The skin around a wound is referred to as the periwound area. And this particular area of skin requires special treatment while a wound is healing.  

That’s because a wound causes trauma to the surrounding skin. Also, as the body works to heal a wound, the periwound area becomes particularly sensitive. For these reasons, it’s very easy for periwound skin to become damaged.

The primary culprits for irritation and damage are excessive moisture, the removal and reapplying of dressings, and infection.

It’s important to spot any signs of irritation and damage early because, left untreated, it can cause a range of problems. These include:

• Moisture-Associated Skin Damage (MASD)
• Medical Adhesive-Related Skin Injury (MARSI)
• Maceration (inflammation and erosion of the skin due to moisture)
• Infection
• A slower healing process

So how can you tell if periwound skin is irritated and in need of extra protection?

What are the symptoms to look out for?

Here, we’re going to take a look at a number of warning signs, all of which indicate periwound skin needs timely care and attention.

How do we define the periwound area?

Let’s start by clarifying what we mean by the periwound area.

It’s the area around a primary wound site. Typically, this means the 4cm of skin surrounding a wound in all directions.

However, it’s worth noting that simply measuring the space around a wound won’t be relevant to all patients, wounds, and wound areas. The periwound area may extend for more or less than 4 cm and it’s important to assess periwound areas on a case-by-case basis.

Signs of irritation to look out for

If we’re to keep periwound skin healthy and protected, we need to know all of the signs of skin irritation and damage that we should be looking out for.

Anyone with a healing wound can experience periwound complications. But some people are at particular risk. You’re more likely to experience irritation around a wound site if you have:  

• A skin condition like psoriasis
• Incontinence
• Diabetes
• A poor diet
• Reduced mobility

Deep wounds and wounds located in a fold of the skin are also particularly prone to periwound area damage.

But whether you fall into a high-risk category or not, you should monitor the skin around your wound for the following issues.

Pain and irritation

We’re starting with the most obvious. If the area around a wound is painful or tender to the touch, this could be a sign that some damage has occurred.

Of course, the area around a wound is likely to be tender. But if you notice an increase in the pain or sensitivity you’re experiencing, this is a sign that something isn’t quite right.

With a proper cleansing and moisturising routine, you shouldn’t have much pain around the periwound area. So don’t put up with pain thinking that it is to be expected.

Colour change and swelling

Even perfectly healthy periwound skin will be slightly redder and more swollen than the rest of your skin. However, you should keep an eye out for a significant change in the colour of your skin or any additional swelling.

Damaged skin can turn redder or even go grey. And if skin becomes pale, weak, and wrinkly, this is a likely sign of maceration.

Likewise, if you find that periwound skin is more swollen than it was, err on the side of caution and speak to a healthcare professional.

Scaling and thickening

Another tell-tale sign of skin damage and maceration? Scaling and thickening of the skin.

This usually occurs when damaged skin has been left untreated. After turning weak and thin, the skin starts to toughen up, becoming discoloured, dry and scaly.

If you think that you’re experiencing either of these signs of irritation, it’s important to take action right away as it’s likely that your skin has already undergone significant damage.

Changes in wound exudate

Depending on the type of wound you have, the type and amount of wound exudate will vary. It’s important to keep an eye on exudate so you know what is normal for you. This makes it easier to spot any changes.

If your wound exudate does change, this could be a sign of damage or infection. And when there’s increased exudate, things can quickly turn into a vicious cycle.

Moisture on the skin for a prolonged period of time can cause further irritation and damage, so keep an eye on your wound exudate and seek advice if anything changes.

Other changes to the periwound area

Any changes to the periwound area can be a cause for concern. For example, if you have a wound and periwound area of 10cm, and that suddenly expands to 20cm, there is likely to be something wrong.

Other changes to look out for include:

• The shape of the wound and periwound area
• Temperature of periwound skin compared to unaffected skin

Essentially, like with all of the points listed above, it’s important to know what is normal for you. And if that changes, seek medical support right away.

Fever or flu-like symptoms

If you have a raised temperature or start to feel that you’re coming down with a bad case of the flu, then your wound may be infected.

Don’t wait to see how you are in a day or two — it’s best to seek medical attention quickly if you have any wound infection concerns.

The best treatment is prevention