In everyday clinical settings, wound care professionals routinely employ medical adhesives to secure surgical wound dressings, sites of blood draws, catheters, and feeding tubes. While their usefulness is self-evident, these adhesive materials are known to adversely affect the skin of susceptible patients (such as older individuals and kids) with more fragile skin resulting in acute skin injuries.

What Are Medical Adhesive-Related Skin Injuries (MARSI)?

Medical adhesive-related skin injuries refer to injuries sustained as a result of the application of adhesive materials to the superficial layer of the skin. These retaining materials are usually used to hold medical devices, medications, and wound dressings in place over considerably longer periods. As a result of prolonged contact, the skin underlying the adhesive material will undergo trauma and inflammation lasting at least thirty minutes after it has been removed.

How Does MARSI Occur?

In susceptible patients, the application of a medical adhesive to their skin places them at a higher risk of developing tissue injury when the adhesive is removed after serving its purpose. The removal of the glue material will shear off the upper portion of the epidermis triggering an acute inflammatory response. 

Categories of MARSI

Skin injuries resulting from the use of medical adhesives include the following categories:

• Irritant dermatitis
• Allergic dermatitis
• Folliculitis
• Maceration

Clinical Features

Depending on the type of adhesive-related skin injury sustained, the symptoms a patient presents with will also vary. For MARSI due to irritant contact dermatitis, the affected skin will appear erythematous (reddened) with well-defined borders. The erythema usually resolves in one to two days if the dressing isn’t replaced. Differentiating MARSI due to irritant dermatitis from an allergic cause is tricky even for wound care experts however the presence of vesicles in addition to the erythema and a positive patient history of allergies may indicate allergic dermatitis. 

Patients with folliculitis due to MARSI will usually have papular or pustular rashes resulting from bacterial colonization and localized infection in affected areas. Macerated skin will appear gray, wrinkled, and friable and is easily damaged by frictional forces or irritant chemicals. 

Which Patients Are the Most at Risk?

The underlisted category of patients are at a higher risk of developing MARSI than the rest of the population based on the presence of intrinsic and extrinsic modifying factors. Intrinsic risk factors for MARSI include the following:

• Older individuals with more fragile skin
• Babies being nurtured in neonatal intensive care units with immature skin, and imperfect thermoregulatory mechanisms 
• Malnourished patients from various illnesses that limit their oral intake of required nutrients
• Dehydrated patients
• Patients with copious wound exudate from chronic wounds
• The presence of chronic medical conditions like diabetes that impair sensory perception making patients more likely to remain unaware of injuries sustained
• Patients with mental illnesses
• Individuals with dermatological conditions that diminish the tensile strength of the skin

Modifiable external risk factors for developing MARSI include:

• Individuals who have undergone radiation therapy
• Patients with urinary incontinence
• Patients who require frequent dressings as the epidermis is more frequently
• Skincare products like soaps and lotions
• Dry skin increases the risk of shear and friction
• Limited ambulatory capacity for example immobilization following orthopedic surgery
• Exposure to sharp edges and surfaces that can damage the skin

Assessment of MARSI

While there is no universally agreed scale to assess the severity of MARSI in patients with acute to chronic wounds, wound care experts can utilize established scales for predicting pressure sores as a template for categorizing MARSI.

Wound Care for Patients With MARSI: Treatment and Prevention Strategies

The treatment and prevention principles used in treating medical adhesive-related injuries are quite intertwined. With early recognition of signs and symptoms of MARSI, wound care experts can offer methods that treat sustained injuries and prevent their future recurrence.

To limit the risk of developing injuries due to the use of medical adhesives, wound care providers can apply the precautions/preventive measures listed below:

• Early recognition of at-risk patients and careful selection of wound adhesives
• Utilize softer paper or cloth adhesives in place of nylon tapes
• Apply adhesive removers to limit friction or shear during removal of tougher adhesive materials
• Encourage patients to keep their skin moisturized at all times
• Avoid leaving adhesives in place for prolonged time intervals, changes should ideally be done twice weekly
• Use skin sealants, sleeves to protect the area around adhesive dressings

Commonly employed treatment methods include:

• Infection control
• Pain management
• Wound drainage, cleansing, and moisture control
• Double layer wound dressing strategies

Infection Control

Some forms of MARSI such as folliculitis requires wound care experts to prescribe appropriate oral or intravenous antibiotics to eliminate the harmful bacteria causing patient symptoms. Swabs taken at injury sites can be used for laboratory culture and sensitivity tests to determine the most appropriate class of antibiotics to treat identified organisms.

Pain Management

The loss of superficial skin can be a painful experience for patients and might hinder cooperation with further treatments. Wound care providers must provide adequate analgesia to relieve pain associated with MARSI.

Wound Drainage, Cleansing, and Moisture Control

Patients with MARSI require constant wound care inclusive of drainage and cleansing. Saline can be used to irrigate wound sites after proper drainage to limit bacterial colonization and promote wound healing. Further, moisture control with absorbent wound dressings must also be considered as too little or too much wound moisture can adversely affect tissue recovery.

Double-Layer Wound Dressings

To reduce injury to the skin surface, wound care experts can use a double layer dressing which is more convenient to remove. A non-adhesive dressing can be placed over the affected skin area covered up with a second dressing. This will prevent additional trauma occurring with already injured skin.