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Inkontinenzassoziierte Dermatitis: ein Positionspapier

Incontinence-associated dermatitis: a position paper

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Zusammenfassung

Die inkontinenzassoziierte Dermatitis (IAD) beschreibt eine Schädigung der Haut, verursacht durch den wiederholten und länger andauernden Kontakt mit Urin und/oder Stuhl. Betroffen können Patienten in allen Altersgruppen sein; die Diagnose wird bevorzugt bei Erwachsenen und Jugendlichen verwendet. Die Prädilektionsstellen sind perineal, perianal, die Oberschenkelinnenseiten und die konvexen Areale des Gesäßes. Vermehrte Feuchtigkeit auf der Hautoberfläche, erhöhte pH-Werte, Okklusion, Verdauungsenzyme aus dem Stuhl und wiederholte Hautreinigungsprozeduren sind pathophysiologisch relevante Faktoren. Typische klinische Zeichen der IAD sind Erytheme, Erosionen, Exkoriationen und Schmerzen. Die Diagnostik gestaltet sich oft schwierig, da es viele relevante Differenzialdiagnosen gibt, die teils auch gemeinsam mit einer IAD auftreten können. Hier sind es insbesondere Dekubitus, Kontaktdermatitis und Intertrigo, die abgegrenzt und differenziert behandelt werden müssen. Wirksame Strategien der Prävention und Therapie der IAD sind Kontinenzmanagement, die Verwendung leistungsfähiger, aufsaugender Hilfsmittel sowie konsequenter Hautschutz und -pflege. Die IAD ist eine oft nicht oder falsch diagnostizierte Hauterkrankung, die möglichst frühzeitig, gemeinsam mit den verursachenden Faktoren wie Stuhl- und/oder Harninkontinenz therapiert werden sollte, da es ansonsten zu einer unnötig langen Dauer und Schwere der Beschwerden kommen kann.

Abstract

Incontinence-associated dermatitis (IAD) describes damage to the skin caused by repeated and prolonged contact with urine and/or feces. Patients of all ages can be affected; the diagnosis is preferably used in adults and adolescents. The predilection sites are perineal, perianal, the inner thighs and the convex areas of the buttocks. Increased moisture on the skin surface, increased pH, occlusion, feces digestive enzymes and repeated skin cleansing procedures are pathophysiologically relevant factors. Typical clinical signs of IAD are erythema, erosions, excoriations and pain. Diagnosis is often difficult because there are many relevant differential diagnoses, some of which may occur together with an IAD. In particular, pressure ulcer, contact dermatitis and intertrigo need to be differentiated and treated. Effective strategies of prevention and therapy of IAD are continence management, the use of efficient, absorbent products as well as consistent skin protection and care. IAD is a skin disease that is often not or incorrectly diagnosed. It should be treated as early as possible, together with the causative factors such a fecal and/or urinary incontinence, as otherwise it can lead to an unnecessarily long duration and severity of the symptoms.

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Author information

Authors and Affiliations

  1. Klinik für Dermatologie, Venerologie und Allergologie, Clinical Research Center for Hair and Skin Science, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland

    J. Kottner

  2. Wundmanagement, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland

    N. Kolbig

  3. Abteilung für Gefäß- und endovaskuläre Chirurgie, Wundcentrum, Asklepios Klinikum Hamburg-Harburg, Eißendorfer Pferdeweg 52, 21075, Hamburg, Deutschland

    A. Bültemann

  4. Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland

    J. Dissemond

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Correspondence to J. Kottner.

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Interessenkonflikt

J. Kottner, N. Kolbig, A. Bültemann und J. Dissemond geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien. Für Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts, über die Patienten zu identifizieren sind, liegt von ihnen und/oder ihren gesetzlichen Vertretern eine schriftliche Einwilligung vor.

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Kottner, J., Kolbig, N., Bültemann, A. et al. Inkontinenzassoziierte Dermatitis: ein Positionspapier. Hautarzt 71, 46–52 (2020). https://doi.org/10.1007/s00105-019-04480-7

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