Feature: Incontinence-related skin damage: Essential knowledge
University of Virginia, Department of Urology and School of Nursing, Charlottesville, VA 22908, USA. Ostomy/wound management
(Impact Factor: 1.12).
Incontinence-associated dermatitis, a clinical manifestation of moisture-associated skin damage, is a common consideration in patients with fecal and/or urinary incontinence. Among hospitalized patients, the prevalence rate has been found to be as high as 27%. Exposure to skin surface irritants may be a predictor and the condition, in turn, may be a factor in pressure ulcer risk because skin integrity is compromised. Differential diagnosis, usually based on visual examination, can help determine whether incontinence-associated dermatitis or a pressure ulcer is present. Prevention comprises following a structured skin care regimen that includes gentle cleansing, moisturization, and application of a skin protectant or moisture barrier. Treatment goals include protecting the skin from further exposure to irritants, establishing a healing environment, and eradicating any cutaneous infection. This concise review of relevant literature underscores the scant amount of evidence-based information available and highlights the need for further studies that involve comparing protocol and product efficacy to determine best practice for this oft-encountered condition.
Available from: Joanne Yip
- "According to previous research, skin conditions are one of the intrinsic factors that affect tissue tolerance to pressure (Bass and Phillips, 2007; Murray et al., 2001). Dry, flaky, or scaling skin will reduce the resistance of tissues to mechanical forces, including pressure, friction, and shearing (Bass and Phillips, 2007; Gray, 2007; Murray et al., 2001). On the other hand, according to the literature, the chances that pressure ulcers will form in moist skin are greater than in dry skin. "
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The heels are one of the most common sites of pressure ulcers, and the incidence rate in the elderly aged 70years or older is high. Although there is literature on heel interface pressure, the heel interface pressure of the elderly in different postures has not yet been explored, which will be investigated in this study, as well as the effects of different foot positions. Their skin conditions will also be examined.
Twenty-five females and twenty-six males, 70years old or older, are evaluated while lying down, with only their naked foot in its natural position on a mattress, as well as placed on a standard or pressure-relieving mattress in different positions. The moisture, sebum content, and elasticity of the skin of the heel are tested.
The heel of most of the participants is positioned at a 60°-69° or 90°-99° angle to the support surface. The heel interface pressure is the greatest when the foot is upright. The age, weight, and body mass index have no significant impacts. The moisture and sebum content are extremely low while elasticity is normal.
The relaxed position of the foot is in neutral external rotation and upright positions. A greater amount of pressure is experienced when the foot is upright. The pressure-relieving mattress is more effective for reducing heel pressure but may not apply to all cases. Finally, the skin of the heel is dry and lacks sebum, which implies greater risk of developing heel sores.
Available from: Sue Woodward
- "Despite current research on IAD management, current practice in the community may be less than optimal. It is well known that prevention can reduce substantially the prevalence and incidence of IAD (Lewis-Byers and Thayer, 2002); prevention has also been proven to be cost-effective (Ersser et al, 2005; Gray, 2007; Beeckman et al, 2009). However, prevention is not an easy task; it requires persistent vigilance from health professionals and family members. "
Available from: PubMed Central
- "This neglects an overt clinical problem commonly referred to as incontinence associated dermatitis (IAD). IAD is an irritant or contact type of skin inflammation of the perineal or perigenital region and needs to be clearly distinguished from cutaneous type IV allergies [11,12]. IAD is reported to affect incontinent patients from 5.7% to more than 42% [13,14]. "
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ABSTRACT: Incontinence associated dermatitis (IAD) is an inflammatory skin disease mainly triggered by prolonged skin contact with urine, feces but also liberal detergent use when cleansing the skin. To minimize the epidermal barrier challenge we optimized the design of adult incontinence briefs. In the fluid absorption area we interposed a special type of acidic, curled-type of cellulose between the top sheet in contact with the skin and the absorption core beneath containing the polyacrylate superabsorber. The intention was to minimize disturbance of the already weak acid mantle of aged skin. We also employed air-permeable side panels to minimize skin occlusion and swelling of the stratum corneum.
The surface pH of diapers was measured after repeated wetting with a urine substitute fluid at the level of the top sheet. Occlusive effects and hydration of the stratum corneum were measured after a 4 hour application of different side panel materials by corneometry on human volunteers. Finally, we evaluated skin symptoms in 12 patients with preexisting IAD for 21 days following the institutional switch to the optimized diaper design. Local skin care protocols remained in place unchanged.
The improved design created a surface pH of 4.6 which was stable even after repeated wetting throughout a 5 hour period. The "standard design" briefs had values of 7.1, which is alkaline compared to the acidic surface of normal skin. Side panels made from non-woven material with an air-permeability of more than 1200 l/m2/s avoided excessive hydration of the stratum corneum when compared to the commonly employed air-impermeable plastic films. Resolution of pre-existing IAD skin lesions was noted in 8 out of 12 patients after the switch to the optimized brief design.
An improved design of adult-type briefs can create an acidic pH on the surface and breathable side panels avoid over-hydration of the stratum corneum and occlusion. This may support the epidermal barrier function and may help to reduce the occurrence of IAD.
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