If you’ve ever watched an adhesive dressing take skin with it, you already understand the core problem this post is about.
Older adults are disproportionately vulnerable to medical adhesive-related skin injury (MARSI). A single painful dressing change can turn “routine wound care” into a skin tear, blistering, or inflammation that delays healing and forces more frequent interventions.
This guide is an awareness-stage set of best practices for atraumatic care: how to reduce MARSI risk, why soft silicone is often chosen when skin is fragile, and how to remove silicone foam dressings with less trauma.
Clinical note: This article is for education and procurement/clinical alignment. Follow facility policy and consult a qualified clinician for patient-specific decisions.
What MARSI is (and why older adults are higher risk)
MARSI is skin damage that persists after removal of an adhesive product. It can show up as erythema, blistering, skin stripping, or tearing. The preventable part is not “never use adhesives.” It’s using them with risk screening, skin protection, and atraumatic removal.
A practical summary of prevention steps appears in Prevention of medical adhesive-related skin injury during patient care (2022), including risk assessment, using adhesives only when necessary, and barrier protection for at-risk skin.Prevention of medical adhesive-related skin injury during patient care (2022)
For older adults, risk is amplified because aged skin is often drier and more fragile, and because comorbidities (edema, steroid use, anticoagulation, poor nutrition) are common. That combination means:
Less “margin for error” when you remove an adhesive
Higher likelihood of shear forces causing a skin tear
More severe consequences when the barrier is compromised
Why soft silicone matters when skin is fragile
Soft silicone dressings are designed to adhere gently to intact peri-wound skin while releasing with less trauma. DermNet describes the “tack” behavior of soft silicone: it forms contact with the skin to create a seal but is intended to be removable without aggressive stripping.DermNet NZ: Silicone dressings (2023)
A key reason soft silicone is associated with atraumatic removal is reduced disruption of the stratum corneum (the outermost barrier layer). In a study examining the effects of dressing removal on the stratum corneum, silicone adhesive and self-adhesive polyurethane foam removed less stratum corneum than comparators.Removal of adhesive wound dressing and its effects on the stratum corneum (2012)
More recent experimental work comparing skin response metrics also found silicone adhesive tapes were less disruptive to the skin barrier than acrylate adhesive tapes in healthy volunteers.Comparison of Medical Tape Performance Using Skin Response… (2024)
Soft silicone isn’t magic, and it’s not right for every scenario. But in a fragile-skin population, a soft silicone adhesive interface can be a practical default because it reduces the chance that removal itself becomes the injury.
Best practices for atraumatic care with silicone foam (MARSI-focused)
Below are best practices you can translate into an internal protocol. Each includes (1) why it matters, (2) how to implement it, and (3) what failure looks like.
1) Treat “fragile skin” as a first-class risk flag
Why it matters: Aged skin is more likely to strip or tear with adhesive removal.
How to implement: Before applying any adhesive dressing, document risk factors (age-related fragility, prior MARSI, corticosteroids, edema, anticoagulants, malnutrition, history of dermatitis). Reassess at each dressing change.
Failure mode: The team uses a “standard” adhesive routine across all patients, and skin injury becomes a predictable complication.
2) Prep the skin like you’re protecting a barrier, not just “cleaning”
Why it matters: Over-cleansing, friction, and incomplete drying increase irritation and reduce tolerance to adhesives.
How to implement:
Cleanse gently per protocol
Pat dry completely (don’t rub)
Moisturize intact surrounding skin routinely (avoid applying moisturizer directly where the adhesive must bond unless the product guidance allows it)
Failure mode: The dressing edges lift, staff re-tape repeatedly, and removal becomes progressively more traumatic.
3) Use a skin barrier film when risk is high
Why it matters: A barrier can reduce friction and limit direct adhesive interaction with fragile skin.
How to implement: Apply barrier film to intact peri-wound skin (per product instructions) and let it dry fully before placing adhesive.
Failure mode: Mild erythema after each change progresses to stripping or blistering because the barrier was never established.
4) Avoid “making it stick better” with tackifiers unless clinically justified
Why it matters: Adhesive enhancers can increase removal trauma in fragile skin.
How to implement: Default to securement strategies that don’t increase adhesive aggressiveness. If additional adhesion is needed, step back and check the cause (skin moisture, placement tension, body contours, dressing size).
Failure mode: The dressing stays on, but removal causes skin stripping that becomes the bigger clinical problem.
For a concise checklist-style reminder set, see the MARSI Consensus Cheat Sheet (Solventum, 2025).
5) Apply without tension and minimize rework
Why it matters: Tension increases shear forces during wear and during removal.
How to implement:
Position the limb and smooth the dressing into place without stretching skin
Choose a size/shape that fits the anatomy to reduce edge lift
If you must reposition, do it gently and early (before strong edge bonding develops)
Failure mode: Wrinkles and tension points create micro-tears, and “touch-ups” add layers of adhesive stress.
6) Remove “low and slow,” at a low angle, while supporting the skin
Why it matters: Pulling up and away concentrates force and can strip the stratum corneum.
How to implement (micro-technique):
Start at a corner and loosen the edge
Keep the dressing parallel to the skin (low angle)
Peel back slowly while supporting the skin with your free hand
This aligns with widely taught adhesive removal principles; see American Nurse: A guide for adhesive removal (2017).
Failure mode: A quick “rip” (even if unintentional) causes skin stripping or a tear that then needs additional dressing and increases total cost of care.
Pro Tip: If the patient reports sharp pain during removal, pause and reassess. Pain can be the earliest warning signal before you see visible injury.
7) Use an adhesive remover thoughtfully (and avoid harsh solvents on fragile skin)
Why it matters: Some solvents dry or irritate skin, which worsens fragility.
How to implement: Use remover products intended for medical adhesives per facility policy. Apply at the interface to release adhesion, then continue low-angle removal.
Failure mode: Alcohol-based shortcuts dry the skin and increase irritation; the next dressing change is worse.
8) Monitor early irritation and don’t wait for blistering
Why it matters: MARSI often escalates across repeated cycles of apply-remove-apply.
How to implement: At each change, document:
Edge erythema or rash patterns
Complaints of burning/itching
Any lifting that triggers extra tape use
Failure mode: The team keeps the same routine until a blister or skin tear forces a change.
9) Match silicone foam use to wound and skin needs (not just habit)
Why it matters: Foam dressings are typically chosen for exudate management and cushioning, but not every wound is exudative, and not every skin condition tolerates prolonged occlusion.
How to implement: Use silicone foam when it fits the wound’s exudate level and protection needs, and reassess as the wound changes.
Failure mode: A foam dressing stays in place out of routine even when the wound becomes drier, and the dressing choice stops matching the wound environment.
10) Have an escalation rule for suspected sensitivity or dermatitis
Why it matters: “Hypoallergenic” is not “no one reacts.” Contact dermatitis can mimic infection or worsen skin breakdown.
How to implement: If you see blistering under adhesive, patterned rash, or escalating itching/burning:
Stop and assess for dermatitis
Consider alternative securement strategies
Involve wound/dermatology expertise per facility protocol
Failure mode: The team continues adhesive exposure, worsening the reaction and expanding the damaged area.
Atraumatic removal mini-SOP (copy/paste)
Use this as a quick internal standard for dressing changes on fragile skin.
Assess risk (fragile skin, prior MARSI, steroids, edema, anticoagulants).
Prep skin: cleanse gently, pat dry, apply barrier film if indicated.
Apply without tension: avoid stretching skin; smooth edges.
Remove low and slow: low angle, parallel to skin; support adjacent skin.
Use remover as needed per protocol; avoid harsh solvents on fragile skin.
Document skin response after removal and before re-application.
Escalate if rash/blistering/pain suggests sensitivity.
Where silicone foam fits (a neutral note for procurement teams)
When your clinicians are trying to reduce dressing-change trauma in a fragile-skin population, soft silicone silicone-foam constructions are commonly considered because they aim to balance secure placement with atraumatic removal.
If you’re building a documentation packet for hospital review, a manufacturer like SLK Medical may provide silicone foam options. For general compliance and documentation support, SLK Medical’s overview page on manufacturing standards and regulatory documentation is a practical starting point: SLK Medical’s wound care OEM/ODM compliance and documentation overview (2026).
Key takeaways
MARSI is often preventable when you combine risk screening, skin protection, and atraumatic removal.
Fragile geriatric skin has less tolerance for adhesive trauma; the removal technique matters as much as the dressing.
Soft silicone is associated with reduced skin stripping compared with stronger adhesive systems in published evidence.
“Low and slow, low angle” removal with skin support is the core technique to standardize.
Build an escalation rule for suspected dermatitis or sensitivity; don’t wait for blistering.
Next step (low-commitment)
If you maintain a wound care formulary or SOP library, share the mini-SOP above with your clinical stakeholders and ask one question: Do we train and audit adhesive removal technique the same way we train and audit dressing selection?
