Managing incontinence-associated dermatitis in the community: an overview

A significant portion of the community nurse's caseload will be occupied by moisture-associated skin damage (MASD), which is defined as inflammation and erosion of the skin caused by prolonged exposure to various sources of moisture (Gray et al, 2011). The majority of the literature on the community nurse's role in the treatment and management of MASD is focused on the damage caused by wound exudate, but one of the clinical manifestations of MASD that receives less attention in research, but will often be encountered in practice, is incontinence-associated dermatitis (IAD). IAD is a common, under-recognised and painful skin condition caused by erosion of the skin from chronic exposure to urine, stool or both (Babino and Argenziano, 2023). Depending on the type of setting and population studied, prevalence of IAD ranges between 5.2–46.0% (Babino and Argenziano, 2023). However, it is estimated that 14 million people in the UK experience some degree of urinary incontinence, while over half a million adults experience regular faecal incontinence that impacts their quality of life (Lewis and Powell, 2023). Relatedly, one study has reported the prevalence of IAD among patients with incontinence to be 45.7% (1140/2492) (Gray and Giuliano, 2018), and another demonstrated that IAD occurred in 52.5% of a cohort of 189 community-living individuals with faecal incontinence (Rohwer et al, 2013). This would suggest that IAD presents an urgent challenge for community nurses.