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Incontinence-Associated Dermatitis (IAD) and Pressure Ulcers: An Overview

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Science and Practice of Pressure Ulcer Management

Abstract

Ageing is associated with an increase of incontinence-associated problems such as incontinence-associated dermatitis (IAD). IAD is a type of irritant contact dermatitis related to chemical and physical irritation of the skin barrier, triggering inflammation and subsequent skin damage. Since the past decade, the body of knowledge regarding IAD epidemiology, etiology, pathophysiology, association with pressure ulcers, and management is growing. The lack of an ICD-10 coding and an internationally validated and standardized method for IAD data collection contribute to the variation in prevalence and incidence figures. Frequent episodes of incontinence (especially fecal), the use of occlusive containment products, poor skin condition, reduced mobility, diminished cognitive awareness, inability to perform personal hygiene, pain, pyrexia, certain medications (antibiotics, immunosuppressant), poor nutritional status, and critical illness are associated with IAD. Clinicians often experience difficulties to correctly identify IAD and to distinguish it from pressure ulcers. In healthcare systems where pressure ulcers are used to assess the quality of care and are linked with reimbursement and litigation, misdiagnosis has potentially serious implications. Even though the clinical presentation of partial thickness pressure ulcers and IAD is similar, the underlying etiologic factors differ. However, incontinence and IAD were found to be risk factors for pressure ulcer development. Management of IAD should essentially focus on skin cleansing to remove dirt, debris and microorganisms; skin moisturization to repair or augment the skin’s barrier, retain and/or increase its water content, reduce transepidermal water loss and restore or improve the intercellular lipid structure; and the application of a skin barrier product to prevent skin breakdown by providing an impermeable or semi-permeable barrier on the skin. Tissue viability experts and incontinence specialists must play a leading role in developing this area.

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Author information

Authors and Affiliations

  1. Department of Public Health, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium

    Dimitri Beeckman

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  1. Dimitri Beeckman
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Correspondence to Dimitri Beeckman .

Editor information

Editors and Affiliations

  1. Department of Dermatology, Santa Chiara Hospital, University of Pisa, Pisa, Italy

    Marco Romanelli

  2. Welsh Wound Innovation Centre, Rhondda Cynon Taf Wales, United Kingdom

    Michael Clark

  3. Department of Biomedical Engineering, Faculty of Engineering Tel Aviv University, Tel Aviv, Israel

    Amit Gefen

  4. Bambino GesuĘĽ ChildrenĘĽs Hospital, Rome, Italy

    Guido Ciprandi

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Beeckman, D. (2018). Incontinence-Associated Dermatitis (IAD) and Pressure Ulcers: An Overview. In: Romanelli, M., Clark, M., Gefen, A., Ciprandi, G. (eds) Science and Practice of Pressure Ulcer Management. Springer, London. https://doi.org/10.1007/978-1-4471-7413-4_7

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  • DOI: https://doi.org/10.1007/978-1-4471-7413-4_7

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