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Incontinence-Associated Dermatitis: A Comprehensive Review and Update

Gray, Mikel; Beeckman, Dimitri; Bliss, Donna Z.; Fader, Mandy; Logan, Susan; Junkin, Joan; Selekof, Joan; Doughty, Dorothy; Kurz, Peter

Journal of Wound, Ostomy and Continence Nursing: January/February 2012 - Volume 39 - Issue 1 - p 61–74
doi: 10.1097/WON.0b013e31823fe246

In 2009, a multinational group of clinicians was charged with reviewing and evaluating the research base pertaining to incontinence-associated dermatitis (IAD) and synthesizing this knowledge into best practice recommendations based on existing evidence. This is the first of 2 articles focusing on IAD; it updates current research and identifies persistent gaps in our knowledge. Our literature review revealed a small but growing body of evidence that provides additional insight into the epidemiology, etiology, and pathophysiology of IAD when compared to the review generated by the first IAD consensus group convened 5 years earlier. We identified research supporting the use of a defined skin care regimen based on principles of gentle perineal cleansing, moisturization, and application of a skin protectant. Clinical experience also supports application of an antifungal powder, ointment, or cream in patients with evidence of cutaneous candidiasis, aggressive containment of urinary or fecal incontinence, and highly selective use of a mild topical anti-inflammatory product in selected cases. The panel concluded that research remains limited and additional studies are urgently needed to enhance our understanding of IAD and to establish evidence-based protocols for its prevention and treatment.

Mikel Gray, PhD, FNP, PNP, CUNP, CCCN, FAANP, FAAN, Professor and Nurse Practitioner, University of Virginia Department of Urology and School of Nursing, Charlottesville.

Dimitri Beeckman, PhD, RN, SEANS, King's College London, Florence Nightingale School of Nursing & Midwifery, London, England.

Donna Z. Bliss, PhD, RN, FAAN, University of Minnesota School of Nursing, Minneapolis.

Mandy Fader, PhD, University College London, Centre for Clinical Technology & Science, London, England.

Susan Logan, BSN, RN, CWS, FACCWS, Kindred Healthcare Inc, Louisville, Kentucky.

Joan Junkin, MSN, RN, CWOCN, Bryan LGH Medical Center, Lincoln, Nebraska.

Joan Selekof, BSN, RN, CWOCN, University of Maryland Medical Center, Columbia.

Dorothy Doughty, MSN, WOC Nursing Education Center, Emory University, Atlanta, Georgia.

Peter Kurz, WPM Wund Pflege Management, Managing Director, Graduate nurse for wound management, Vienna, Austria.

Correspondence: Mikel Gray, PhD, FNP, PNP, CUNP, CCCN, FAANP, FAAN, Department of Urology, University of Virginia, PO Box 800422, Charlottesville, VA 22902 (

The authors declare no conflict of interest.

Copyright © 2012 by the Wound, Ostomy and Continence Nurses Society