What is MARSI?

The use of precise terminology is essential for professional and scientific communication, documentation, and clinical decision making. It also serves as the cornerstone for evidence-based practice. Concepts, labels, and words we use guide our thinking.

Reports about cutaneous side effects due to dressings date back to the 1950s1 but it was not before 2013 when the term “Medical adhesive-related skin injury (MARSI)” was introduced into the international literature.2 This term was developed to describe various clinical signs including skin stripping, tension blisters, skin tears, irritant and allergic contact dermatitis, maceration and folliculitis.2 Since then, this term has become very popular, with more than 50 publications in Web of Science having MARSI in the title (this number was determined based on a search of electronic database October 2024).

The big advantage of introducing new concepts such as MARSI is, that the importance of this health problem is emphasized and appropriate interventions regarding assessment, prevention and therapy are brought to the fore. However, this advantage must be weighed against the disadvantage that new terms are useful only if they describe health risks, problems or diseases for which a commonly accepted terminology is not already established. Otherwise, it may introduce confusion and hinder communication especially between professions and disciplines.

For example, contact and allergic dermatitis are established diagnoses in dermatology and skin research and have been used for decades. Both diagnoses are defined and coded in the International Classification of Diseases by the World Health Organization (including “Allergic contact dermatitis due to adhesives” (L23.1) in the ICD-10CM system) which can be regarded as the international reference classification. Therefore, I assert it is not immediately clear why this precisely defined type of dermatitis should be relabeled MARSI from now on.

A subsequent question is: Is dermatitis an injury? Debates about what injuries are in comparison to ulcerations have been conducted intensively elsewhere, particularly in the area of pressure injury versus ulceration. What is certain is that in international reference classifications of an injury is understood as having a “rapid onset in response to a well-defined event (e.g. a car crash, striking the ground after falling…”).3 This definition definitely applies to skin stripping and skin tears as trauma caused by medical adhesive removal, but not to dermatitis, folliculitis or maceration.

Irrespective of this, terms such as skin tears or maceration have also been defined in detail elsewhere. For example, skin tears might be related to adhesive product application or not. Periwound and peristomal maceration and dermatitis have also been proposed to be forms of so called “moisture-associated dermatitis” (MASD). However, is it actually possible to decide, whether for example periwound dermatitis is MASD caused by “moisture” or MARSI caused by an medical adhesive? In most cases, it is a combination of several triggering factors including occlusion beneath dressings or tapes. From a clinical point of view, I assert it makes no difference.

One may argue that MARSI is just an umbrella term, because the application and removal of medical adhesives may cause a wide range of unwanted skin reactions.4 However, this does not answer the question of why contact dermatitis, maceration, skin tears or other skin lesions should be called MARSI rather that the specific, well-defined, and established terms I have identified in this View from Here? For clinicians and researchers, it is much more important to know, that a medical adhesive caused an allergic reaction or a maceration, because this guides the clinical decision making and the subsequent course of treatment. The same applies for prevention. For example, preventing maceration of the wound edge requires a different approach than preventing skin tears or allergic dermatitis. For scientists, it is comparatively unimportant to know whether a MARSI developed or not, but rather which skin reaction, lesion, or injury occurred.

Irrespective of the term MARSI, there seems to be a tendency for creative word creations and new names, especially in the field of pressure and wound care, although the underlying theory and clinical and scientific advantages are not always clearly established.5 Therefore, I strongly recommended that new terms are only introduced if they improve clinical care and outcomes.