, Ostomy and Continence Nursing, 38(3), 233–241. https://doi.org/10.1097/WON.0b013e318215f798

National Pressure Injury Advisory Panel (NPIAP). (2016). NPIAP Pressure Injury Stages. National Pressure Injury Advisory Panel. https://npiap.com/page/PressureInjuryStages

Written By:

Brandy Hayes, RN, RAC-CT, RAC-CTA

Clinical Consultant

Proactive LTC Consulting