What is the best treatment method for skin irritation due to incontinence?

Treatment of Incontinence-Associated Dermatitis

The best treatment for skin irritation due to incontinence is a structured skin care regimen consisting of gentle cleansing with a no-rinse skin cleanser (avoiding soap and water), followed by application of a barrier cream or protectant containing dimethicone or zinc oxide after each incontinence episode. 1, 2, 3

Core Treatment Algorithm

Step 1: Immediate Skin Protection

• Apply barrier creams containing dimethicone or zinc oxide after each incontinence episode to create a moisture barrier that prevents and treats effects from wetness, urine, or stool 2, 3
• Clean the skin gently with a mild skin cleanser, pat dry or allow to air dry, then apply the barrier product 2
• For perineal areas, reapply after every incontinent episode or diaper change 2

Step 2: Proper Cleansing Technique

• Use a no-rinse foam cleanser or disposable washcloth containing 3% dimethicone instead of soap and water, as this may be more effective at preventing incontinence-associated dermatitis 4, 5
• Avoid traditional soap and water, which can worsen skin breakdown 4, 5
• Cleanse after each incontinence episode, particularly when feces are present 5

Step 3: Containment Management

• Use high-absorbency incontinence products and change them regularly to reduce overhydration of the epidermis and minimize skin exposure to irritants 6, 7
• The 2024 AUA/SUFU guidelines classify incontinence management strategies (diapering, pads, absorbent underwear, barrier creams) as a distinct treatment category that reduces adverse sequelae like urine dermatitis 1

Step 4: Address Underlying Incontinence

• Implement behavioral therapies including timed voiding, urgency suppression, and fluid management to reduce incontinence frequency 1
• Optimize comorbidities that worsen incontinence, such as constipation, diabetes, and obesity 1

Evidence Quality and Nuances

The evidence supporting specific skin care interventions is of very low to low certainty due to small sample sizes and heterogeneity in products tested 4. However, the consistent finding across multiple studies is that:

• Combination therapy (cleanser plus leave-on barrier product) may be superior to cleansing alone (RR 0.03,95% CI 0.00 to 0.53), though this evidence is very uncertain 4
• Foam cleansers may reduce dermatitis risk compared to soap and water (RR 0.35,95% CI 0.14 to 0.85), but again with very low certainty 4
• Pain and itching may be reduced with proper skin care regimens 4

Critical Pitfalls to Avoid

• Never use soap and water for routine cleansing in patients with incontinence, as this disrupts the skin barrier and increases dermatitis risk 4, 5
• Do not delay barrier cream application – it must be applied after every incontinence episode, not just once or twice daily 2, 5
• Avoid allowing the skin to remain wet – change incontinence products promptly and ensure skin is dry before applying barriers 6, 7
• Do not overlook secondary infection – weeping erosions or excoriations require appropriate topical antimicrobial treatment 6

Severe or Refractory Cases

For severe incontinence-associated dermatitis that fails conservative management:

• Consider short-term, controlled use of topical corticosteroids for inflammation 6
• Evaluate for external urine or stool collection devices as temporary measures 6
• In extreme cases, indwelling urinary catheters might be considered, though this should be a last resort given infection risks 6
• Rule out allergic contact dermatitis, the most common differential diagnosis in older adults, which requires different management 6

Supporting Evidence from Cancer Care

The 2025 British Society of Gastroenterology guidelines note that skin irritation from incontinence may be helped by barrier agents, with incontinence pads as needed for containment 1. This reinforces the universal applicability of barrier protection across different patient populations experiencing incontinence.