This blog will focus on preventing and treating IAD for individuals that correction of incontinence may not be impossible. Incontinence-associated dermatitis (IAD) is a type of moisture-associated skin damage (MASD). It is a form of irritant dermatitis from chronic urine and or stool exposure. The skin becomes inflamed. Therefore, prolonged exposure can lead to blistering, erosion, and skin infection. The skin is the largest organ of the body. Healthy normal skin provides a protective barrier. The normal pH of the skin ranges between 4-6 in the acidic range. The skin becomes vulnerable when it is in the alkaline range (>7.5). Repeated exposure to alkaline irritants increases the skin’s pH level. When the skin’s pH is in the alkaline range, it is associated with increased absorbance to the skin. Mnemonics is a memory tool for remembering an extensive list of steps. The assess, cleanse, and treat (ACT) tool will help individuals recognize the steps for care instructions.
The first step is to assess to provide appropriate care. The three considerations with skin assessment for IAD are cause, color, and condition.
- Cause: Assess if the incontinence is urinary, fecal, or a mix of both types. Fecal and mixed incontinence has an increased prevalence and severity rate for IAD. Determine if the cause is incontinence-related rather than pressure.
- Color: The inflammation causes color changes to the skin. The color changes in lightly pigmented skin appear to be bright red. In darkly pigmented skin, the color is darker than the natural skin tone.
- Condition: Assess if the skin is closed or open. Open areas related to IAD are called erosions. Erosions of the skin have indistinct irregular wound edges, partial-thickness depth without necrosis, and widespread clustered open areas. Pressure injuries have distinct wound edges with variations in ulcer depth and may have necrosis.
Cleansing helps remove the irritants from the skin after each incontinent episode. However, cleansing with harsh alkaline soap and water with materials such as washcloths can be harmful to the skin. The increased skin pH heightens the absorption of irritants from incontinence. Therefore, the process of cleansing and drying with washcloths can cause injury to the skin rather than increase blood flow. Current research studies recommend using pH-balanced no-rinse cleansers with a soft cloth or cleansing wipes.
Moisturize and Protect: Many products are available to prevent and treat IAD. Moisturizers promote skin repair with emollients or humectants, and occlusive skin barriers protect the skin from exposure to irritants. Ingredients may contain dimethicone, petroleum, and zinc oxide. Some or all of the ingredients are combined. Dimethicone is a silicone base clear, non-occlusive, and moisturizes the skin. Petroleum is used as a base ingredient and is a clear and occlusive moisturizer. Zinc oxide is opaque and helps to prevent water loss from the skin.
Single Step Wipes: This intervention provides cleansing, moisturizing, and protection in a one-step incorporated in a cleansing cloth. Some studies report this process is efficient with a higher rate of caregiver adherence to skin protocols.
Acrylate Terpolymer: This is a protective film applied to the skin with an applicator. The film is long-acting and does not require removal or reapplication after each incontinent episode.
Fungal/Yeast Infection: Notify physician for treatment for skin infections.
Contain: Current evidence-based practice discourages indwelling catheters and plastic-backed pads and briefs. Currently, there are external catheters for men and women. The latest advanced technology in body-worn absorptive products (BWAP) offers multilayer wicking absorption layers that are unbacked (without plastic covering). The latest BWAP products offer wicking away moisture and breathability to decrease skin damage from IAD.
IAD management involves a combination of preventative and therapy solutions. Simple mnemonics combined with evaluation can aid caregivers in adopting intervention and treatment options.
The views and opinions stated in this blog are exclusively those of the author and do not reflect those of iWound, its affiliates, or partner companies.
Further Reading and References
Davis, N. J., & Wyman, J. F. (2020, February). Managing Urinary Incontinence. American Journal of Nursing, 120(2), 55-60.
Koudounas, S., Bader, D. L., & Voegeli, D. (2020). Knowledge Gaps in the Etiology and Pathophysiology of Incontinence-Associated Dermatitis. Journal Wound, Ostomy, and Continence Nurs., 47(4), 388-395.
McNichol, L. L., Ayello, E. A., Phearman, L. A., & Culver, E. A. (2018, November). Incontinence-Associated Dermatitis. Advances in Skin & Wound Care, 31(11), 502-513.
Phipps, L., Gray, M., & Call, E. (2019). Time of Onset to Changes in Skin Condition During Exposure to Synthetic Urine. Journal Wound, Ostomy, Continence Nurs., 45(4), 315-320.
Rodriquez-Palma, M., Verdu-Soriano, J., Soldevilla-Agreda, J., Pancorbo-Hidalgo, P. L., & Garcia-Fernandez, F. P. (2021, May/June). Conceptual Framework for Incontinence-Associated Dermatitis Based on Scoping Review and Expert Consensus Process. Journal Wound, Ostomy, and Continence Nurs., 43(3), 239-248.