We have an incontinent resident who is continually experiencing skin breakdown in the gluteal folds and buttocks area. Would this be considered a pressure ulcer?
If the skin breakdown is related to exposure from urinary and fecal incontinence, this is referred to as “incontinence associated dermatitis (IAD).” Incontinence dermatitis is characterized by irritation and inflammation of the skin from prolonged exposure to urine or stool. It also can be caused by the regular use of an absorptive containment device such
as an incontinence brief or pad, which raises the pH level of the underlying skin and increases production of perspiration.
The clinical characteristics of incontinence dermatitis will appear as redness, blistering and erosion; lesions remain partial-thickness and free from necrosis (slough or eschar). The areas of redness may be patchy or consolidated. IAD associated with urinary incontinence tends to occur in the folds of the labia majora in women or the scrotum in men, whereas IAD associated with fecal incontinence tends to originate in the perianal area. A full-thickness wound (tissue destruction into the subcutaneous tissue or deeper), with or without necrosis (slough or eschar), reflects ischemic tissue damage and would be classified as a pressure ulcer, not as incontinence dermatitis.
Incontinence dermatitis is often referred to by other names, including perineal dermatitis, irritant dermatitis, intertrigo, heat rash, and diaper rash when noted in children.
Another common description for IAD used by many nurses is “excoriated.” However, this is incorrect. The definition of excoriation is a linear erosion, or destruction of the skin by mechanical means. Loss of epidermis, caused by exposure to urine, feces, body fluids, wound drainage, or friction should be described as “denuded.”
From the February 01, 2009 Issue of McKnight's Long-Term Care News
