From the Guidelines
Perineal irritation can be effectively treated with a combination of gentle cleansing, moisture management, and topical treatments, as recommended by the most recent guidelines 1. To manage perineal irritation, it is essential to keep the area clean using warm water and mild, fragrance-free soap, patting dry gently rather than rubbing.
- Apply a barrier cream containing zinc oxide (like Desitin or Calmoseptine) or petroleum jelly (Vaseline) to protect irritated skin.
- For inflammation, over-the-counter 1% hydrocortisone cream can be applied sparingly for up to 7 days.
- Witch hazel pads or sitz baths (warm water soaks for 10-15 minutes, 2-3 times daily) can provide soothing relief.
- Wear loose-fitting, breathable cotton underwear and avoid potential irritants like scented products, harsh soaps, and tight clothing. If the irritation is due to a fungal infection, an antifungal cream like clotrimazole 1% (Lotrimin) applied twice daily for 7-14 days may help, as suggested by the American Gastroenterological Association 1. These treatments work by creating a protective barrier, reducing inflammation, and eliminating infectious causes while allowing the skin to heal. It is crucial to note that if symptoms persist beyond two weeks, worsen, or are accompanied by severe pain, bleeding, or discharge, medical evaluation is necessary as this could indicate a more serious condition requiring prescription treatment, such as Fournier’s gangrene, which has a high mortality rate and requires prompt recognition and treatment 1.
From the Research
Perineal Irritation Treatment
- Perineal skin damage secondary to incontinence is painful, prevalent, and preventable 2
- Regular application of skin protectants for patients with incontinence is considered the standard of care for preventing perineal skin injury secondary to incontinence 2
- A routine cleansing regimen that removes irritants and moisturizes while protecting the skin from additional irritation is effective for prevention of dermatitis and for managing mild cases 3
Treatment Options
- Xenaderm ointment combines three active ingredients in a hydrophobic ointment that promotes healing while acting as a moisture barrier to prevent further irritation and damage 3
- Clotrimazole belongs to the drugs of choice for the treatment of vulvovaginal candidosis, and has been shown to be effective in treating uncomplicated and complicated vulvovaginal candidosis 4
- Chlorhexidine vaginal gel has been shown to be effective in the treatment of vulvovaginal candidiasis, bacterial vaginosis, and nonspecific vaginitis, and may be a more effective method for the treatment and improvement of vaginal infections than other treatments 5
Prevention and Management
- Preventive perineal skin programs in high-risk patients and aggressive management of incontinence-related dermatitis are essential for effective holistic management 3
- Skin care professionals consider regular application of skin protectants for patients with incontinence the standard of care for preventing perineal skin injury secondary to incontinence 2
- Further study is warranted and necessary to ensure the application of evidence-based protocols of care in practice 2