Incontinence Associated Dermatitis

A short presentation on incontinence associated dermatitis

1. INCONTINENCE ASSOCIATED DERMATITIS AMY ZINDZI MAGANYA, BSN, RN The Henderson nurse academy

2. Objectives Define incontinence associated dermatitis (IAD) Describe the pathophysiology of IAD S tate predisposing factors to IAD. Describe diagnosis of IAD Describe treatment of IAD

3. Definition Incontinence-associated dermatitis is a condition which presents as inflammation and/or disruption of skin integrity as a result of urinary or faecal incontinence, or a combination of both.

4. Anatomy of the skin The skin has three layers Epidermis Dermis Hypodermis

5. Functions of the skin Protects the body from invasion by bacteria and other foreign matter. Sensory perception (temperature, light touch, pressure and pain). Temperature regulation Fluid balance Immune response function Vitamin production

6. Layers of the skin The stratum corneum is the outmost skin layer Lipids are synthesized within this layer and enhances the barrier function The pH on the skin surfaces is acidic (5.5) enhancing protective function

7. Pathophysiology IAD occurs when the skin barrier function is impaired as a result of incontinence. Constant contact with urine and faeces causes over-hydration and skin maceration, which increases the risk of bacterial infection and disrupts the lipid matrix. Faeces contain digestive enzymes, which can lead to skin erosion. The skin has an acidic pH (5.5 ),however , when in contact with urine and faeces , the pH of the skin becomes more alkaline (6.5–7). This increases protease and lipase activity, thus reducing the natural barrier function of the skin and increasing the skin’s permeability.

8. Predisposing factors Medication (steroids increase risk of skin damage, while some medications, e.g. antibiotics or metformin may increase the potential for diarrhoea ) Age (extreme of ages when the skin is delicate) Nerve/sensory damage Poor mobility Cognitive impairment Inability to perform own hygiene Poor nutritional status Poor fitting or inappropriate incontinence products.

9. Diagnosis of IAD Accurate holistic skin assessment is necessary for correct diagnosis and treatment. Good clinical history bearing in mind the predisposing factors is the first step. Thorough regular skin inspection paying particular attention to the perianal areas, natal cleft, thighs, skin folds and buttocks which are the at risk areas is the next step IAD is often confused with pressure ulcers which result in mismanagement.

10. Diagnosis The third step is making the diagnosis. Characteristic features of IAD in contrast to those of pressure ulcers are listed in the table below. IAD Pressure damage Common on fleshy areas Usually over bony areas Multiple lesions Isolated lesions Ill defined edges Well defined edges Superficial skin loss Partial to full thickness skin damage

11. IAD Pressure ulcer

12. Management Upon diagnosis a skin care regimen is formulated. This includes Cleansing after each episode of incontinence. A soap of neutral pH should be used to avoid destabilising the skin’s natural pH. The area should be gently cleaned and patted dry to prevent injury to the skin through shear and frictional forces.

13. Management Applying an effective skin barrier preparation Products with dimethicone are favoured because they do not cause pad blocking The extent of skin damage and severity of incontinence are to be factored in, in the regimen Barriers with bio adhesives are used in cases of extensive skin damage

14. Management Regular inspection to monitor progress Emollients are used when the skin is dry and to replenish the barrier function of the lipid layer of the skin.

15. Thank you