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Incontinence-Associated Dermatitis: Pathogenesis, Contributing Factors, Prevention and Management Options

  • Therapy in Practice
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Abstract

Incontinence-associated dermatitis (IAD) is a common type of irritant contact dermatitis, seen in patients with urinary or faecal incontinence. Mechanical factors such as traumata and friction may aggravate the lesions. The fragile skin in elderly patients is more prone to developing IAD. The clinical picture of IAD consists of persistent redness on the one hand and skin loss on the other. Both categories may be associated with clinical signs of major colonisation or infection. It is important to distinguish IAD from pressure ulcers and other dermatoses in the genital region. Due to the lack of well-established clinical trials, recommendations about prevention and treatment are based on expert opinion and best practice. Gentle cleansing, use of hydrating topical agents and application of barrier products are the main elements in the prevention and treatment of IAD. It is important to translate these recommendations and general guidelines into ready-to-use protocols that can be implemented for each specific clinical manifestation of IAD.

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References

  1. Junkin J, Selekof JL. Prevalence of incontinence and associated skin injury in the acute care inpatient. J Wound Ostomy Cont Nurs. 2007;34:260–9.

    Article  Google Scholar 

  2. Campbell JL, Coyer FM, Osborne SR. Incontinence-associated dermatitis: a cross-sectional prevalence study in the Australian acute care hospital setting. Int Wound J. 2016;13:403–11.

    Article  PubMed  Google Scholar 

  3. Gray M, Beeckman D, Bliss DZ, Fader M, Logan S, Junkin J, et al. Incontinence-associated dermatitis: a comprehensive review and update. J Wound Ostomy Cont Nurs. 2012;39(1):61–74.

    Article  Google Scholar 

  4. Beeckman D, Van Damme N, Schoonhoven L, Van Lancker A, Kottner J, Beele H, et al. Interventions for preventing and treating incontinence-associated dermatitis in adults. Cochrane Database Syst Rev. 2016;11:CD011627.

    PubMed  Google Scholar 

  5. Foureur N, Vanzo B, Meaume S. Prospective aetiological study of diaper dermatitis in the elderly. Br J Dermatol. 2006;155:941–6.

    Article  CAS  PubMed  Google Scholar 

  6. Fluhr JW, Elias PM. Stratum corneum pH: formation and function of the ‘acid mantle’. Exog Dermatol. 2002;1:163–75.

    Article  CAS  Google Scholar 

  7. Adam R. Skin care of the diaper region. Pediatr Dermatol. 2008;25(4):427–33.

    Article  PubMed  Google Scholar 

  8. Mugita Y, Minematsu T, Huang L, Nakagami G, Kishi C, Ichikawa Y, et al. Histopathology of incontinence-associated skin lesions: inner tissue damage due to invasion of proteolytic enzymes and bacteria in macerated rat skin. PLoS One. 2015;10:e0138117.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Rayanfar P, Wallace JS, Pace NC. Diaper dermatitis: a review and update. Curr Opin Pediatr. 2012;24:472–9.

    Google Scholar 

  10. Black JM, Bliss DZ, Logan S, Baharestani MM, Glodberg M, Rathcliff CR. MASD part 2: incontinence-associated dermatitis and intertriginous dermatitis: a consensus. J Wound Ostomy Continence Nurs. 2011;38:359–70.

    Article  PubMed  Google Scholar 

  11. Odio M, Thaman L. Diapering, diaper technology, and diaper area skin health. Pediatr Dermatol. 2014;31(Suppl 1):9–14.

    Article  PubMed  Google Scholar 

  12. Miyauchi Y, Shimaoka Y, Fujimura T, Koike Y, Yatabe M, Nishikawa M, et al. Developmental changes in neonatal and infant skin structures during the first 6 months: in vivo observation. Pediatr Dermatol. 2016;33(3):289–95.

    Article  PubMed  Google Scholar 

  13. Lagier L, Mazereeuw-Hautier J, Raffin D, Beneton N, Lorette G, Maruani A. Société française de dermatologie pédiatrique. Diaper dermatitis [in French]. Ann Dermatol Venereol. 2015;142(1):54–61.

    Article  CAS  PubMed  Google Scholar 

  14. Stamatas GN, Tierney NK. Diaper dermatitis: etiology, manifestations, prevention, and management. Pediatr Dermatol. 2014;31(1):1–7.

    Article  PubMed  Google Scholar 

  15. Atherton DJ. Understanding irritant napkin dermatitis. Int J Dermatol. 2016;55(Suppl 1):7–9.

    Article  PubMed  Google Scholar 

  16. Stalder JF, Tennstedt D, Deleuran M, Fabbrocini G, de Lucas R, Haftek M, et al. Fragility of epidermis and its consequence in dermatology. J Eur Acad Dermatol Venereol. 2014;28(Suppl 4):1–18.

    Article  CAS  PubMed  Google Scholar 

  17. Al-Nuaimi Y, Sherratt MJ, Griffiths CE. Skin health in older age. Maturitas. 2014;79(3):256–64.

    Article  PubMed  Google Scholar 

  18. Kaya GL, Saurat JH. Dermatoporosis: a chronic cutaneous insufficiency/fragility syndrome. Clinicopathological features, mechanisms, prevention and potential treatments. Dermatology. 2007;215(4):284–94.

    Article  PubMed  Google Scholar 

  19. Mengeaud V, Dautezac-Vieu C, Josse G, Vellas B, Schmitt AM. Prevalence of dermatoporosis in elderly French hospital in-patients: a cross-sectional study. Br J Dermatol. 2012;166(2):442–3.

    Article  CAS  PubMed  Google Scholar 

  20. Visscher MD, Chatterjee R, Munson KA, Bare D, Hoath SB. Development of diaper rash in the newborn. Pediatr Dermatol. 2000;17:52–7.

    Article  CAS  PubMed  Google Scholar 

  21. Jacobs JJ, Lehé CL, Hasegawa H, Elliott GR, Das PK. Skin irritants and contact sensitizers induce Langerhans cell migration and maturation at irritant concentration. Exp Dermatol. 2006;15(6):432–40.

    Article  CAS  PubMed  Google Scholar 

  22. Fluhr JW, Akengin A, Bornkessel A, Fuchs S, Praessler J, Norgauer J. Additive impairment of the barrier function by mechanical irritation, occlusion and sodium lauryl sulphate in vivo. Br J Dermatol. 2005;153(1):125–31.

    Article  CAS  PubMed  Google Scholar 

  23. Slotosch CM, Kampf G, Löffler H. Effects of disinfectants and detergents on skin irritation. Contact Dermat. 2007;57(4):235–41.

    Article  CAS  Google Scholar 

  24. de Jongh CM, Khrenova L, Verberk MM, Calkoen F, van Dijk FJ, Voss H. Loss-of-function polymorphisms in the filaggrin gene are associated with an increased susceptibility to chronic irritant contact dermatitis: a case-control study. Br J Dermatol. 2008;159(3):621–7.

    Article  PubMed  Google Scholar 

  25. Park HS, Pham C, Paul E, Padiglione A, Lo C, Cleland H. Early pathogenic colonisers of acute burn wounds: a retrospective review. Burns. 2017. https://doi.org/10.1016/j.burns.2017.04.027 (Epub 2017 Jun 8. pii: S0305-4179(17)30285-1).

    PubMed  Google Scholar 

  26. Campbell JL, Coyer FM, Mudge AM, Robertson IM, Osborne SR. Candida albicans colonization, continence status and incontinence-associated dermatitis in the acute care setting: a pilot study. Int Wound J. 2017;14(3):488–95.

    Article  PubMed  Google Scholar 

  27. Gunderson CG, Martinello RA. A systematic review of bacteremias in cellulitis and erysipelas. J Infect. 2012;64(2):148–55.

    Article  PubMed  Google Scholar 

  28. Payne D. Not just another rash: management of incontinence-associated dermatitis. Br J Commun Nurs. 2016;21(9):434–40.

    Article  Google Scholar 

  29. Beeckman D, Campbell J, Campbell K, Chimentão D, Coyer F, Domansky R, et al., Global IAD Expert Panel. Incontinence associated dermatitis: moving prevention forward. Wounds Int. 2015. http://www.woundsinternational.com/consensus-documents/view/incontinence-associated-dermatitis-moving-prevention-forward. Accessed Sep 2017.

  30. Beeckman D, Van den Bussche K, Alves P, Arnold Long MC, Beele H, Ciprandi G, et al. Towards an international language for Incontinence-Associated Dermatitis (IAD): design and evaluation of psychometric properties of the Ghent Global IAD Categorisation Tool (GLOBIAD) in 30 countries. Br J. Dermatol. 2017. [Under review].

  31. Houwing RH, Koopman ES. Decubitus or incontinence-associated dermatitis? [in Dutch]. Ned Tijdschr Geneeskd. 2014;158:A7450.

    PubMed  Google Scholar 

  32. Defloor T, Schoonhoven L, Fletcher J, Furtado K, Heyman H, Lubbers M, et al. Trustees of the european pressure ulcer advisory panel. statement of the european pressure ulcer advisory panel—pressure ulcer classification: differentiation between pressure ulcers and moisture lesions. J Wound Ostomy Cont Nurs. 2005;32(5):302–6.

    Article  Google Scholar 

  33. Pather P, Hines S. Best practice nursing care for ICU patients with incontinence-associated dermatitis and skin complications resulting from faecal incontinence and diarrhoea. Int J Evid Based Healthc. 2016;14(1):15–23.

    Article  PubMed  Google Scholar 

  34. Borchert K, Bliss DZ, Savik K. The incontinence-associated dermatitis and its severity instrument: development and validation. J Wound Ostomy Cont Nurs. 2010;37:527–35.

    Article  Google Scholar 

  35. Kottner J, Lichterfeld A, Blume-Peytavi U. Incontinence-associated dermatitis: new insights into an old problem. Br J Nurs. 2016;25(5):256–62.

    Article  Google Scholar 

  36. Lichterfeld A, Hauss A, Surber C, Peters T, Blume-Peytavi U, Kottner J. Evidence-based skin care: a systematic literature review and the development of a basic skin care algorithm. J Wound Ostomy Cont Nurs. 2015;42(5):501–24.

    Article  Google Scholar 

  37. Corcoran E, Woodward S. Incontinence-associated dermatitis in the elderly: treatment options. Br J Nurs. 2013;22(8):1234–40.

    Article  Google Scholar 

  38. Lynde CW. Moisturizers: what they are and how they work. Skin Therapy Lett. 2001;6(13):3–5.

    CAS  PubMed  Google Scholar 

  39. Lodén M. Role of topical emollients and moisturizers in the treatment of dry skin barrier disorders. Am J Clin Dermatol. 2003;4(11):771–88.

    Article  PubMed  Google Scholar 

  40. Mostosi C, Simonart T. Effectiveness of barrier creams against irritant contact dermatitis. Dermatology. 2016;232(3):353–62.

    Article  PubMed  Google Scholar 

  41. Sparr E, Millecamps D, Isoir M, Burnier V, Larsson A, Cabane B. Controlling the hydration of the skin though the application of occluding barrier creams. J R Soc Interface. 2013;10(80):20120788.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Del Rosso JQ. Incorporation of a barrier protection cream in the management of chronic hand dermatitis: focus on data supporting an established hand protectant formulation and modifications designed to assist in barrier repair. J Clin Aesthet Dermatol. 2014;7(2):40–8.

    PubMed  PubMed Central  Google Scholar 

  43. Corazza ML, Minghetti S, Bianchi A, Virgili A, Borghi A. Barrier creams: facts and controversies. Dermatitis. 2014;25(6):327–33.

    Article  CAS  PubMed  Google Scholar 

  44. Kim H, Kim JT, Barua S, Yoo SY, Hong SC, Lee KB, Lee J. Seeking better topical delivery technologies of moisturizing agents for enhanced skin moisturization. Expert Opin Drug Deliv. 2017;20:1–15. https://doi.org/10.1080/17425247.2017.1306054 (Epub 2017 Mar).

    Google Scholar 

  45. Beeckman D, Van Lancker A, Van Hecke A, Verhaeghe S. A systematic review and meta-analysis of incontinence-associated dermatitis, incontinence, and moisture as risk factors for pressure ulcer development. Res Nurs Health. 2014;37(3):204–18.

    Article  PubMed  Google Scholar 

  46. Taylor C. Importance of nutrition in preventing and treating pressure ulcers. Nurs Older People. 2017;29(6):33–9.

    Article  PubMed  Google Scholar 

  47. Amin AN, Cerceo EA, Deitelzweig SB, Pile JC, Rosenberg DJ, Sherman BM. Hospitalist perspective on the treatment of skin and soft tissue infections. Mayo Clin Proc. 2014;89(10):1436–51.

    Article  PubMed  Google Scholar 

  48. Russo A, Concia E, Cristini F, De Rosa FG, Esposito S, Menichetti F, et al. Current and future trends in antibiotic therapy of acute bacterial skin and skin-structure infections. Clin Microbiol Infect. 2016;22(Suppl 2):S27–36.

    Article  CAS  PubMed  Google Scholar 

  49. Raff AB, Kroshinsky D. Cellulitis: a review. JAMA. 2016;316(3):325–37.

    Article  PubMed  Google Scholar 

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Correspondence to Hilde Beele.

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No funding was received for the preparation of this review.

Conflict of interest

Dimitri Beeckman serves as an academic on the scientific advisory boards of companies developing skin care products (3 M Medical, ArjoHuntleigh and SCA Hygiene Products) and has received a study grant from 3 M. Hilde Beele has been involved in a number of clinical trials in the field of dermatology and wound healing; however, there is no direct link with the current article. Steven Smet has received a study grant from 3 M. Nele Van Damme has no conflicts of interests to declare.

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Beele, H., Smet, S., Van Damme, N. et al. Incontinence-Associated Dermatitis: Pathogenesis, Contributing Factors, Prevention and Management Options. Drugs Aging 35, 1–10 (2018). https://doi.org/10.1007/s40266-017-0507-1

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