Incontinence Dermatitis - Common, Yet Often Overlooked Diagnosis

Damage spreads from the surface to the deeper layers of the skin

In the first phase, due to moisture and increased temperature, there is swelling and maceration of the skin. Such affected skin is more prone to injury from friction and irritation, but also to the penetration of bacteria or toxins. The most common secondary infection in these areas is candidiasis, so it is always necessary to consider the possibility of secondary infection. An inflammatory reaction then develops, leading to a breach of the skin barrier. The damage can deepen, with the risk of blisters or ulcers forming, and in severe cases, even exposure of the dermis can occur. Incontinence dermatitis always progresses from the surface layers of the skin downward.

The most commonly affected areas are the perineum, perigenital area, buttocks, thighs, and lower abdomen. The damage causes significant discomfort to patients − from burning or itching to severe pain, which disrupts sleep and lowers their quality of life.

Risk factors for the development of incontinence dermatitis

Other factors that may contribute to the development or worsening of incontinence dermatitis include inadequate or inappropriate skin care, the use of low-quality aids, or their insufficient change. Special cosmetics are designed for incontinent patients, which, unlike regular soaps, protect and do not irritate the skin. It is also advisable to avoid frequent rinsing of the skin with water and using washcloths and towels that can cause surface lesions. The high-risk group includes primarily elderly, malnourished, or immobile patients and also those with a combination of urinary and fecal incontinence.

Incontinence dermatitis and pressure ulcers = two different diagnoses

In clinical practice, it is often difficult to identify the disease, as it is confused with pressure ulcers, which arise from prolonged exposure to pressure − damage thus originates first in the deeper layers of the soft tissues and skin and spreads to the surface. It is not uncommon, especially in immobile patients, for both types of skin damage to combine.

Distinguishing incontinence dermatitis from pressure ulcers can be helped by the discoloration of the skin in the affected area. Incontinence dermatitis initially appears as erythema ranging in color from pink to red, and the affected areas often have poorly defined edges, whereas pressure ulcers typically have a significantly dark to maroon discoloration, sometimes with necrosis, and develop typically over bony prominences.

Conclusion

The basis of successful therapy for incontinence dermatitis is proper diagnosis and the implementation of regimen and preventive measures. These consist of preventing long-term skin contact with urine or feces by using high-quality breathable aids with high absorption capacity, thorough hygiene and skin protection, and not least carefully performed nursing care during patient positioning and hygiene to reduce the risk of skin damage from friction and abrasion. Sufficient skin hydration and the application of products that affect skin resistance and support barrier skin function are also important.

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Sources:
1. Zímová J., Zímová P. Skin care in urinary and fecal incontinence. Urology for practice 2015; 16 (1): 16–20.
2. Beeckman D. et al. Proceedings of the Global IAD Expert Panel. Incontinence-associated dermatitis: moving prevention forward. Wounds International, 2015. Available at: www.woundsinternational.com