A short presentation on incontinence associated dermatitis

1. INCONTINENCE
ASSOCIATED
DERMATITIS
AMY ZINDZI MAGANYA, BSN, RN
THE HENDERSON NURSE ACADEMY

2. Objectives
 Define incontinence associated dermatitis (IAD)
 Describe the pathophysiology of IAD
 State predisposing factors to IAD.
 Describe diagnosis of IAD
 Describe treatment of IAD

3. Definition
 Incontinence-associated dermatitis is a condition which presents as
inflammation and/or disruption of skin integrity as a result of urinary
or faecal incontinence, or a combination of both.

4. Anatomy of the skin
The skin has three layers
i. Epidermis
ii. Dermis
iii. Hypodermis

5. Functions of the skin
 Protects the body from invasion by bacteria and other foreign matter.
 Sensory perception (temperature, light touch, pressure and pain).
 Temperature regulation
 Fluid balance
 Immune response function
 Vitamin production

6. Layers of the skin
The stratum corneum is the
outmost skin layer
Lipids are synthesized
within this layer and
enhances the barrier
function
The pH on the skin surfaces
is acidic (5.5) enhancing
protective function

7. Pathophysiology
 IAD occurs when the skin barrier function is impaired as a result of
incontinence.
 Constant contact with urine and faeces causes over-hydration and skin
maceration, which increases the risk of bacterial infection and disrupts the
lipid matrix.
 Faeces contain digestive enzymes, which can lead to skin erosion.
 The skin has an acidic pH (5.5),however, when in contact with urine and
faeces, the pH of the skin becomes more alkaline (6.5–7). This increases
protease and lipase activity, thus reducing the natural barrier function of
the skin and increasing the skin’s permeability.

8. Predisposing factors
 Medication (steroids increase risk of skin damage, while some medications,
e.g. antibiotics or metformin may increase the potential for diarrhoea)
 Age (extreme of ages when the skin is delicate)
 Nerve/sensory damage
 Poor mobility
 Cognitive impairment
 Inability to perform own hygiene
 Poor nutritional status
 Poor fitting or inappropriate incontinence products.

9. Diagnosis of IAD
 Accurate holistic skin assessment is necessary for correct diagnosis and
treatment.
 Good clinical history bearing in mind the predisposing factors is the first
step.
 Thorough regular skin inspection paying particular attention to the
perianal areas, natal cleft, thighs, skin folds and buttocks which are the at
risk areas is the next step
 IAD is often confused with pressure ulcers which result in mismanagement.

10. Diagnosis
 The third step is making the diagnosis. Characteristic features of IAD in
contrast to those of pressure ulcers are listed in the table below.
IAD Pressure damage
Common on fleshy areas Usually over bony areas
Multiple lesions Isolated lesions
Ill defined edges Well defined edges
Superficial skin loss Partial to full thickness skin damage

11. IAD Pressure ulcer

12. Management
 Upon diagnosis a skin care regimen is formulated. This includes
1. Cleansing after each episode of incontinence.
A soap of neutral pH should be used to avoid destabilising the skin’s
natural pH.
The area should be gently cleaned and patted dry to prevent injury to
the skin through shear and frictional forces.

13. Management
2. Applying an effective skin barrier preparation
Products with dimethicone are favoured because they do not cause
pad blocking
The extent of skin damage and severity of incontinence are to be
factored in, in the regimen
Barriers with bio adhesives are used in cases of extensive skin damage

14. Management
3. Regular inspection to monitor progress
Emollients are used when the skin is dry and to replenish the barrier
function of the lipid layer of the skin.

15. Thank you