Skip to main content
Erschienen in: Drugs & Aging 1/2018

14.12.2017 | Therapy in Practice

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

verfasst von: Hilde Beele, Steven Smet, Nele Van Damme, Dimitri Beeckman

Erschienen in: Drugs & Aging | Ausgabe 1/2018

Einloggen, um Zugang zu erhalten

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.
Literatur
1.
Zurück zum Zitat 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.CrossRef 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.CrossRef
2.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
3.
Zurück zum Zitat 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.CrossRef 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.CrossRef
4.
Zurück zum Zitat 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 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
5.
Zurück zum Zitat Foureur N, Vanzo B, Meaume S. Prospective aetiological study of diaper dermatitis in the elderly. Br J Dermatol. 2006;155:941–6.CrossRefPubMed Foureur N, Vanzo B, Meaume S. Prospective aetiological study of diaper dermatitis in the elderly. Br J Dermatol. 2006;155:941–6.CrossRefPubMed
6.
Zurück zum Zitat Fluhr JW, Elias PM. Stratum corneum pH: formation and function of the ‘acid mantle’. Exog Dermatol. 2002;1:163–75.CrossRef Fluhr JW, Elias PM. Stratum corneum pH: formation and function of the ‘acid mantle’. Exog Dermatol. 2002;1:163–75.CrossRef
8.
Zurück zum Zitat 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Rayanfar P, Wallace JS, Pace NC. Diaper dermatitis: a review and update. Curr Opin Pediatr. 2012;24:472–9. Rayanfar P, Wallace JS, Pace NC. Diaper dermatitis: a review and update. Curr Opin Pediatr. 2012;24:472–9.
10.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
11.
Zurück zum Zitat Odio M, Thaman L. Diapering, diaper technology, and diaper area skin health. Pediatr Dermatol. 2014;31(Suppl 1):9–14.CrossRefPubMed Odio M, Thaman L. Diapering, diaper technology, and diaper area skin health. Pediatr Dermatol. 2014;31(Suppl 1):9–14.CrossRefPubMed
12.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
13.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
14.
Zurück zum Zitat Stamatas GN, Tierney NK. Diaper dermatitis: etiology, manifestations, prevention, and management. Pediatr Dermatol. 2014;31(1):1–7.CrossRefPubMed Stamatas GN, Tierney NK. Diaper dermatitis: etiology, manifestations, prevention, and management. Pediatr Dermatol. 2014;31(1):1–7.CrossRefPubMed
15.
Zurück zum Zitat Atherton DJ. Understanding irritant napkin dermatitis. Int J Dermatol. 2016;55(Suppl 1):7–9.CrossRefPubMed Atherton DJ. Understanding irritant napkin dermatitis. Int J Dermatol. 2016;55(Suppl 1):7–9.CrossRefPubMed
16.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
17.
Zurück zum Zitat Al-Nuaimi Y, Sherratt MJ, Griffiths CE. Skin health in older age. Maturitas. 2014;79(3):256–64.CrossRefPubMed Al-Nuaimi Y, Sherratt MJ, Griffiths CE. Skin health in older age. Maturitas. 2014;79(3):256–64.CrossRefPubMed
18.
Zurück zum Zitat Kaya GL, Saurat JH. Dermatoporosis: a chronic cutaneous insufficiency/fragility syndrome. Clinicopathological features, mechanisms, prevention and potential treatments. Dermatology. 2007;215(4):284–94.CrossRefPubMed Kaya GL, Saurat JH. Dermatoporosis: a chronic cutaneous insufficiency/fragility syndrome. Clinicopathological features, mechanisms, prevention and potential treatments. Dermatology. 2007;215(4):284–94.CrossRefPubMed
19.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
20.
Zurück zum Zitat Visscher MD, Chatterjee R, Munson KA, Bare D, Hoath SB. Development of diaper rash in the newborn. Pediatr Dermatol. 2000;17:52–7.CrossRefPubMed Visscher MD, Chatterjee R, Munson KA, Bare D, Hoath SB. Development of diaper rash in the newborn. Pediatr Dermatol. 2000;17:52–7.CrossRefPubMed
21.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
22.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
23.
Zurück zum Zitat Slotosch CM, Kampf G, Löffler H. Effects of disinfectants and detergents on skin irritation. Contact Dermat. 2007;57(4):235–41.CrossRef Slotosch CM, Kampf G, Löffler H. Effects of disinfectants and detergents on skin irritation. Contact Dermat. 2007;57(4):235–41.CrossRef
24.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
26.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
27.
Zurück zum Zitat Gunderson CG, Martinello RA. A systematic review of bacteremias in cellulitis and erysipelas. J Infect. 2012;64(2):148–55.CrossRefPubMed Gunderson CG, Martinello RA. A systematic review of bacteremias in cellulitis and erysipelas. J Infect. 2012;64(2):148–55.CrossRefPubMed
28.
Zurück zum Zitat Payne D. Not just another rash: management of incontinence-associated dermatitis. Br J Commun Nurs. 2016;21(9):434–40.CrossRef Payne D. Not just another rash: management of incontinence-associated dermatitis. Br J Commun Nurs. 2016;21(9):434–40.CrossRef
30.
Zurück zum Zitat 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]. 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.
Zurück zum Zitat Houwing RH, Koopman ES. Decubitus or incontinence-associated dermatitis? [in Dutch]. Ned Tijdschr Geneeskd. 2014;158:A7450.PubMed Houwing RH, Koopman ES. Decubitus or incontinence-associated dermatitis? [in Dutch]. Ned Tijdschr Geneeskd. 2014;158:A7450.PubMed
32.
Zurück zum Zitat 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.CrossRef 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.CrossRef
33.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
34.
Zurück zum Zitat 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.CrossRef 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.CrossRef
35.
Zurück zum Zitat Kottner J, Lichterfeld A, Blume-Peytavi U. Incontinence-associated dermatitis: new insights into an old problem. Br J Nurs. 2016;25(5):256–62.CrossRef Kottner J, Lichterfeld A, Blume-Peytavi U. Incontinence-associated dermatitis: new insights into an old problem. Br J Nurs. 2016;25(5):256–62.CrossRef
36.
Zurück zum Zitat 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.CrossRef 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.CrossRef
37.
Zurück zum Zitat Corcoran E, Woodward S. Incontinence-associated dermatitis in the elderly: treatment options. Br J Nurs. 2013;22(8):1234–40.CrossRef Corcoran E, Woodward S. Incontinence-associated dermatitis in the elderly: treatment options. Br J Nurs. 2013;22(8):1234–40.CrossRef
38.
Zurück zum Zitat Lynde CW. Moisturizers: what they are and how they work. Skin Therapy Lett. 2001;6(13):3–5.PubMed Lynde CW. Moisturizers: what they are and how they work. Skin Therapy Lett. 2001;6(13):3–5.PubMed
39.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
40.
Zurück zum Zitat Mostosi C, Simonart T. Effectiveness of barrier creams against irritant contact dermatitis. Dermatology. 2016;232(3):353–62.CrossRefPubMed Mostosi C, Simonart T. Effectiveness of barrier creams against irritant contact dermatitis. Dermatology. 2016;232(3):353–62.CrossRefPubMed
41.
Zurück zum Zitat 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
42.
Zurück zum Zitat 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.PubMedPubMedCentral 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.PubMedPubMedCentral
43.
Zurück zum Zitat Corazza ML, Minghetti S, Bianchi A, Virgili A, Borghi A. Barrier creams: facts and controversies. Dermatitis. 2014;25(6):327–33.CrossRefPubMed Corazza ML, Minghetti S, Bianchi A, Virgili A, Borghi A. Barrier creams: facts and controversies. Dermatitis. 2014;25(6):327–33.CrossRefPubMed
45.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
46.
Zurück zum Zitat Taylor C. Importance of nutrition in preventing and treating pressure ulcers. Nurs Older People. 2017;29(6):33–9.CrossRefPubMed Taylor C. Importance of nutrition in preventing and treating pressure ulcers. Nurs Older People. 2017;29(6):33–9.CrossRefPubMed
47.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
48.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
Metadaten
Titel
Incontinence-Associated Dermatitis: Pathogenesis, Contributing Factors, Prevention and Management Options
verfasst von
Hilde Beele
Steven Smet
Nele Van Damme
Dimitri Beeckman
Publikationsdatum
14.12.2017
Verlag
Springer International Publishing
Erschienen in
Drugs & Aging / Ausgabe 1/2018
Print ISSN: 1170-229X
Elektronische ISSN: 1179-1969
DOI
https://doi.org/10.1007/s40266-017-0507-1

Weitere Artikel der Ausgabe 1/2018

Drugs & Aging 1/2018 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.