Treatment of Excoriated Skin from Incontinence
Implement a structured skin care regimen after each incontinence episode consisting of gentle cleansing with a no-rinse pH-neutral cleanser followed by application of a barrier cream containing dimethicone or zinc oxide to create a moisture barrier. 1
Core Treatment Protocol
The American Urological Association and Society of Urologic Nurses and Associates provide clear guidance on managing incontinence-associated dermatitis through a systematic approach 1:
Cleanse the skin gently with a no-rinse skin cleanser after each incontinence episode, avoiding soap and water which performs poorly in both prevention and treatment of incontinence-associated dermatitis 1, 2
Apply barrier protection using products containing dimethicone or zinc oxide after cleansing to prevent moisture, urine, and stool from further damaging the skin 1, 3
Pat dry or allow to air dry before applying barrier products, particularly in the perineal area 3
Reapply barrier cream after each incontinence episode or diaper change to maintain continuous protection 3
Why Soap and Water Should Be Avoided
Evidence from multiple trials demonstrates that soap and water is significantly less effective than specialized cleansers 2. One trial showed that skin cleansers were more effective than soap and water (RR 0.39,95% CI 0.17 to 0.87), while another demonstrated that a structured skin care procedure with cleansing, moisturizing, and protecting properties outperformed soap and water (RR 0.31,95% CI 0.12 to 0.79) 2. The British Society of Gastroenterology similarly emphasizes barrier agents as the primary intervention 1.
Adjunctive Measures to Reduce Incontinence Frequency
Beyond treating the damaged skin, reducing incontinence episodes accelerates healing 1:
Implement behavioral therapies including timed voiding, urgency suppression techniques, and fluid management to decrease incontinence frequency 1
Use high-absorbency incontinence products with regular changes to minimize skin exposure to irritants 1
Optimize contributing comorbidities such as constipation, diabetes, and obesity that worsen incontinence 1
Application Frequency and Technique
The frequency of skin care directly impacts outcomes 4:
Perform skin care after every incontinence episode, particularly when feces are present, as stool is more damaging than urine alone 4
Leave-on products are essential—applying moisturizers and skin protectants is more effective than cleansing alone 2
Time-saving consideration: No-rinse cleansers with durable barrier products save approximately 79 minutes per patient per day compared to soap and water regimens 5
Common Pitfalls to Avoid
Do not use soap and water as the primary cleansing method—this is the most common error and significantly worsens outcomes 2
Do not skip the barrier product—cleansing alone without protection allows continued damage from subsequent incontinence episodes 2, 4
Avoid indwelling catheters when possible, as they increase infection risk and should be removed within 24 hours when medically appropriate 6
Do not apply barrier products to wet skin—ensure the area is dry first for optimal barrier formation 3
Expected Outcomes
With proper implementation of this structured approach, skin integrity can be maintained in approximately 70% of patients and improvement occurs in an additional 8-17% of cases 5. The combination of effective cleansing, skin protection, and moisturization forms the foundation of successful incontinence-associated dermatitis management 4.