We have an incontinent resident who frequently has perineal skin breakdown. Would this be considered denuded skin, excoriated skin or should we stage it as a pressure ulcer?
Excoriated and denuded are both considered descriptive words, but they have different definitions. Excoriated is defined as a linear erosion of the skin caused by mechanical means, such as scratching or rubbing. Denuded, on the other hand, is the loss of the epidermis, caused by exposure to urine, feces, body fluids, wound exudate or friction.
As defined by the National Pressure Ulcer Advisory Panel (NPUAP), a pressure ulcer is a localized injury to the skin and/or underlying tissue that is usually over a bony prominence, caused as a result of pressure, or pressure in combination with shear and/or friction.
If the breakdown is characterized by irritation and inflammation of the skin from prolonged exposure to urine or stool, this would be considered Incontinence Associated Dermatitis (IAD).
Skin breakdown related to IAD will be seen in skin folds or areas of skin regularly exposed to fecal and/or urinary incontinence or also under absorptive briefs. It is often accompanied by candidiasis. This skin breakdown will remain partial thickness and free from necrosis.
A full-thickness wound, with or without necrosis, reflects ischemic tissue damage and should be classified as a pressure ulcer. Therefore, the decision of what to classify the skin breakdown will depend upon the cause and assessment findings.