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Incontinence-associated dermatitis (IAD) is a painful complication in elderly patients, leading to reduced quality of life. Despite recent attention, its underlying inflammatory mechanisms remain poorly understood. This study was designed to quantify the release of inflammatory cytokines in a human model of IAD. The left volar forearm of ten healthy volunteers was exposed to synthetic urine and synthetic faeces for 2 h, simulating the effects of urinary and faecal incontinence, respectively, and the subsequent cytokine response compared to that of an untreated control site. Inflammatory cytokines were collected using both the Sebutape® absorption method and dermal microdialysis and quantified using immunoassays. Results from the former demonstrated an upregulation in IL-1α, IL-1RA and TNF-α. Synthetic urine caused a higher median increase in IL-1α from baseline compared to synthetic faeces, whereas synthetic faeces were associated with significantly higher median TNF-α levels compared to synthetic urine (p = 0.01). An increase in IL-1α/IL-1RA ratio was also observed with significant differences evident following exposure to synthetic urine (p = 0.047). Additionally, microdialysis revealed a time-dependent increase in IL-1β and IL-8 following exposure of up to 120 min to synthetic urine and synthetic faeces, respectively. This study demonstrated the suitability of both sampling approaches to recover quantifiable cytokine levels in biofluids for the assessment of skin status following exposure to synthetic fluids associated with incontinence. Findings suggest some differences in the inflammatory mechanisms of IAD, depending on moisture source, and the potential of the cytokines, IL-1α and TNF-α, as responsive markers of early skin damage caused by incontinence., (Copyright © 2021 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.)

Purpose: Incontinence-associated dermatitis (IAD) due to the prolonged exposure of the skin to urinary, fecal, or double incontinence represents a major clinical practice challenge. The aim of this review was to identify and critically appraise the results of published studies on the etiology and pathophysiology of IAD and highlight the current gaps in empirical evidence., Methods: Scoping literature review., Search Strategy: The electronic databases PubMed, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, and Embase were searched for relevant articles published from 1996 to April 2018. Thirteen studies and review articles related to the etiology and pathophysiology of IAD were identified in our initial review, and 3 studies published subsequent to our initial review were evaluated and included in our final review., Findings: These studies suggest that several etiologic factors contribute to the development of IAD including exposure to urine, stool, or a combination of these substances (dual incontinence), the duration and frequency of exposure, frequent cleaning, and inflammatory responses. Results from the current scoping review showed that despite the increasing interest in IAD, evidence related to the underlying mechanisms causing IAD remains sparse. This paucity represents a clear gap in knowledge and indicates a need for additional research., Implications: Future studies should aim at elucidating: (1) the role of urine and its inherent pH on skin integrity, (2) the role of stool, specific digestive enzymes, and fecal bacteria on skin integrity, (3) the permeability and susceptibility of the skin to damage following frequent cleansing activities and occlusion, and (4) the specific inflammatory response triggered following exposure to urine and fecal matter.

The harmful effects of excessive moisture on a patient's skin are well known. While traditionally considered an issue only encountered in continence care and older people, it is now recognised that the harmful effects of excessive moisture can occur across the lifespan and in various patient groups. The term 'moisture-associated skin damage' describes the spectrum of inflammatory damage that occurs in response to the prolonged exposure of a patient's skin to perspiration, urine, faeces or wound exudate. It is generally accepted that moisture-associated skin damage consists of four conditions: incontinence-associated dermatitis, intertrigo, peristomal moisture-associated dermatitis, and periwound moisture-associated dermatitis. This article describes the aetiologies of each of the different types of moisture-associated skin damage, and outlines the nursing interventions required for their prevention and management., Competing Interests: None declared, (© 2019 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

David Voegeli, Associate Professor of Nursing, Skin Health Research Group, Faculty of Health Sciences, University of Southampton, discusses the care of patients with incontinence-associated dermatitis and how to distinguish this condition from pressure ulcers.

Incontinence-associated dermatitis (IAD) is a common skin disorder seen in patients with incontinence. Typically IAD presents as inflammation of the skin surface characterised by redness, and in extreme cases, swelling and blister formation. If untreated this usually rapidly leads to excoriation and skin breakdown, which may subsequently become infected by the skin flora. While this is a common condition encountered in all areas of nursing practice, gaps remain in our understanding of the many contributing factors. A lack of standardised definitions of IAD, differences in terminology, and a bewildering increase in products available to prevent and manage IAD, makes it difficult for nurses to deliver evidence-based care. However, it is an area where nursing research has made a considerable contribution over the past few years. This article explores the current thinking on IAD and the implications for nursing practice.