Incontinence-associated dermatitis (IAD) is a form of skin inflammation and moisture-associated skin damage resulting from contact with urine and feces. This condition, referred to as IAD, causes symptoms such as irritation, redness, inflammation, burning, itching, and pain.
What is IAD?
IAD is a very uncomfortable and painful condition that compromises comfort and quality of life. If left untreated, it can lead to disabling secondary infections. IAD is the most common form of moisture-associated skin damage (MASD) and is characterized by erythema and edema of the skin surface. It often presents with inflammation, erosion, or denudation in the context of fecal or urinary incontinence.
Dermatitis associated with incontinence mostly affects the elderly and specifically impacts about 25% of patients in intensive care, 7% of those in long-term care units, and 3.4% of residents in nursing homes.
The Causes
Excessive hydration and the consequent increase in moisture of the stratum corneum impair the integrity of the epidermal layer of the skin. As a result, inflammation occurs due to the irritants in urine and feces penetrating this layer.
The risk of IAD is increased by the frequency of incontinence, along with the following factors:
- Previous scarring or history of pressure injuries
- Pre-existing comorbidities
- Immobility or impaired mobility
- Medications
- Nutritional status
- Inability to independently perform activities of daily
- living, such as cleaning the skin
- Level of cognitive functioning
- General skin condition
- Frictional skin injury
However, preventing the discomfort and pain of IAD is possible.
Prevention
The most effective way to prevent the worsening of IAD is to eliminate or reduce episodes of incontinence. This approach removes the primary factors—moisture, skin irritants, and friction—that contribute to skin lesions.
Methods to prevent IAD include:
- Using breathable incontinence aids
- Following a structured program for incontinence management
- Hygiene with products that do not require water and rinsing
- Checking the skin for redness, inflammation, rash, pain, or itching
- Avoiding rubbing the skin around the perineum
- Choosing products with a neutral pH (± 5.0)
In general, it is good to follow the three main steps to prevent and treat irritation:
- Waterless Cleansing: Use wipes, foam, or soapy gloves without rinsing.
- Hydration: Use lotions, oils, or barrier creams.
- Protection: Use creams and sprays containing zinc.
Diagnosis and Classification
IAD is classified according to severity: category 1 (mild) if the skin has redness but is intact; category 2 (moderate-severe) if redness is accompanied by skin damage.
The diagnosis of incontinence-associated dermatitis is based on two factors:
- Medical History of the Patient: information is collected on urinary and fecal incontinence, routine and use of absorbent devices such as diapers
- Observation and Inspection of the Skin: Patients with incontinence should be evaluated at least once a day. The areas exposed to feces and urine should be closely monitored.
Living with IAD
The treatment of dermatitis associated with incontinence involves the use of products with specific characteristics. The most appropriate ingredients for this category are:
- Allantoin: Stimulates the skin’s self-healing
- Glycerin: Acts as a moisturizer
- Zinc oxide: Has antiseptic properties and creates a protective barrier
- Dimethicone: Silicone oil that creates a barrier
The application of the products must take place with some precautions, such as the use of pre-soaked gloves that avoid rinsing with water, creams and sprays applied gently and without friction on the skin.
