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Incontinence-associated dermatitis: cleaning and protecting skin is vital

The treatment of urinary incontinence-associated dermatitis 

The treatment of urinary incontinence-associated dermatitis 

Picture: iStock

When urine remains on the skin it can cause overhydration that leads to a breakdown of the skin’s barrier, triggering an inflammatory response. At the same time the enzyme urease hydrolyses urea forming ammonia, which leads to an increase in skin pH. Bacteria, previously controlled by the acid mantle, can now multiply.

Treatment consists of two key interventions – clean and protect. Soap is alkaline so can further raise the skin’s pH and removes lipids so increasing dryness.

A better alternative is to use a leave-on or no-rinse cleanser. A barrier is then needed to protect the skin. This should not be a thick, occlusive layer as it will affect the absorbency of pads and lead to overhydration. Instead nurses should use a proprietary film, which leaves a thin, semi-permeable coating providing protection for recurrent episodes of incontinence.

Alternatively, nurses can use a specialised barrier cream, which does not have to be reapplied for every episode of incontinence.

Damaged skin can easily become infected and normal barrier creams or sprays should not be used. The most common problem is fungal infection, which requires a topical remedy. If bacterial infection is suspected, a swab should be taken so appropriate treatment can be given.

One possibility is silver sulfadiazine cream, which is antimicrobial and soothes any burning sensation.

Wilson M (2018) Incontinence-associated dermatitis from a urinary incontinence perspective. British Journal of Nursing.

Ruth Sander is an independent consultant in care of the older person

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