What is the treatment for incontinence dermatitis?

Treatment of Incontinence-Associated Dermatitis

The treatment of incontinence-associated dermatitis (IAD) requires a structured skin care program that includes gentle cleansing, moisturizing, and application of a skin protectant or barrier cream after each incontinence episode. 1, 2

Understanding Incontinence-Associated Dermatitis

IAD is inflammation of the skin resulting from repeated contact with urine and/or feces. It causes:

• Pain
• Redness
• Swelling
• Excoriation
• Potential complications including fungal skin infections and pressure injuries

Treatment Protocol

1. Cleansing

• Replace soaps and detergents with gentle skin cleansers 3
  • Perineal skin cleansers are preferable to water and soap 2
  • Soap and water perform poorly in prevention and treatment of IAD 4
  • Use a dispersible cream as a soap substitute 3

2. Drying

• Gently pat the skin dry (do not rub)
• Ensure skin is completely dry before applying any protective products

3. Moisturizing

• Apply a moisturizer to hydrate the skin 2
• Most effective when applied after cleansing 3

4. Skin Protection

• Apply a skin protectant/barrier cream after each incontinence episode, particularly when feces are present 2
• Zinc oxide is recommended as it:
  • Protects chafed skin
  • Helps protect skin from wetness
  • Helps treat and prevent rash 5

5. Incontinence Management

• Use appropriate absorbent products (pads, liners, absorbent underwear) 3
• Change incontinence products promptly after soiling

Special Considerations

For Severe Cases

• If secondary infection is present:
  • Bacterial infection: Look for crusting or weeping 3
  • Fungal infection: Consider antifungal treatment
  • Viral infection (herpes simplex): Look for grouped, punched-out erosions 3

For Different Types of Incontinence

• Urinary incontinence: Focus on quick absorption and pH neutralization
• Fecal incontinence: More aggressive skin protection needed due to enzymatic damage
• Mixed incontinence: Requires comprehensive approach addressing both types

Effectiveness of Treatment

Evidence suggests that:

• Implementation of a structured perineal skin care program is effective in both prevention and treatment of IAD 2
• Application of leave-on products (moisturizers, skin protectants) is more effective than withholding these products 4
• The performance of leave-on products depends on the combination of ingredients and overall formulation 4

Common Pitfalls to Avoid

• Misdiagnosis: IAD is often confused with pressure ulcers 6
• Inadequate cleansing: Failing to remove all residue after incontinence episodes
• Insufficient protection: Not applying barrier products after each episode of incontinence
• Harsh cleansing: Using soap and water which can further damage the skin 4
• Overlooking the cause: Not addressing the underlying incontinence issue

By following this structured approach to treating incontinence-associated dermatitis, healthcare providers can effectively manage this common condition and improve patient comfort and skin integrity.