How to treat and help prevent IAD.

February 13, 2020 Karen E. Campbell, RN, PhD

How to recognize and treat IAD

Incontinence-associated dermatitis (IAD) represents a significant health challenge worldwide. IAD can cause immense pain and discomfort for patients who are affected, and it can be difficult, time-consuming, and expensive for clinicians to treat.1

Also known as perineal dermatitis, or diaper rash, IAD refers to the irritation and damage that can occur after prolonged skin exposure to urine and/or feces. This can cause the skin to become inflamed and infected, which is why it is important to regularly assess risk factors and to recognize, categorize, and treat IAD accordingly.

Who is at risk for developing incontinence-associated dermatitis?

While IAD can affect any patient with urinary or fecal incontinence, patients with the latter are at higher risk of developing IAD than those with urinary incontinence alone.2

how to manage, treat and prevent IAD

However, all patients who experience incontinence may be at risk of developing IAD, making it important to create individualized prevention plans to help reduce the risk of IAD and other associated conditions.

How to recognize and categorize IAD.

IAD initially appears as erythema, which makes the skin look pink to red (for light skin tones) or dark red to purple (for deep skin tones). Erythema may develop into the loss of skin thickness, resulting in excoriated, open, and weepy skin. Patients can experience pain and discomfort, such as burning, itching, or tingling in the affected areas.

Depending on the extent of contact with urine and faeces, IAD may affect large areas of the skin from the perineal region to the genitals, and even the abdomen and the anterior and medial thighs.

IAD Severity Categorisation tool

Graphic Image - Click to Reveal

How to prevent and manage IAD.

Treatment for IAD should focus first and foremost on the comprehensive assessment and treatment of the patient’s incontinence. This can involve non-invasive behavioural interventions, such as nutritional management, fluid management or toileting techniques.3

Once these interventions are undertaken, implementing a structured skin care regimen is paramount for the prevention and treatment of IAD. The aim of this regimen should be to:

Adding these three steps to a patient’s skin care regimen can go a long way toward managing and preventing IAD.

REFERENCES

  1. Doughty, D., Junkin, J., Kurz, P. et al. 2012. Incontinence-associated dermatitis. Consensus statements, evidence-based guidelines for prevention and treatment, current challenges. J WOCN 39(3): 303-15.
  2. Campbell, J. L., Coyer F. M., Osborne, S.R. 2014. Incontinence-associated dermatitis: a cross-sectional prevalence study in the Australian acute care hospital setting. Int Wound J. doi:10.1111/iwj.12322.
  3. Gray M. 2014. Incontinence associated dermatitis in the elderly patient: Assessment, prevention and management. J Geriatric Care Med
  4. Beeckman, D., Verhaeghe, S., Defloor, T., et al. 2011. A 3-in-1 perineal care washcloth impregnated with dimethicone 3% versus water and pH neutral soap to prevent and treat incontinence-associated dermatitis. J WOCN 38(6): 627-34.
  5. Beeckman, D. et al. 2015. Proceedings of the Global IAD Expert Panel. Incontinence associated dermatitis: moving prevention forward. Wounds International. Available to download from www.woundsinternational.com.

About the Author

Karen E. Campbell, RN, PhD

[enBio=Karen is a member of the adjunct faculty for the Masters of Clinical Science in Wound Healing at Western University in London, ON. She has worked as an advanced practice nurse in Wound Care and Continence, and recently completed her education as a Nurse, specializing in wounds and ostomy at the Academy of NSWOC Canada. She is a faculty member at the RNAO Wound Care Institute and has a strong interest in skin health, publishing, and spreading awareness about this topic. ],[enJob=Registered Nurse],[frBio=Karen est membre auxiliaire du corps professoral pour la maîtrise en science clinique en traitement des plaies à l’Université Western, à London en Ontario. Elle a travaillé en tant qu’infirmière en pratique avancée pour le traitement des plaies et l’incontinence, et a récemment terminé sa formation en tant qu’infirmière spécialisée en stomothérapie à l’ISPSCC au Canada. Elle est membre du corps professoral à l’Institut de soin des plaies de l’Association des infirmières et infirmiers autorisés de l’Ontario et présente un intérêt soutenu en santé cutanée. Elle publie également des articles et sensibilise les gens à ce sujet. ],[frJob=Infirmière autorisée]

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