Skin cleansers boost healing of incontinence‐associated dermatitis

Using specialized skin cleansers and body wipes in combination with a skin protectant can keep a lid on skin deterioration and promote incontinence‐associated dermatitis (IAD) healing, according to a study.

The introduction of skin cleansing into the management of IAD raises the likelihood of healing by approximately 50 percent, with the effect increasing threefold in patients with skin loss, as pointed out by a team of researchers from Tan Tock Seng Hospital, Singapore.

“To our knowledge, no published studies have examined the combined use of skin cleansers with body wipes and protectants in IAD healing, with the majority of research based around IAD prevention and not IAD treatment to produce healing,” the team said. [Int J Nurs Stud 2020;103:103509]

“Our findings are aligned with current research, which points towards the benefit of skin cleansers over other cleansing media, such as soap and water or body wipes alone, in improving IAD outcomes. The combination of a skin cleanser and protectant reduced the risk of IAD development by approximately 30 percent,” they added. [tinyurl.com/ycvbunuz; Br J Nurs 2001;10:S6‐S8; Ostomy Wound Manage 2002;48:44‐51]

In the study, 84 patients were randomly assigned to three treatment interventions. Treatments 1 and 2 consisted of the skin cleanser with disposable body wipes and a moisturizer containing either acrylic terpolymer liquid (T1; n=23) or zinc oxide (T2; n=37). The control treatment comprised disposable body wipes alone and a zinc oxide protectant (n=24).

Patients treated with T1 and T2 were 1.5 times as likely as those who received the control treatment to experience IAD healing within 7 days, although the difference failed to achieve statistical significance (p=0.66). Furthermore, healing with T1 and T2 was more evident in patients with skin loss. [Int Wound J 2021;doi:10.1111/iwj.13588]

The effect on preventing IAD deterioration was similar across all treatment groups. The prevalence of skin deterioration remained minimal at 8 percent to 14 percent.

“The addition of such skin cleansers could have contributed towards more effective removal of urine and faeces on the skin, reducing the risk of dermal irritation and improving the conditions for skin healing,” according to the researchers. [Br J Nurs 2017;26:1128-1132; Adv Skin Wound Care 2018;31:502-513]

Cleansers are formulated to be pH‐balanced, which potentially enhance skin conditions by preserving the natural acidity of the stratum corneum, they explained. In addition, they contain surfactant that reduces surface tension and loosen urine and faecal debris, facilitating their easy removal from the skin with body wipes. The hypoallergenic nature of skin cleansers also limits the risk of vulnerable skin developing hypersensitivity reactions and further irritation, producing a conducive environment for IAD healing. [Int J Nurs Stud 2020;103:103509; J Wound Care 2016;25:268-276]

Meanwhile, skin protectants create a barrier between the stratum corneum and irritants, such as urine and faeces. This lowers exposure to caustic agents that can disturb skin integrity and, in so doing, minimizes the risk of skin deterioration and IAD development. [Br J Nurs 2017;26:1128-1132; Int J Nurs Stud 2020;103:103509]

“Our study underlines two important findings: (1) the benefit of combining specialized skin cleansers with body wipes when cleaning skin instead of body wipes alone to promote IAD healing, and (2) adhering to a structured skin care regimen of skin cleansing and protecting to prevent IAD skin deterioration,” the researchers said.

“As such, it would be sound for healthcare institutions to introduce a structured skin care regimen of skin cleaning and protecting for any patients at risk of direct skin exposure to urinary, faecal, or dual incontinence. This would greatly aid in the prevention and treatment of IAD. These regimens could be stated in hospital skin care guidelines to standardise practices,” they added.