Macerated Skin

What Causes It and How to Treat It

Dressing a patient’s wound.
Dressing a patient’s wound. Science Photo Library/Getty Images

Maceration is a skin condition that occurs when fluid or moisture is in contact with the skin for an extended period of time. The macerated skin softens, turns white, soggy, and wrinkly, and can more easily become infected with bacteria or fungi. Sometimes macerated skin causes pain or soreness and exposes an underlying layer of tissue.

Macerated skin is usually associated wounds, especially wound dressings that aren't changed regularly enough.

(Think about how, say, the skin on your finger can look when you wear a Band-Aid for too long.) Maceration can slow the healing of the wound. 

Causes of Maceration

Maceration can be caused by urinary incontinence, soaking in a tub, and sweating, but it's most often caused by the fluids that wounds produce. A wound produces fluids that are meant to aid healing, but if the wound is not cared for in the right way, an accumulation of this fluid can cause the skin to deteriorate. This can happen when a bandage is wrapped too tightly around a wound or isn't replaced often enough.

Macerated skin is often a side effect of several different chronic wounds, including bedsores, diabetic foot ulcers, leg ulcers, and fungating lesions. The fluids that these chronic wounds create contain proteases: enzymes that break down proteins and peptides. In other words, proteases break down even healthy skin tissue.

How the Wound Healing Process Works 

The normal wound healing process begins when damaged cells release histamine, which causes blood vessels to leak plasma. As a result, nearby skin tissue begins to swell—and this swelling is clinically known as edema. Fluid starts to accumulate. At first, the fluid is clear, but it later becomes thicker and more opaque.

The amount of fluid that's produced varies, depending on the wound. For example, a wound that is not properly cared for could produce a greater level of fluid.

Treating and Preventing Macerated Skin

There are two types of wound dressings that are used to both treat and prevent macerated skin: occlusive dressings and Hydrofibers. An occlusive dressing is a wax-coated wound covering that provides an air- and water-tight seal. Hydrofiber dressings, like sterile gauze pads, absorb moisture and promote healing. Some gauze pads contain iodine, which further prevents maceration.

They key is knowing which type of dressing to use, how to put it on, and when to replace it with a new one. So it's very important to talk to your doctor about these two points. For example, a gauze pad can absorb only so much fluid, so it's critical that it's discarded and replaced after a certain amount of time has passed. Otherwise, fluid can build up and maceration can occur. Maceration can also happen if the dressing is applied too tightly. 

Minor cuts and scrapes (like a small nick on your finger) can be treated at home, but a larger laceration or lesion (like a burn on your arm) that produces a significant amount of fluid should be seen by a doctor.Remember, macerated skin raises the risk of infection and can slow wound healing, so take it seriously and consult a doctor right away if you notice any symptoms of the condition.