Incontinence-Associated Dermatitis: a Practical Guide for the Consulting Dermatologist

Purpose of Review Incontinence-associated dermatitis (IAD) is a common irritant contact dermatitis associated with exposure to urine or feces. This review provides an overview of the etiology, diagnosis, and clinical management of IAD. Recent Findings Incontinent patients should follow a comprehensive preventive care regimen to minimize the occurrence of IAD. This regimen includes daily and as-needed cleansing using specialized “no-rinse” cleansers to cleanse the skin, remove irritants, and provide protection. Additionally, cleansers containing miconazole may be added to provide additional defense and reduce candidal infections. To reduce frictional irritation and preserve the skin barrier, it is recommended to minimize towel drying and apply an emollient moisturizer and skin protectant. Additionally, incorporating fecal collection devices or protective hydrocolloid dressings in combination with or as alternatives to adult containment briefs has proven effective in reducing the prevalence of IAD by minimizing exposure to moisture, irritants, and friction. Summary IAD causes significant discomfort and is a risk factor for pressure ulcers and skin infections. Elderly hospitalized patients and individuals with fecal incontinence are at a high risk for developing IAD. Diagnosing IAD can be challenging as it is often misdiagnosed as stage I and II pressure ulcers. Visual indicators of pressure ulcers include distinct lesions over bony prominences, non-blanchable erythema, and localized skin changes with or without necrosis. Prevention of IAD involves minimizing exposure to stool and/or urine and implementing a skincare regimen that includes gentle cleansing, moisturization, and application of a skin protectant.