Optimal management of incontinence-associated dermatitis in the elderly

Incontinence-associated dermatitis (IAD), sometimes referred to as perineal dermatitis, is an inflammation of the skin associated with exposure to urine or stool. Elderly adults, and especially those in long-term care facilities, are at risk for urinary or fecal incontinence and IAD. Traditionally, IAD has received little attention as a distinct disorder, and it is sometimes confused with stage I or II pressure ulcers. However, a modest but growing body of research is beginning to provide insights into the epidemiology, etiology, and pathophysiology of IAD. In addition, recent changes in reimbursement policies from the US Center for Medicare and Medicaid Services regarding pressure ulcer prevention has focused attention on the differential diagnosis of IAD versus pressure ulcer, and its influence on pressure ulcer risk. Color, location, depth, and the presence or absence of necrotic tissue are visual indicators used to differentiate IAD from pressure-related skin damage. Prevention is based on avoiding or minimizing exposure to stool or urine combined with a structured skin-care program based on principles of gentle cleansing, moisturization, preferably with an emollient, and application of a skin protectant. Treatment of IAD focuses on three main goals: (i) removal of irritants from the affected skin; (ii) eradication of cutaneous infections such as candidiasis; and (iii) containment or diversion of incontinent urine or stool.