Ask the treatment expert: What's the best way to manage incontinence-associated dermatitis?

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What's the best way to prevent skin tears?
What's the best way to prevent skin tears?
Q: What is incontinence-associated dermatitis and how should we manage it?

A: Incontinence-associated dermatitis, also known as IAD, is a term that appeared in 2007.  It is defined as inflammation and irritation of the skin due to prolonged exposure to moisture from urine or fecal matter.

The skin usually appears to have redness and erosion. Blistering may or may not be present. Prior to 2007, IAD was labeled as “diaper rash.” Peri–rash is also a term that you may have heard associated with this condition.

As the definition implies, IAD often presents similar to Stage I or Stage II pressure ulcer but will not appear over a bony prominence and will be absent of necrotic tissue. In addition, the affected area is usually painful. It is often described as a burning or stinging sensation by residents with the ability to communicate.

An important part of managing incontinence-associated dermatitis in the elderly is to prevent or minimize the exposure to urine and stool. Assessing and identifying the causes of incontinence will assist you in addressing IAD. Keeping the area clean along with use of a moisturizer and application of a skin protectant is key.

There is an Incontinence-Associated Dermatitis Intervention Tool (IADIT) that was developed in 2008 by Junkin and Selekof that is extremely helpful. This can be requested with permission at IADIT@medbiopub.com. It describes, along with the use of pictures, the different stages of IAD, from early to severe. There is an intervention to accompany each stage.

As residents in long-term care facilities frequently are incontinent of urine and/or stool, thereby predisposing them to IAD, it is important to know how to identify and treat this condition.