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# Incontinence-associated dermatitis

Skin irritation and breakdown from long contact with urine or stool on the perineum, buttocks and groin. Gentle cleaning and barrier products prevent it.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Skin](https://durgical.com/en/anatomy/skin/)
- [Sacrum](https://durgical.com/en/anatomy/sacrum/)
- [Coccyx](https://durgical.com/en/anatomy/coccyx/)
- [Perineal body](https://durgical.com/en/anatomy/perineal-body/)
- [External anal sphincter](https://durgical.com/en/anatomy/external-anal-sphincter/)

## Why it happens

- [Skin: epidermis layers, dermis, hypodermis](https://durgical.com/en/histology/skin-epidermis-layers-dermis-hypodermis/)

## What it is

A form of moisture-associated skin damage in which repeated or prolonged exposure to urine and/or stool causes inflammation and erosion of the skin in the perineal, perigenital, buttock and inner thigh areas. It starts on the surface (top-down), unlike pressure injury.

## Who gets it

Common in patients with incontinence in nursing homes, intensive care units and hospital wards; rates are highest with fecal or double incontinence, particularly liquid stool. It is a frequent nursing quality problem in Colombian and Latin American hospitals and long-term care homes.

## Causes

- Prolonged contact of skin with urine, which over-hydrates the skin and raises its pH
- Liquid stool containing digestive enzymes that damage the skin
- Friction from absorbent products, bed linen and repeated cleaning
- Use of soap and water and harsh scrubbing
- Occlusive diapers or pads left on too long

## Risk factors

- Fecal incontinence, especially liquid stool, and double incontinence
- Frequent incontinence episodes
- Use of occlusive containment products
- Poor skin condition and advanced age
- Reduced mobility and dependence for hygiene
- Cognitive impairment, critical illness and fever
- Antibiotic use and diarrhea

## Pathophysiology

Urine and sweat over-hydrate the outer skin layer, weakening it and making it vulnerable to friction. Bacteria convert urea to ammonia, raising skin pH and activating fecal enzymes (proteases and lipases) that digest the skin. The result is inflammation, loss of barrier function and erosion; damaged skin is then easily colonised by Candida.

## Classification

- Category 1: persistent redness with intact skin
- Category 2: redness with skin loss (erosion, denudation, vesicles); may have secondary infection
- Severity scored as mild, moderate or severe in several assessment tools

## Symptoms and signs

- Diffuse redness with poorly defined edges in the perineum, buttocks, groin or inner thighs
- Shiny, macerated skin and superficial erosions
- Burning, itching or pain, especially during cleaning
- Satellite papules or pustules if Candida superinfection develops

## Red flags

- Spreading redness, warmth or fever (cellulitis)
- Deep or localised wound over a bony prominence (pressure injury rather than IAD)
- Extensive skin loss with pain that limits care
- Persistent liquid stool with dehydration or suspected Clostridioides difficile infection

## Diagnosis

**Clinical**
Clinical diagnosis based on history of incontinence and the pattern of [skin](https://durgical.com/en/anatomy/skin/) damage: diffuse, superficial, in areas exposed to urine or stool, with blurred edges. Distinguish from pressure injury, which is localised over a bony prominence, has defined edges and may be deep with necrosis. Assess incontinence type and frequency and the products used.

**Tests**
Not usually needed. Microscopy or culture when fungal or bacterial infection is suspected; stool testing for C. difficile if there is diarrhea.

**Imaging**
Not required.

## Differential diagnosis

- Pressure injury
- Intertriginous dermatitis (intertrigo)
- Cutaneous candidiasis
- Irritant or allergic contact dermatitis
- Psoriasis or other inflammatory dermatoses of the folds

## Goal of treatment

Remove irritants, protect and restore the skin barrier, treat infection, and manage the underlying incontinence.

## Treatment

**Conservative**
Structured skin care: gentle cleansing soon after each episode with a pH-balanced, no-rinse cleanser instead of soap and water, patting rather than rubbing dry.

**Conservative**
Protect with a skin barrier product (zinc oxide, dimethicone, petrolatum or polymer film) applied after each cleansing.

**Conservative**
Manage incontinence: assess cause, timed toileting, treat diarrhea, choose breathable absorbent products and change them promptly; consider a fecal management system for severe liquid stool.

**Medical**
Topical antifungals when Candida superinfection is present.

**Follow-up**
Inspect the skin at least daily, document category and response, and reassess pressure injury risk.

## Complications

- Secondary Candida or bacterial infection
- Pressure injuries (moist, damaged skin is more vulnerable)
- Pain, sleep disturbance and reduced quality of life
- Higher nursing workload and costs

## Prognosis

With prompt structured skin care and incontinence management, IAD usually improves within days. Recurrence is common while incontinence persists.

## Prevention

- Prompt cleaning after each incontinence episode
- Routine barrier products in at-risk patients
- Avoid soap and vigorous rubbing
- Breathable pads and avoiding layers of linen under the patient
- Continence assessment and treatment of reversible causes

## Test yourself

Think of the answer, then tap the question to see it.

## How does IAD differ from a pressure injury in location and depth?

IAD is diffuse and superficial in areas exposed to urine or stool; pressure injury is localised over a bony prominence and can be deep.

## Which type of incontinence carries the highest risk of IAD?

Fecal incontinence with liquid stool (and double incontinence).

## What should replace soap and water for perineal cleansing?

A pH-balanced, no-rinse cleanser, followed by a barrier product.

## Satellite papules around IAD suggest what complication?

Candida superinfection.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/conditions/incontinence-associated-dermatitis/)

## Related conditions

- [Urinary incontinence in older adults (urge, overflow, functional)](https://durgical.com/en/conditions/urinary-incontinence-in-older-adults/)
- [Fecal incontinence](https://durgical.com/en/conditions/fecal-incontinence/)
- [Skin tears in older adults](https://durgical.com/en/conditions/skin-tears-in-older-adults/)
- [Immobility syndrome and hospital-associated deconditioning](https://durgical.com/en/conditions/immobility-syndrome-and-hospital-associated-deconditioning/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Incontinence-associated dermatitis: consensus statements, evidence-based guidelines for prevention and treatment, and current challenges](https://pubmed.ncbi.nlm.nih.gov/22572899/) (Journal of Wound, Ostomy and Continence Nursing, 2012); Incontinence-associated dermatitis: a consensus (Journal of Wound, Ostomy and Continence Nursing, 2007).

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Source: https://durgical.com/en/conditions/incontinence-associated-dermatitis/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/incontinence-associated-dermatitis/