Periwound Skin Protection: Prevention and Treatment

Periwound Skin Protection in Wound Care

The wound bed gets most of the clinical attention. The skin around it often gets none -- until it breaks down. Periwound skin protection in wound care is not a secondary concern. Damaged periwound skin enlarges the wound, compromises dressing adhesion, increases pain, and creates a new problem layered on top of the original one.

Periwound skin damage is preventable. When it does occur, it is treatable. But both prevention and treatment require deliberate assessment and product selection at every dressing change, not after the damage is visible.

Types of Periwound Skin Damage

Understanding what is damaging the periwound skin determines the intervention. The four most common mechanisms in wound care are distinct and require different responses.

Maceration

Prolonged exposure to wound exudate softens and breaks down the epidermal barrier. Macerated skin appears white, wrinkled, and fragile. It tears easily, extends the wound margin, and creates an environment favorable to bacterial colonization.

Cause: Poorly managed exudate, dressings left in place too long, inadequate absorptive capacity of the chosen dressing, wound exudate pooling at the wound edge.

Moisture-Associated Skin Damage (MASD)

MASD encompasses maceration but also includes damage from urine, stool, perspiration, and wound drainage that contacts intact skin over time. In wound care, the most common form is periwound moisture-associated dermatitis -- erythema, erosion, and pain caused by chronic exudate exposure.

Cause: Same as maceration but often compounded by enzymatic content of wound exudate (proteases, MMPs) that actively degrade skin proteins.

Contact Dermatitis

Allergic or irritant reactions to wound care products -- adhesives, skin preps, antimicrobial agents, or dressing components. Presents as erythema, vesicles, or pruritus in the pattern of product application.

Cause: Sensitization to acrylate adhesives, colophony (rosin) in tapes, latex, or chemical irritants in wound cleansers.

Skin Stripping

Mechanical removal of the epidermal layer when adhesive dressings or tapes are removed. Appears as partial-thickness skin loss in the pattern of the adhesive, often with pain disproportionate to wound size.

Cause: Aggressive adhesive removal, frequency of dressing changes with strong adhesives, fragile skin (elderly, steroid-dependent, malnourished patients).

Barrier Products for Periwound Protection

Barrier Films (Liquid Skin Protectants)

Products like Cavilon No-Sting Barrier Film, Skin-Prep, and Marathon Liquid Skin Protectant create a transparent, breathable polymer layer on intact periwound skin.

Application: Apply to clean, dry periwound skin before placing the primary dressing. Allow to dry completely (30-60 seconds). The barrier film protects against both exudate exposure and adhesive stripping.

Best for: Routine periwound protection at every dressing change, wounds with moderate exudate, skin at risk for adhesive damage, and as a base layer under transparent film dressings.

Barrier Creams and Ointments

Zinc oxide-based products (Desitin, Calmoseptine) and dimethicone-based barriers (Critic-Aid, Proshield) provide thicker, longer-lasting moisture barriers.

Application: Apply a thin, uniform layer to periwound skin. Do not apply into the wound bed. These products repel moisture and protect against enzymatic degradation.

Best for: Heavily exudating wounds, wounds in skin fold areas (groin, gluteal cleft, under pannus), periwound skin already showing early signs of maceration, MASD around fistula sites.

Consideration: Thick ointment barriers can interfere with adhesive dressing adhesion. Apply barrier cream to the periwound skin and barrier film to the area where adhesive dressings will be placed.

Skin Protectant Wipes and Sprays

Convenient single-use applicators for barrier film application. Functionally equivalent to liquid barrier films but easier to apply in the field and in home health settings.

Best for: Mobile wound care, home health visits, patient self-care education.

Maceration Prevention Strategies

Preventing maceration is a moisture balance problem. The wound needs a moist environment, but the periwound skin needs a dry one. Managing this boundary is the core skill.

Dressing Selection

Match absorptive capacity to exudate volume. Alginates and hydrofibers for heavy exudate. Foams for moderate. Hydrocolloids for light-to-moderate.
Superabsorbent dressings for wounds with very high output where standard absorptive dressings saturate between visits
Change dressings before saturation, not after. A saturated dressing cannot manage additional exudate and becomes a maceration source.

Dressing Technique

Cut primary dressings to wound size. Absorptive dressings overlapping onto intact periwound skin pull moisture to the skin surface and cause maceration.
Ensure secondary dressings extend beyond the wound margin to catch any exudate that migrates laterally
For wounds in dependent positions, consider a secondary absorptive pad placed at the lowest gravity point to catch drainage that pools

Wound Edge Management

Apply barrier film or cream to the wound edge and periwound skin at every dressing change
If maceration is already present, assess whether the current dressing plan is managing exudate adequately -- persistent maceration despite barrier products means the dressing itself needs to change
Wound edge epibole (rolled wound edges) can trap moisture and worsen maceration. This requires clinical assessment and possible wound edge debridement.

Adhesive Selection for Fragile Skin

Adhesive-related skin damage is preventable with appropriate product selection.

Silicone Adhesives

Products using Safetac (Mepilex, Mepitel) or other silicone-based adhesive technology minimize skin stripping. Silicone adhesives adhere to the skin surface without bonding to the epidermis, allowing atraumatic removal.

Best for: Elderly patients, patients on chronic steroids, patients with skin tears, frequent dressing changes, any wound where adhesive stripping has been a problem.

Acrylate Adhesives

Standard medical tape and many transparent film dressings use acrylate adhesives. These provide strong adhesion but carry higher skin stripping risk, especially with repeated application to the same skin area.

Best for: Situations requiring strong adhesion (NPWT drapes, high-movement areas) where silicone adhesion is insufficient. Always use with skin prep or barrier film underneath.

Adhesive Removal Technique

Remove adhesive dressings low and slow -- pull parallel to the skin surface, not perpendicular
Support the skin ahead of the removal line with one hand while peeling with the other
Use adhesive remover wipes (silicone-based) for dressings that resist low-and-slow removal
Never "rip" adhesive dressings from elderly or fragile skin patients

Key Takeaways

Assess periwound skin at every dressing change -- damage that goes unaddressed enlarges the wound and compromises dressing function
Apply barrier film or cream to periwound skin routinely, not reactively after maceration has developed
Match dressing absorptive capacity to exudate volume and change dressings before saturation to prevent maceration
Use silicone-adhesive dressings for fragile skin and practice low-and-slow removal technique to prevent skin stripping
Periwound skin damage from adhesives, maceration, or contact dermatitis should be documented as a separate clinical finding with its own treatment plan