Evaluating an incontinence cleanser and skin protectant ointment for managing incontinence-associated dermatitis

Moisture-associated skin damage (MASD) occurs when there is prolonged exposure of the skin to excessive amounts of moisture from incontinence, wound exudate or perspiration. Incontinenceassociated dermatitis (IAD) relates specifically to skin breakdown from faecal and/or urinary incontinence (Beeckman et al, 2009), and has been defined as erythema and oedema of the skin surface, which may be accompanied by bullae with serous exudate, erosion or secondary cutaneous infection (Gray et al, 2012). IAD may also be referred to as a moisture lesion, moisture ulcer, perineal dermatitis or diaper dermatitis (Ousey, 2012). The effects of ageing on the skin are known to affect skin integrity, as is the underdeveloped nature of very young skin; as such, elderly patients and neonates are particularly vulnerable to damage from moisture (Voegeli, 2007). The increase in moisture resulting from episodes of incontinence is exacerbated due to bacterial and enzymatic activity associated with urine and faeces, particularly when both are present, which leads to an increase in skin pH alongside over-hydration of the skin surface. This damages the natural protection of the acid mantle, the skin’s naturally acidic pH, which is an important defence mechanism against external irritants and microorganisms. This damage leads to the breakdown of vulnerable skin and increased susceptibility to secondary infection (Beeckman et al, 2009). It has become well recognised that presence of IAD greatly increases the likelihood of pressure ulcer development, since over-hydrated skin is much more susceptible to damage by extrinsic factors such as pressure, friction and shear as compared with normal skin (Clarke et al, 2010). While it is important to firstly understand that pressure and moisture damage are separate aetiologies and, secondly, be able to recognise the clinical differences in presentation, one of the factors to consider for prevention of pressure ulcers is minimising exposure to moisture/ incontinence. Another important consideration with IAD is the effect on the patient. IAD can be painful and debilitating, and has been associated with reduced quality of life. It can also be time-consuming and expensive to treat, which has an impact on clinical resources and financial implications (Doughty et al, 2012). IAD is known to impact on direct Incontinence-associated dermatitis (IAD) relates to skin breakdown from exposure to urine or faeces, and its management involves implementation of structured skin care regimens that incorporate use of appropriate skin barrier products to protect the skin from exposure to moisture and irritants. Medi Derma-Pro Foam & Spray Cleanser and Medi Derma-Pro Skin Protectant Ointment are recent additions to the Total Barrier ProtectionTM (Medicareplus International) range indicated for management of moderateto-severe IAD and other moisture-associated skin damage. This article discusses a series of case studies and product evaluations performed to determine clinical outcomes and clinician feedback based on use of the Medi Derma-Pro skin barrier products to manage IAD. Results showed improvements to patients’ skin condition following use of Medi Derma-Pro, and the cleanser and skin protectant ointment were considered better than or the same as the most equivalent products on the market.