Incontinence-Associated Dermatitis in Older Adults: A Critical Review of Risk Factors, Prevention and Management

Prolonged and repeated exposure of the skin to urine and/or faeces may lead to incontinence-associated dermatitis (IAD). IAD is an irritant contact dermatitis characterised by pain, erythema, maceration, erosion, scaling and very often associated with secondary infection. Older adults who are incontinent are at high IAD risk. Several differential diagnoses must be separated from IAD, with allergic contact dermatitis being the most common in older people. The main prevention and treatment principles are to reduce or to avoid the exposure of the skin to urine and stool. The type of incontinence should be assessed first and strategies to enhance continence implemented. Especially in older adults, high absorbency incontinence products should be used and changed regularly to reduce overhydration of the epidermis. Protective skin care products and mild cleansing should be applied. Weeping erosions, excoriations or infection should be treated with appropriate topical products. The short-term and controlled use of corticosteroids or external urine or stool collection devices or indwelling urinary catheters might be considered in severe cases. Owing to demographic changes, the management of incontinence and associated IAD will become more important. This will be especially relevant in primary care for older adults.