Incontinence Associated Dermatitis (IAD) is a significant but largely preventable problem (1, 2). IAD is inflammation of the skin because of urinary and/or faecal incontinence (3). The management and prevention of IAD consists of assessment and management of incontinence and adopting a structured skin care routine (1).

A structured skin care routine consists of cleansing the skin prior to application of a skin protectant, protecting the skin to avoid or minimise exposure to urine and/or faeces, and restoring the skin to support and maintain the barrier function of the skin using a suitable leave on product (4).

Avoid the use of soap for cleansing the skin and instead use products that are as close to neutral pH as possible (4.5-5.5). These products include foam cleansers, moistened body tissues, or emollients that cleanse and moisturise the skin at the same time. Pat the skin dry rather than rub.

After cleansing the skin, it is important to apply a barrier preparation to protect the skin. These products help to maintain the barrier function of the skin by providing an impermeable or semi-permeable barrier to protect it from urine and/or faeces.

Barrier preparations are available as a cream, spray, wipe, or foam-based film. Ideal barrier preparations are those that are non-occlusive and transparent after application allow skin inspection and do not require removal. A barrier preparation should resist water wash off, lock in moisture to hydrate the skin and protect it from moisture.

There are several different types of barrier preparations available. There are silicone polymers which contain dimethicone creating a dry, water-repellent, flexible barrier to protect the skin from moisture whilst also hydrating the skin by locking in moisture (4). Acrylate terpolymers bond to the skin forming a transparent polymer film. Cyanoacrylate-based polymers bond to the stratum corneum of the skin forming a robust elastomeric polymer film. Unlike pure acylate terpolymers, cyanoacrylate polymers are resistive to cracking providing greater barrier protection for high-risk areas where there is wet and weeping skin. Barrier preparations usually require application after every episode of incontinence whilst some can provide up to 72 hours of protection. Creams should be thinly applied so they are absorbed into the skin. Barrier preparations should be applied to all areas of the skin in contact with urine and/or faeces.

Zinc oxide barrier preparations can be difficult to remove and must be applied sparingly or they can clog continence aids. When applied sparingly, petrolatum (petroleum jelly) preparations form an occlusive layer and increase hydration of the skin but can affect the absorption of continence products.

Maintaining skin barrier function can be achieved by using a leave-on skin care product.

If the skin is broken, there is localised erythema and/or signs of fungal or bacterial infection, consider the need for an indwelling catheter and/or faecal management system to temporarily remove the source of inflammation. If there is bacterial and/ or fungal infection, then treat the infection using appropriate topical and/or systemic antifungals or antibiotics.

With a structured skin care plan, there should be an improvement in symptoms within 1-2 days and complete resolution within two weeks. However, if there are no signs of improvement or there is deterioration, then refer for specialist advice.

Written by Dr Michelle Gibb, founder of Wound Specialist Services.

References:

1. Dissemond J, Assenheimer B, Gerber V, Hintner M, Puntigam MJ, Kolbig N, et al. Moisture-associated skin damage (MASD): A best practice recommendation from Wund-D.A.CH. J Dtsch Dermatol Ges. 2021;19(6):815-25.

2. Campbell J, Gosley S, Coleman K, Coyer F. Combining pressure injury and incontinence-associated dermatitis prevalence surveys: an effective protocol? Wound Practice and Research. 2016;24(3):170-7.

3. Beeckman D, Campbell J, Campbell K, Chimentao D, Coyer F, Domansky R, et al. Proceedings of hte Global IAD Expert Panel. Incontinence-associated dermatitis: moving prevention forward. Wounds International. 2015.

4. Ousey K, O’Connor L. IAD Made Easy. Wounds UK; 2017. p. 1-6.