Posted June 14, 2015
  • | Continuum of Care
  • | Other

Identifying Skin Breakdown in the “Gluteal Cleft”

Margaret Lehmann

According to the CDC, the prevalence of obesity in the US has soared to 42.4%, with medical costs exceeding the billion-dollar mark. Caring for this patient population poses unique challenges particularly in the area of skin breakdown. Pressure injuries don’t always form in the usual locations like the heels and sacrum. That’s too easy. Sometimes they present in hard-to-reach areas such as the gluteal cleft. But just because these wounds are difficult to get to, doesn’t mean these areas can be neglected. 

Obese patients with firm buttock tissue are particularly at risk. When clinicians can’t separate the gluteal cleft for skin integrity evaluation or cleansing and drying, skin breakdown may develop. But first, it is important to understand the difference between pressure injuries and moisture damaged skin. 

Moisture-related skin breakdown is usually characterized by superficial skin loss and irregular edges, classified as MASD (moisture associated skin damage). Prolonged exposure of the skin to high levels of moisture can result in acute maceration. The outer layer of epidermal cells become over-hydrated, causing swelling which weakens the skin tissue and its ability to withstand damage. The outer layer of the epidermis can be stripped away, increasing pain and the risk of secondary infection from bacterial and/or fungal organisms. 

Linear lesions in the intergluteal cleft are caused by moisture with or without a friction component and should be classified as intertriginous (between skin folds) dermatitis (inflammation of the skin). Pressure injuries, however, are ischemic injuries to the skin and underlying soft tissue that can result in full-thickness tissue damage. Pressure and shear factors cause compression of the circulation, distortion of tissue and blood vessels, and reperfusion tissue injury that result in the development of pressure injuries. So, what’s the best way to address the gluteal cleft dilemma?

Understanding the possibility of pressure injury development in patients with a firm inter-gluteal cleft is the first step towards prevention. Awareness is paramount. Carefully examining the gluteal cleft on a regular basis and palpating the area to assess for pain and bogginess is important. And it may be necessary for two caregivers to assist with skin assessment in this patient population. At the end of the day establishing solid interventions to manage moisture and initiating pressure redistribution support surfaces for at-risk individuals is the best course of action. But don’t forget the chairs. Compromised individuals need to be protected in and out of bed. Find the ideal support solutions for every patient population – Match the product to the patient!