Wound Care Made Incredibly Easy

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Moisture-associated skin damage

called the GLOBIAD-M that includes daily monitoring tools and more precise marking of areas affected by persistent erythema, skin loss, and signs of infection. The full text of that article including the additional tools is available for free at https://pubmed.ncbi.nlm.nih​ .gov/29797507/ A more complicated but useful tool to assess severity of IAD due to incontinence is the Incontinence-Associated Skin Damage and Its Se verity (IASD.D.2) tool (Bliss et al., 2018). It requires a score from 0 (no damage) to 4 (skin loss) in each of 14 areas where skin is likely to be affected by incontinence. Using the sum of the 14 scores allows track ing over time to quantify improvement and so is useful for research. The reason long-term exposure to saliva on the skin is damaging is partly due to the moisture exposure. Also, saliva contains digestive enzymes such as alpha-amylase, lysozyme, lactoferrin, and peroxidase, which help begin digestion of food as we chew. Saliva contains im munoglobulins with antibacterial properties that are helpful in the mouth, but not on top of the skin. One cause of irritation near the mouth from saliva is sialorrhea, excessive drooling. This can be corrected with medication or removal of one or more salivary glands. Another method is salivary gland ab lation; injecting the glands with alcohol shrinks them, but they still produce some saliva to prevent dry mouth. Botulism toxin injections have also been used. Using lip protectants is useful for prevention and treatment. Solid versions often contain a wax or other longer-lasting ingredients to help protect perioral skin from the effects of saliva ex posure. Other causes of irritant contact dermatitis (ICD) due to saliva are excess licking of the lips, neurologic deficits such as cerebral vas cular accident or coma, or a fistula of the oral cavity due to head and neck cancer. ICD due to respiratory secretions may occur near a related stoma or a fistula. The secretions will be 95% water with a pH around 6.0 but also contain mucus, which holds moisture longer and may be more damaging along with chemokines and cytokines that are known skin irritants. Managing secretions around a respira tory stoma such as a tracheostomy requires a different approach because of the risk of aspiration of many barrier products used to protect skin. Sometimes, a nonalcohol liquid protectant can be utilized successfully. The wicking textiles with silver that can be used in moist skin folds have also been successfully used to wick

Irritant contact dermatitis due to other body fluids Saliva

Respiratory secretions from a stoma or fistula

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