What is the treatment for an adult with gluteal cleft skin breakdown and skin breakdown?

Treatment for Gluteal Cleft Skin Breakdown in Adults

The treatment for gluteal cleft skin breakdown in adults should focus on a structured skin care regimen including gentle cleansing, moisture barrier application, and addressing the underlying cause of excessive moisture, with appropriate dressings to manage exudate and promote healing. 1

Assessment and Initial Management

• Perform thorough assessment of skin integrity to determine extent of breakdown and identify contributing factors 1
• Clean affected skin gently using pH-balanced, non-irritating cleansers with tepid water or saline for irrigation 1
• Regularly cleanse wounds by irrigating gently using warmed sterile water, saline, or a mild antimicrobial such as chlorhexidine (1/5000) 2, 1

Skin Protection and Moisture Management

Barrier Application

• Apply a greasy emollient, such as 50% white soft paraffin with 50% liquid paraffin, over the affected areas to:
  • Support barrier function
  • Reduce transcutaneous water loss
  • Encourage re-epithelialization 2, 1
• Use moisture barrier products to protect periwound skin from maceration 1

Dressing Selection

• Apply non-adherent dressings to denuded dermis (suitable options include Mepitel™ or Telfa™) 2
• Use secondary foam dressings to collect exudate 2
• Consider silver-containing products/dressings for areas showing signs of infection or slough 2, 1

Infection Management

• Take swabs for bacterial and candidal culture from three areas of lesional skin, particularly sloughy or crusted areas 2
• Administer systemic antibiotics only if there are clinical signs of infection, not prophylactically 2
• Monitor for signs of infection including:
  • Increased pain
  • Erythema
  • Purulent discharge
  • Malodor
  • Delayed healing 2

Positioning and Environmental Factors

• Position patients to minimize skin-on-skin contact in fold areas 1
• Place patients on pressure-relieving mattresses to reduce friction and shear 1
• Maintain ambient room temperature between 25°C and 28°C to reduce perspiration 1
• Implement a regular repositioning schedule to reduce pressure on affected areas 1

Advanced Interventions for Refractory Cases

• For severe or non-healing cases, consider surgical consultation for debridement of necrotic tissue 2
• In cases of pilonidal disease contributing to gluteal cleft skin breakdown, reshaping the deep gluteal cleft with a skin flap may be beneficial 3
• For extensive tissue damage, surgical approaches may include:
  • Removal of necrotic/loose infected epidermis
  • Debridement of non-viable tissue
  • Consideration of skin grafts or flaps for large defects 2, 4

Prevention of Recurrence

• Implement a regular toileting schedule (every 2 hours during day, every 4 hours at night) for incontinent patients 1
• Maintain adequate hydration during the day with reduced fluid intake in evening 1
• Consider alternatives to indwelling catheters for patients with urinary incontinence 1
• Use breathable materials for bedding and clothing 1

Monitoring and Follow-up

• Monitor healing progress daily
• Reassess treatment approach if no improvement is seen within 1-2 weeks
• Adjust moisture barrier products and dressings based on wound characteristics and healing progress