Incontinence-associated dermatitis: A comprehensive review and update

Journal of Wound, Ostomy and Continence Nursing

Volumn 39, Issue 1, 2012, Pages 61-74

  Gray, Mikel ^a   Beeckman, Dimitri ^b   Bliss, Donna Z ^c   Fader, Mandy ^d   Logan, Susan ^e   Junkin, Joan ^f   Selekof, Joan ^g   Doughty, Dorothy ^h   Kurz, Peter ⁱ  

^a UNIVERSITY OF VIRGINIA   (United States)

^b KING'S COLLEGE LONDON   (United Kingdom)

^c UNIVERSITY OF MINNESOTA   (United States)

^d UNIVERSITY COLLEGE LONDON   (United Kingdom)

^e Kindred Healthcare   (United States)

^f Bryan LGH Medical Center   (United States)

^g UNIVERSITY OF MARYLAND MEDICAL CENTER   (United States)

^h EMORY UNIVERSITY   (United States)

ⁱ WPM Wund Pflege Management   (Austria)

Author keywords

[No Author keywords available]

Indexed keywords

ZINC OXIDE;

CLINICAL NURSING RESEARCH; CONSENSUS DEVELOPMENT; DERMATITIS; FECES INCONTINENCE; HUMAN; MICROBIOLOGY; NOMENCLATURE; PATHOPHYSIOLOGY; PERINEUM; PREVALENCE; REVIEW; SKIN CARE; URINE INCONTINENCE;

CLINICAL NURSING RESEARCH; CONSENSUS DEVELOPMENT CONFERENCES AS TOPIC; DERMATITIS; FECAL INCONTINENCE; HUMANS; PERINEUM; PREVALENCE; SKIN CARE; TERMINOLOGY AS TOPIC; URINARY INCONTINENCE; ZINC OXIDE;

EID: 84856042578     PISSN: 10715754     EISSN: None     Source Type: Journal    
DOI: 10.1097/WON.0b013e31823fe246     Document Type: Review

References (94)

1. Gray M, Bliss DZ, Ermer-Sulten J, Kennedy-Evans KL, Palmer MH. Incontinence associated dermatitis: a consensus. J Wound Ostomy Continence Nurs. 2007 ; 34 ( 1 ): 45-54 .
2. National Pressure Ulcer Advisory Panel/European Pressure Ulcer Advisory Panel. Pressure ulcer prevention guide: quick reference. http://www.npuap.org/ Final-Quick-Prevention-for-web-2010.pdf. Accessed July 1, 2011.
3. Gray M, Black JM, Baherastani MM, et al. Moisture associated skin damage: an overview. J Wound Ostomy Continence Nurs. 2011 ; 38 ( 3 ): 233-241 .
4. Bliss DZ, Zehrer C, Savik K, Thayer D, Smith G. Incontinenceassociated skin damage in nursing home residents: a secondary analysis of a prospective multicenter study. Ostomy Wound Manage. 2006 ; 52 ( 12 ): 46-55 .
5. Defl oor T, Bouzegta N, Beeckman D, Vanderwee K, Gobert M, Van Durme T. PUMap Project: Studie van de decubitusprevalentie in de Belgische Ziekenhuizen 2008. Brussels, Belgium : Federal Public Service: Health, Food Chain Safety and Environment, 120. http://www.decubitus.be/downloads/PUMAP-NL.pdf. Accessed July 26, 2011.
6. Junkin J, Moore-Lisi L, Selekof JL. What we don't know can hurt us, pilot prevalence survey of incontinence and related perineal skin injury in acute care [Abstract]. Las Vegas, NV : Paper presented at: WOCN National Conference ; 2005 .
7. Junkin J, Selekof JL. Prevalence of incontinence and associated skin injury in the acute care inpatient. J Wound Ostomy Continence Nurs. 2007 ; 34 ( 3 ): 260-269 .
8. Driver DS. Perineal dermatitis in critical care patients. Crit Care Nurse. 2007 ; 27 ( 4 ): 42-46 .
9. Bliss D, Lowry A, Whitebird R, et al. Absorbent product use and incontinence associated dermatitis in community dwelling persons with fecal incontinence [Abstract]. Cairo, Egypt : International Continence Society ; 2008. https://www.icsoffi ce.org/Abstracts/Publish/46/000427.pdf. Accessed July 15, 2011.
10. Arnold-Long M, Reed L. Incontinence associated dermatitis in a long-term acute care facility: fi ndings from a 12 week prospective study [Abstract]. J Wound Ostomy Continence Nurs. 2011 ; 38 ( suppl ): S7 .
11. Beeckman D, Verhaeghe S, Defl oor T, Schoonhoven L, Vanderwee K. A 3-in-1 perineal care washcloth impregnated with dimethicone 3% versus water and pH neutral soap to prevent and treat incontinence-associated dermatitis: a randomized, controlled clinical trial. J Wound Ostomy Continence Nurs. 2011 ; 38 ( 6 ): 627-634 .
12. Bliss DZ, Savik K, Thorson MAL, Ehman SJ, Lebak K, Beilman G. Incontinence-associated dermatitis in critically ill adults: time to development, severity, and risk factors. J Wound Ostomy Continence Nurs. 2011 ; 38 ( 4 ): 1-13 .
13. Bliss DZ, Zehrer C, Savik K, Smith G, Hedblom E. An economic evaluation of four skin damage prevention regimens in nursing home residents with incontinence: economics of skin damage prevention. J Wound Ostomy Continence Nurs. 2007 ; 34 ( 2 ): 143-152 .
14. Visscher MO, Chatterjee R, Munson K, Bare DE, Hoath SB. Development of diaper rash in the newborn. Pediatri Dermatol. 2000 ; 17 ( 1 ): 52-57 . (Pubitemid 30198242)
15. Visscher MO, Chatterjee R, Munson K, Pickens WL, Hoath SB. Changes in diapered and nondiapered infant skin over the fi rst month of life. Pediatri Dermatol. 2000 ; 17 ( 1 ): 45-51 . (Pubitemid 30198241)
16. Montes LF. The histopathology of diaper dermatitis. Historical review. J Cutan Pathol. 1978 ; 5 : 1-4 . (Pubitemid 8334806)
17. Houwing RH, Arends JW, Canninga-van Dijk MR, Koopman E, Haalboom JR. Is the distinction between superfi cial pressure ulcers and moisture lesions justifi able? A clinical-pathologic study. Skinmed. 2007 ; 6 ( 3 ): 113-117 .
18. Quintavalle PR, Lyder CH, Mertz PJ, Phillips-Jones C, Dyson M. Use of high-resolution, high-frequency diagnostic ultrasound to investigate the pathogenesis of pressure ulcer development. Adv Skin Wound Care. 2006 ; 19 ( 9 ): 498-505 .
19. Bliss DZ, Savik K, Harms S, Fan Q, Wyman JF. Prevalence and correlates of perineal dermatitis in nursing home residents. Nurs Res. 2006 ; 55 ( 4 ): 243-251 . (Pubitemid 44503655)
20. Mayrovitz HN, Sims N. Biophysical effects of water and synthetic urine on skin. Adv Skin Wound Care. 2001 ; 14 ( 6 ): 302-308 .
21. Berg RW. Etiology and pathophysiology of diaper dermatitis. Adv Dermatol. 1988 ; 3 : 75-98 .
22. Buckingham KW, Berg RW. Etiologic factors in diaper dermatitis: the role of feces. Pediatri Dermatol. 1986 ; 3 : 107-112 . (Pubitemid 16129246)
23. Denat Y, Khorshid L. The effect of 2 different care products on incontinence-associated dermatitis in patients with fecal incontinence. J Wound Ostomy Continence Nurs. 2011 ; 38 ( 2 ): 171-176 .
24. Caplan RM. The irritant role of feces in the genesis of perianal itch. Gastroenterology. 1966 ; 50 : 19-23 .
25. Bidmead MC, Roger MN. The effect of enzymes on the stratum corneum. J Soc Cosmet Chem. 1973 ; 24 : 493-500 .
26. Ferrazzini G, Kaiser RR, Cheng SK, et al. Microbiological aspects of diaper dermatitis. Dermatology. 2003 ; 206 : 136-141 . (Pubitemid 36205281)
27. Zimmerer RE, Lawson KD, Calvert CJ. The effects of wearing diapers on skin. Pediatr Dermatol. 1986 ; 3 : 95-101 . (Pubitemid 16129244)
28. Runeman B. Skin interaction with absorbent hygiene products. Clin Dermatol. 2008 ; 26 : 45-51 . (Pubitemid 351246714)
29. Larralde M, Raspa ML, Silvia H, Lamas F. Diaper dermatitis: a new clinical feature. Pediatri Dermatol 2001 ; 18 ( 2 ): 167-168 . (Pubitemid 32410968)
30. Karlberg AT, Magnusson K. Rosin components identifi ed in diapers. Contact Dermat. 1996 ; 34 : 176-180 .
31. Belhadjali H, Giordano-Labadie F, Rance F, Bazex J. " Lucky Luke" contact dermatitis from diapers: a new allergen? Contact Dermat. 2001 ; 44 ( 4 ):248. (Pubitemid 32234763)
32. Di Landro A, Greco V, Valsecchi R. " Lucky Luke" contact dermatitis from diapers with negative patch tests. Contact Dermat. 2002 ; 46 ( 1 ): 48-49 . (Pubitemid 34275741)
33. Fader M, Clarke-O'Neill S, Cook D, et al. Management of nighttime urinary incontinence in residential settings for older people: an investigation into the effects of different pad changing regimes on skin health. J Clin Nurs. 2003 ; 12 ( 3 ): 374-386 . (Pubitemid 37266834)
34. Fader M, Cottenden AM, Getliffe K. Absorbent products for moderate-heavy urinary and/or faecal incontinence in women and men. Cochrane Database Syst Rev. 2008 ;( 4 ): CD007408. doi: 10.1002/14651858.CD007408.
35. Akin F, Spraker M, Aly R, Leyden J, Raynor W, Landin W. Effects of breathable disposable diapers: reduced prevalence of Candida and common diaper dermatitis. Pediatri Dermatol. 2001 ; 18 ( 4 ): 282-290 . (Pubitemid 32847900)
36. Beguin AM, Malaquin-Pavan E, Guihaire C, et al. Improving diaper design to address incontinence-associated dermatitis. BMC Geriatr. 2010 ; 10 : 86 .
37. Kottner J, Halfens R. Moisture lesions: interrater agreement and reliability. J Clin Nurs. 2010 ; 19 : 716-720 .
38. Roberts MJ. Preventing and managing skin tears: a review. J Wound Ostomy Continence Nurs. 2007 ; 34 ( 3 ): 256-259 .
39. Mahoney M, Rozenboom B, Doughty D, Smith H. Issues related to accurate classifi cation of buttocks wounds. J Wound Ostomy Continence Nurs. 2011 ; 38 ( 6 ): 635-642 .
40. European Pressure Ulcer Advisory Panel. Pressure ulcer classifi - cation: differentiation between pressure ulcers and moisture lesions. EPUAP Rev. 2005 ; 6 : 35-38 .
41. Defl oor T, Schoonhoven L, Fletcher J, et al. Statement of the European Pressure Ulcer Advisory Panel-pressure ulcer classifi cation: differentiation between pressure ulcers and moisture lesions. J Wound Ostomy Continence Nurs. 2005 ; 32 ( 5 ): 302-306 .
42. Gray M, Bohacek L, Weir D, Zdanuk J. Moisture vs pressure: making sense out of perineal wounds. J Wound Ostomy Continence Nurs. 2007 ; 34 ( 2 ): 134-142 .
43. Beeckman D, Schoonhoven L, Fletcher J, et al. Pressure ulcers and incontinence-associated dermatitis: effectiveness of the Pressure Ulcer Classifi cation education tool on classifi cation by nurses. Qual Saf Health Care. 2010 ; 19 ( 5 ): e3 .
44. Beeckman D, Schoonhoven L, Fletcher J, et al. EPUAP classifi - cation system for pressure ulcers: European reliability study. J Adv Nurs. 2007 ; 60 ( 6 ): 682-691 .
45. Beeckman D, Schoonhoven L, Boucqué H, Van Maele G, Defl oor T. Pressure ulcers: e-learning to improve classifi cation by nursing students. J Clin Nurs 2008 ; 17 ( 13 ): 1697-1707 .
46. Nix DH. Validity and reliability of the Perineal Assessment Tool. Ostomy Wound Manage. 2002 ; 48 ( 2 ): 43-46, 48-49 .
47. Storer-Brown D. Perineal dermatitis: can we measure it? Ostomy Wound Manage. 1993 ; 39 ( 7 ): 28-30, 31 .
48. Storer-Brown D, Sears M. Perineal dermatitis: a conceptual framework. Ostomy Wound Manage. 1993 ; 39 ( 7 ): 20-22, 24-25 .
49. Kennedy K, Leighton B, Lutz J. Cost-effectiveness Evaluation of a New Alcohol-free, Film-Forming Incontinence Skin Protectant. White paper. St Paul, MN : 3M Healthcare ; 1996 .
50. Borchert K, Bliss DZ, Savik K, Radosevich DM. The incontinence- associated dermatitis and its severity instrument: development and validation. J Wound Ostomy Continence Nurs. 2010 ; 37 ( 5 ): 527-535 .
51. Aoi N, Yoshimura K, Kadono T, et al. Ultrasound assessment of deep tissue injury in pressure ulcers: possible prediction of pressure ulcer progression. Plast Reconstr Surg. 2009 ; 124 ( 2 ): 540-550 .
52. Andersen ES, Karlsmark T. Evaluation of four non-invasive methods for examination and characterization of pressure ulcers. Skin Res Technol 2008 ; 14 : 270-276 .
53. Bates-Jensen BM, McCreath HE, Kono A, Apeles NC, Alessi C. Subepidermal moisture predicts erythema and stage 1 pressure ulcers in nursing home patients: a pilot study. J Am Geriatr Soc. 2007 ; 55 : 1199-1205 . (Pubitemid 47106691)
54. Bates-Jensen BM, McCreath HE, Pongquan V, Apeles NC. Subepidermal moisture differentiates erythema and stage I pressure ulcers in nursing home residents. Wound Repair Regen. 2008 ; 16 : 189-197 . (Pubitemid 351342128)
55. Farahmand S, Tien L, Hui X, Maibach HI. Measuring transepidermal water loss: a comparative in vivo study of condenserchamber, unventilated-chamber and open-chamber systems. Skin Res Technol. 2009 ; 15 ( 4 ): 392-398 .
56. Xiao P, Imhof RE. Optothermal measurement of water within the stratum corneum. Curr Probl Dermatol. 1998 ; 26 : 48-60 .
57. Xiao P, Packham H, Zheng H, et al. Opto-thermal radiometry and condenser-chamber method for stratum corneum water concentration measurements. Appl Phys B Lasers Opt. 2007 ; 86 : 715-719 . (Pubitemid 46354972)
58. Bates-Jensen BM, Alessi CA, Al-Samarrai NR, Schnelle JF. The effects of an exercise and incontinence intervention on skin health outcomes in nursing home residents. J Am Geriatr Soc. 2003 ; 51 ( 3 ): 348-355 . (Pubitemid 36348896)
59. Bale S, Tebble N, Jones V, Price P. The benefi ts of implementing a new skin care protocol in nursing homes. J Tissue Viability. 2004 ; 14 ( 2 ): 44-50 .
60. Farage MA, Miller KW, Berardesca E, Maibach HI. Incontinence in the aged: contact dermatitis and other cutaneous consequences. Contact Dermat. 2007 ; 57 ( 4 ): 211-217 . (Pubitemid 47397794)
61. Gray M. Optimal management of incontinence-associated dermatitis in the elderly. Am J Clin Dermatol. 2010 ; 11 ( 3 ): 201-210 .
62. Nix D, Ermer-Seltun J. A review of perineal skin care protocols and skin barrier product use. Ostomy Wound Manage. 2004 ; 50 ( 12 ): 59-67 .
63. Voegli D. The effect of washing and drying practices on skin barrier function. J Wound Ostomy Continence Nurs. 2008 ; 35 ( 1 ): 84-90 .
64. Abbas S, Goldberg JW, Massaro M. Personal cleanser technology and clinical performance. Dermatol Ther. 2004 ; 17 ( suppl 1 ): 35-42 .
65. Wolf R, Friedman M. Measurement of the skin-cleaning effects of soaps. Int J Dermatol. 1996 ; 35 : 598-600 . (Pubitemid 26261938)
66. Ananthapadmanabhan KP, Moore DJ, Subramanyan K, Misra M, Meyer F. Cleansing without compromise: the impact of cleansers on the skin barrier and the technology of mild cleansing. Dermatol Ther. 2004 ; 17 ( suppl 1 ): 16-25 .
67. Ersser S, Lattimer V, Surridge H, Brooke S. An analysis of the skin care patient mix attending a primary care-based nurse-led NHS Walk-in Centre. Br J Dermatol. 2005 ; 153 : 992-996 . (Pubitemid 41540767)
68. Rönner AC, Berland CR, Runeman B, Kaijser B. The hygienic effectiveness of 2 different skin cleansing procedures. J Wound Ostomy Continence Nurs. 2010 ; 37 : 260-264 .
69. Cooper P, Gray D. Comparison of two skin care regimes for incontinence. Br J Nurs. 2001 ; 10 ( 6)(suppl ): S6, S8, S10 .
70. Byers PH, Ryan PA, Regan MB, Shields A, Carta SG. Effects of incontinence care cleansing regimens on skin integrity. J Wound Ostomy Continence Nurs. 1995 ; 22 : 187-192 .
71. Warshaw E, Nix D, Kula J, Markon CE. Clinical and cost effectiveness of a cleanser protectant lotion for treatment of perineal skin breakdown in low-risk patients with incontinence. Ostomy Wound Manage. 2002 ; 48 : 44-51 .
72. Hunter S, Anderson J, Hanson D, Thompson P, Langemo D, Klug M. Clinical trial of a prevention and treatment protocol for skin breakdown in two nursing homes. J Wound Ostomy Continence Nurs. 2003 ; 30 : 250-258 . (Pubitemid 37249498)
73. Dieter L, Drolshagen C, Blum K. The development of costeffective care for the patients with incontinence. Minneapolis, MN : Poster presented at the 38th Annual Conference of the WOCN Society ; June 24-28, 2006 .
74. Verdier-Sévrain S, Bonté F. Skin hydration: a review on its molecular mechanisms. J Cosmet Dermatol. 2007 ; 6 ( 2 ): 75-82 . (Pubitemid 46845415)
75. Lynde C. Moisturizers for the treatment of infl ammatory skin conditions. J Drugs Dermatol. 2008 ; 7 ( 11 ): 1038-1043 .
76. Kim JS, Lee CH, Coulombe PA. Modeling the self-organization property of keratin intermediate filaments. Biophys J. 2010 ; 99 ( 9 ): 2748-2756 .
77. Kraft JN, Lynde CW. Moisturizers: what they are and a practical approach to product selection. Skin Ther Lett. 2005 ; 10 ( 5 ): 1-8 .
78. Madison KC. Barrier function of the skin: "la raison d'être" of the epidermis. J Invest Dermatol. 2003 ; 121 ( 2 ): 231-241 .
79. Marks JG Jr. Treatment of apocrine chromhidrosis with topical capsaicin. J Am Acad Dermatol. 1989 ; 21 ( 2, Pt 2 ): 418-420 . (Pubitemid 19192231)
80. Mao-Qiang M, Feingold KR, Jain M, Elias PM. Extracellular processing of phospholipids is required for permeability barrier homeostasis. J Lipid Res. 1995 ; 36 ( 9 ): 1925-1935 .
81. Lodén M. Do moisturizers work? J Cosmet Dermatol. 2003 ; 2 ( 3/4 ): 141-149 .
82. Crowther JM, Sieg A, Blenkiron P, et al. Measuring the effects of topical moisturizers on changes in stratum corneum thickness, water gradients and hydration in vivo. Br J Dermatol. 2008 ; 159 ( 3 ): 567-577 .
83. Buraczewska I, Berne B, Lindberg M, Törmä H, Lodén M. Changes in skin barrier function following long-term treatment with moisturizers, a randomized controlled trial. Br J Dermatol. 2007 ; 156 ( 3 ): 492-498 .
84. Held E, Sveinsdottir S, Agner T. Effect of long-term use of moisturizer on skin hydration, barrier function, and susceptibility to irritants. Acta Derm Venereol. 1999 ; 79 : 49-51 . (Pubitemid 29079329)
85. Flynn TC, Petros J, Clark RE, Viehman GE. Dry skin and moisturizers. Clin Dermatol 2001 ; 19 ( 4 ): 387-392 . (Pubitemid 32842835)
86. Hoggarth A, Waring M, Alexander J, Greenwood A, Callaghan T. A controlled, three-part trial to investigate the barrier function and skin hydration properties of six skin protectants. Ostomy Wound Manage. 2005 ; 51 ( 12 ): 30-42 .
87. Draelos ZD. Active agents in common skin care products. Plast Reconstr Surg. 2010 ; 125 ( 2 ): 719-724 .
88. Shigeta Y, Nakagami G, Sanada H, Konya C, Sugama J. Factors infl uencing intact skin in women with incontinence using absorbent products: results of a cross-sectional, comparative study. Ostomy Wound Manage. 2010 ; 56 ( 12 ): 26-28, 30-33 .
89. Patrizi A, Neri I, Marzaduri S, Fiorillo L. Pigmented and hyperkeratotic napkin dermatitis: a liquid detergent irritant dermatitis. Dermatology. 1996 ; 193 ( 1 ): 36-40 . (Pubitemid 26257091)
90. Van L, Harting M, Rosen T. Jacquet erosive diaper dermatitis: a complication of adult urinary incontinence. Cutis. 2008 ; 82 ( 1 ): 72-74 .
91. Draelos ZD. Hydrogel barrier/repair creams and contact dermatitis. Am J Contact Dermat. 2000 ; 11 ( 4 ): 222-225 .
92. Anthony D, Barnes E, Malone-Lee J, Pluck R. A clinical study of Sudocrem in the management of dermatitis due to the physical stress of incontinence in a geriatric population. J Adv Nurs. 1987 ; 12 ( 5 ): 599-603 .
93. Campbell K, Woodbury MG, Whittle H, Labate T, Hoskin A. A clinical evaluation of 3M No Sting Barrier Film. Ostomy Wound Manage. 2000 ; 46 ( 1 ): 24-30 .
94. Baatenburg de Jong H, Admiraal H. Comparing cost per use of 3M Cavilon No Sting Barrier Film with zinc oxide oil in incontinent patients. J Wound Care. 2004 ; 13 ( 9 ): 398-400 .