Breaking the cycle: the etiology of incontinence dermatitis and evaluating and using skin care products.

Dermatitis is a common problem for incontinent patients; a cycle of moisture, friction, bacteria and breakdown can be established. To break this cycle, the clinician must understand the etiology of incontinence dermatitis and choose appropriate skin care products. Healthy skin has a mean acid mantle of 5.5 pH. This natural acidity discourages bacterial colonization and provides a moisture barrier. Aging skin experiences increased dryness (allowing cracks in which bacteria colonizes) and slower recovery from the effects of alkaline substances. Incontinence results in elevated friction coefficient, exposure to moisture, bacteria and ammonia (leading to alkaline conditions), and increased enzymatic activity. When choosing products to protect the skin, clinicians should check that the product's pH level is within the desirable range (4 to 7), that ingredients are appropriate and not contraindicated for particular patients, and that the product has been tested for dermal irritation and antimicrobial efficacy. Three basic product types are cleansers, moisturizers and barriers. Skin should be cleansed gently without high alkalinity (as in some bar soaps) or rubbing (which denudes fragile skin), patted or air dried, moisturized after bathing, and protected with a barrier. Using the appropriate products can reduce the risk for breakdown and enhance the skin health of your patients.