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Incontinence Associated Dermatitis

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  • Δερματίτιδα που σχετίζεται με την ακράτεια IAD

Incontinence Associated Dermatitis

Anyone who lives with incontinence is also at risk of developing uncomfortable skin conditions such as Incontinence Associated Dermatitis (IAD). Learn more about IAD, its causes and symptoms, and how to prevent it through our three-step process.

What is IAD?

Incontinence Associated Dermatitis (IAD) is a condition that occurs when the skin is damaged as a result of exposure to urine and/or feces. Colloquially IAD is also known as diaper rash. Several factors may contribute to the development of IAD. These include infrequent change of incontinence pads (causing a moist environment), poor hygiene, use of non-breathable absorbent incontinence products, incorrect use of skin care products, or frequent use of soap, water, and rough washcloths and towels (causing excess friction).

The skin becomes more alkaline when exposed to urine and/or feces, allowing microorganisms to thrive which increases the risk of skin problems.

Symptoms of IAD

IAD typically appears as erythema (redness of the skin) ranging in color from pink to red.

The affected area usually has frayed edges and the skin may feel warmer and firmer due to the underlying inflammation.

Patients can experience symptoms ranging from discomfort and pain to insomnia and, if not treated, it can lead to secondary infections. These are disabling for the patient; treating them can be complicated, time-consuming, and expensive.

Patients with urinary and/or fecal incontinence should have their skin checked regularly, preferably daily, for any signs of IAD.

Differentiating IAD from pressure ulcers

Although IAD and pressure ulcers are clinically and pathologically different, differentiating them from each other remains a major challenge for nurses and caregivers.

If a wrong diagnosis is made, it can lead to suboptimal or wrong care and unnecessary costs. In addition, the preventive measures and treatments differ for the two conditions.

Main differences between IAD and pressure ulcers:

IADPressure Ulcer
LocationSkin folds, buttocks, inner thighs, groin Usually over a bony prominence, as a result of pressure
ColorPink or bright redRed to bluish/purple
DepthPartial thickness, blistering Partial or full thickness, injuring
CauseTop-down damage caused by moisture and pH changeBottom-up damage caused by pressure and poor blood circulation
Skin NecrosisNo Yes/No
Pain and itchingYes Yes/No

Who is at risk of developing IAD?

All patients or residents with incontinence are at risk of developing IAD, but it is particularly people over the age of 65 who suffer from the condition.

It is estimated that nearly 1 in 5 people with incontinence also have problems with IAD*.

How to prevent IAD

The good news is that, when treated early, incontinence-associated skin problems can be reduced and cured – and in most cases even prevented. A lot can be done by following a structured skin care program and using appropriate products that protect the skin in the perineal area.

We have divided the prevention of IAD into three steps:

  • Step 1: Breathable protection
  • Step 2: Gentle cleansing
  • Step 3: Moisture and barrier
3steps-iad

Step 1: Breathable protection 

The first step in preventing IAD is to choose the right incontinence product.

We always recommend choosing a product as small as possible and as large as necessary. This concerns both the size and absorbency of the product. A large product, that can absorb more, is not always better.

Besides being more wasteful, it can also be uncomfortable for the patient to wear a product that is too big. A larger product also covers more skin than needed, preventing the skin from breathing, and resulting in it being warm and moist. If the product doesn’t fit snugly on the patient, there is also the risk of leakages.

There are several factors to consider when choosing the right incontinence pad. The patient needs a product that is suitable for the amount and frequency he/she leaks, but it is equally important that the product is suitable for their everyday life, activity level, and personal preferences. Many people find that it is best to use a range of different products at different times of the day and for different activities.

However, it is always crucial to choose a product that allows the users’ skin to breathe, so that moisture can evaporate, and the skin is kept dry. In addition, it is also important to choose incontinence products that quickly absorb urine and keeps the inner layer dry against the skin even after multiple voids.

If you need help finding the right product for a patient, contact us, and we would be happy to help.

Step 2: Gentle cleansing

Gentle cleaning of the skin is especially vital as a part of a regimen to prevent IAD. Cleaning the skin with traditional soap and water can dry out the skin and drying with a towel causes increased friction in the sensitive area.

Cleansing with wet wash gloves or wet wipes is recommended, as it is gentler on the skin. At the same time, washing without water products also improves efficiency in daily care.

When choosing a cleansing product, it is essential to look at its pH value. The pH value has to be adjusted depending on where on the body the product needs to be used. For the perineal area, a pH value of 4-4,5 is ideal. A pH value higher than that removes the skin’s top layer of fat and allows bacteria to get in.

When cleansing the skin, it is always important to screen it for any potential damage such as rashes or redness, to assess the severity and development of IAD, and to ensure the patient has not developed pressure ulcers.

ABENA´s green skincare range consists of products for washing without water. It has been developed in close cooperation with end users, care staff, and Abena’s nurse specialists. It includes solutions for all needs, from light cleansing tasks to full body wash. Explore it here.

ABENA Cleansing foam on wash glove

Step 3: Moisture and barrier application

After thorough and gentle cleansing of the skin, apply moisture and barrier to help restore and protect the skin. Before applying moisture, make sure the skin is completely clean and dry.

When choosing the product to use, it is important to evaluate the skin’s condition.

If the skin has no visible damage or only mild redness, go for products with allantoin and dimethicone, such as ABENA’s skincare ointment. Allantoin is a calming and moisturizing agent, that helps the skin sustain its natural moisture balance and is beneficial for all skin types. Combined with dimethicone it helps form a protective barrier on top of the skin that protects and calms at the same time.

However, if the skin has visible wounds or more pronounced redness, use a product that contains zinc. Zinc forms a protective layer on top of the skin which keeps moisture in, and it also has antiseptic properties. Apply a zinc paste around the edges of wounds, meanwhile, a thinner zinc solution, such as ABENA’s zinc spray can be used to protect against urine and feces.

When applying skincare, be sure to apply the correct amount. Too much product prevents the skin from breathing and ends up being absorbed into the incontinence product, making it less effective.

ABENA’s grey range of skincare range is especially suitable for protecting sensitive skin. Explore it here.

abena zinc paste

ABENA Zinc Paste

Screen the skin

After completing the three steps for IAD prevention, it’s time to apply a new incontinence product. Follow the three steps, every time an incontinence product needs to be changed, and always screen the skin for redness, inflammation, rashes, pain, or itching to assess the severity and development of IAD, and to ensure the patient has not developed pressure ulcers.

Regular screening ensures that caregivers notice changes and developments in the skin and can set in with the right preventive measure in time to avoid further development.

*All sources are available upon request

This article has been written in collaboration with in-house nurses at ABENA.

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