What is the treatment for incontinence-associated 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

Understanding IAD

IAD is inflammation of the skin resulting from repeated contact with urine and/or feces, causing pain, redness, swelling, excoriation, and potential complications including fungal skin infections and pressure injuries. It is a common problem in patients with urinary incontinence, fecal incontinence, or both.

Treatment Protocol

Step 1: Cleansing

• Replace traditional soap and water with gentle skin cleansers specifically designed for incontinence care 1, 2
• Evidence suggests that foam cleansers may be more effective than soap and water for preventing IAD (though evidence quality is very low) 3
• Cleanse the skin promptly after each episode of incontinence, particularly when feces are present 4
• Use pH-balanced, no-rinse cleansers to minimize skin irritation 1

Step 2: Moisturizing

• Apply a moisturizer after cleansing to hydrate the skin 1
• Moisturizers help maintain skin integrity and prevent dryness that can lead to cracking and further damage

Step 3: Barrier Protection

• Apply a skin protectant/barrier cream after cleansing and moisturizing 1
• Barrier products create a protective layer that shields skin from moisture and irritants
• More aggressive skin protection is needed for fecal incontinence due to enzymatic damage 1
• For mixed incontinence, use products that address both urine and fecal exposure 1

Product Selection Considerations

• No single product has been definitively proven superior for IAD treatment 3, 5
• The performance of leave-on products depends on the combination of ingredients and overall formulation 6
• Consider the following factors when selecting products:
  • Type of incontinence (urinary, fecal, or mixed)
  • Severity of skin damage
  • Ease of application
  • Cost and availability

Management of Secondary Infections

• Assess for signs of secondary infection (bacterial, fungal, or viral)
• If fungal infection is present, incorporate appropriate antifungal treatment 1

Incontinence Management

• Use appropriate absorbent products (pads, liners, absorbent underwear) to manage the underlying incontinence 1
• Ensure proper fit and frequent changes of absorbent products to minimize skin exposure to moisture

Special Considerations

• For urinary incontinence: Focus on quick absorption and pH neutralization
• For fecal incontinence: Provide more aggressive skin protection due to enzymatic damage
• For mixed incontinence: Use a comprehensive approach addressing both types 1

Implementation

The implementation of a structured perineal skin care program is effective in both prevention and treatment of IAD 4. Consistency in application after each incontinence episode is crucial for successful treatment.

While the evidence quality for specific product recommendations is generally low to very low 3, 6, the structured approach of cleansing, moisturizing, and protecting the skin has demonstrated effectiveness in clinical practice.