Recommended Moisture Barrier for Incontinence-Associated Dermatitis
For incontinence-associated dermatitis (IAD), a moisture barrier containing dimethicone is recommended as the first-line protective barrier, applied after each incontinent episode to create a protective layer that prevents skin damage from moisture and irritants. 1
Understanding Incontinence-Associated Dermatitis
Incontinence-associated dermatitis is inflammation of the skin resulting from repeated contact with urine and/or feces. It causes pain, redness, swelling, and excoriation, and may lead to complications such as fungal skin infections and pressure injuries 2. IAD occurs in approximately 15-60% of patients with incontinence 3 and requires prompt intervention to prevent skin breakdown and associated complications.
Moisture Barrier Application Protocol
Step 1: Proper Skin Cleansing
- Clean affected skin gently with a mild, soap-free cleanser rather than soap and water 4
- Use lukewarm or cool water (avoid hot water which damages the skin barrier) 4
- Pat dry gently rather than rubbing the skin 4
- Allow skin to air dry completely before applying barrier products 1
Step 2: Moisture Barrier Application
- Apply dimethicone-based moisture barrier to clean, dry skin 1
- Reapply after each incontinent episode or diaper change 1
- Apply a sufficient amount to create an effective barrier (approximately 2 fingertip units per application) 3
Step 3: Frequency of Application
- Apply moisture barrier after each incontinent episode 1
- For prevention in high-risk patients, apply at least every 6-8 hours even without incontinent episodes
Evidence Supporting Dimethicone-Based Barriers
Dimethicone forms a moisture barrier that prevents and helps treat effects associated with skin damage from wetness, urine, or stool 1. It temporarily protects and helps relieve chapped or cracked skin without the side effects associated with other barrier products.
Research evidence suggests that using a skin protectant is recommended for patients considered at risk of incontinence-associated dermatitis development 5. While there is limited high-quality evidence comparing different barrier products, moisture barriers containing dimethicone have shown effectiveness in clinical practice 6.
Additional Considerations
Avoid These Common Pitfalls
- Using soap and water for cleansing (damages skin barrier) 4, 7
- Applying barrier products to wet skin (reduces effectiveness) 1
- Using products containing fragrances or alcohol (causes irritation) 4
- Aggressive scrubbing of affected areas (disrupts skin barrier) 4
- Infrequent application of barrier products (reduces protection) 1
When to Consider Alternative Approaches
- For severe IAD with signs of infection, consider antimicrobial barriers
- For IAD with significant inflammation, a low-potency topical corticosteroid may be needed for short-term use before returning to standard barrier products 3
- For patients with known allergies to dimethicone, consider alternative barrier ingredients like petrolatum or zinc oxide 4
Monitoring for Complications
- Monitor for signs of infection (increased warmth, redness, swelling)
- Watch for development of ulceration
- Assess for failure to respond to conservative measures 4
Prevention Strategies Beyond Barrier Products
- Implement a structured perineal skin care program 5
- Remove indwelling catheters as soon as medically possible 3
- Consider intermittent catheterization instead of indwelling catheters when appropriate 3
- Establish a regular toileting schedule for patients with functional incontinence 3
- Use high-quality incontinence containment products that wick moisture away from skin 5
By following this evidence-based approach to moisture barrier application for IAD, clinicians can effectively prevent and treat this common and potentially serious skin condition in patients with incontinence.