Incontinence-Related Skin Damage: Essential Knowledge
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Index: Ostomy Wound Management 2007;53(12):28–32.
Incontinence-associated dermatitis, a clinical manifestation of moisture-associated skin damage, is a common consideration in patients with fecal and/or urinary incontinence. Among hospitalized patients, the prevalence rate has been found to be as high as 27%. Exposure to skin surface irritants may be a predictor and the condition, in turn, may be a factor in pressure ulcer risk because skin integrity is compromised. Differential diagnosis, usually based on visual examination, can help determine whether incontinence-associated dermatitis or a pressure ulcer is present. Prevention comprises following a structured skin care regimen that includes gentle cleansing, moisturization, and application of a skin protectant or moisture barrier. Treatment goals include protecting the sk
in from further exposure to irritants, establishing a healing environment, and eradicating any cutaneous infection. This concise review of relevant literature underscores the scant amount of evidence-based information available and highlights the need for further studies that involve comparing protocol and product efficacy to determine best practice for this oft-encountered condition.
KEYWORDS: incontinence-associated dermatitis, perineal dermatitis, moisture-associated skin damage, dermatitis, incontinence
Although both continence and wound care specialists often encounter patients with moisture-associated skin damage, knowledge of its prevalence, diagnosis, and management is limited. For the continence specialist, skin damage is a complication of prolonged exposure to urine or stool and often thought to be best managed by treating the underlying incontinence. In contrast, patients with incontinence-related skin damage often are referred to a wound care specialist when they develop a pressure ulcer and treatment tends to focus primarily on the full-thickness wound. The purpose of this brief review is to outline essential knowledge about skin damage related to incontinence from the perspective of the continence clinician. This knowledge includes the epidemiology, primary causes, and clinical course of incontinence-associated dermatitis; its relationship to pressure ulceration and pressure ulcer risk; its distinctive characteristics; and its management.
What is Incontinence-Associated Dermatitis?
Moisture-associated skin damage (MASD) is a term frequently used by clinicians to describe the irritation, inflammation, and erosion associated with prolonged exposure of the skin to perspiration, urine, stool, or wound exudate.1 Clinically, MASD may manifest in several ways. Incontinence-associated dermatitis (IAD),2 sometimes referred to as perineal dermatitis, is characterized by irritation and inflammation of the skin from prolonged exposure to urine or stool. Incontinence-associated dermatitis also is a factor of regular use of an absorptive containment device such as an incontinence brief or pad, which raises the pH of the underlying skin and increases production of perspiration. Erosion of the skin occurs frequently — probably attributable to friction created by moving moist or saturated pads or clothing over irritated skin or to damage from digestive enzymes present in liquid or solid stool.