In an 84-year-old female with acute cystitis requiring IV antibiotics and urine‑related groin excoriation with pruritus, what skin‑protective regimen should be used?

Management of Urine-Related Groin Excoriation in an Elderly Patient with Acute Cystitis

Apply zinc oxide ointment or white soft paraffin (petrolatum) ointment to the affected groin skin every 4 hours to create a moisture barrier, and use a potent topical corticosteroid ointment once daily to non-eroded areas to reduce inflammation and pruritus. 1, 2

Immediate Skin Protection Regimen

Barrier Protection

• Apply white soft paraffin ointment (or zinc oxide ointment) to the urogenital skin and mucosae every 4 hours to prevent further urine contact and maceration 1
• Zinc oxide functions as an FDA-approved skin protectant that creates an effective moisture barrier against irritants 2
• This frequent application schedule is critical in acute illness when continuous urine leakage is present 1

Anti-inflammatory Treatment

• Apply a potent topical corticosteroid ointment (such as betamethasone or clobetasol) once daily to involved but non-eroded surfaces to reduce inflammation and pruritus 1
• Avoid applying corticosteroids to actively eroded or broken skin, as this can delay healing 1
• The once-daily application minimizes systemic absorption risk while providing adequate anti-inflammatory effect 1

Management of Eroded Areas

• Use silicone dressings (such as Mepitel) to any eroded areas to promote healing while maintaining a moist wound environment 1
• These non-adherent dressings prevent further trauma during dressing changes 1

Addressing the Underlying Urinary Issue

Optimize Cystitis Treatment

• Continue IV antibiotics as prescribed for the acute cystitis 3
• The resolution of urinary frequency and urgency will naturally reduce urine leakage and allow skin healing 3, 4

Containment Strategies

• Implement frequent toileting schedules to minimize urine contact with skin 5
• Consider absorbent pads or barrier products specifically designed for incontinence to keep urine away from excoriated skin 5
• Ensure gentle cleansing with warm water after each void, followed by thorough but gentle patting dry 5

Daily Monitoring Protocol

• Perform daily urogenital review during the acute illness to assess healing progress and adjust treatment 1
• Monitor for signs of secondary bacterial infection (increased erythema, purulent drainage, fever) which would require systemic antibiotics 5
• In elderly patients, skin infections can rapidly progress and require prompt recognition 5

Common Pitfalls to Avoid

• Do not use topical corticosteroids on eroded or ulcerated skin, as this impairs healing and increases infection risk 1
• Avoid over-cleansing with harsh soaps or antiseptics, which further damages the skin barrier and worsens irritation 5
• Do not apply occlusive dressings without adequate barrier protection, as this traps moisture and worsens maceration 1
• In elderly patients with thin, fragile skin, be particularly gentle with any mechanical cleansing to prevent further trauma 5

Expected Timeline

• With appropriate barrier protection and resolution of the underlying cystitis, symptomatic improvement in pruritus should occur within 48-72 hours 1
• Complete re-epithelialization of eroded areas typically requires 7-14 days with consistent barrier protection 1
• If no improvement occurs within 3-5 days, consider secondary bacterial or fungal infection requiring culture and targeted antimicrobial therapy 5