Clinical Case Series: Management of Fecal Incontinence-associated Dermatitis (IAD) Utilizing a Three Step Technique

Problem:  Four patients with IAD were admitted for care at our long term acute care (LTAC) hospital.

Past Management:  Patient A was admitted 4/11 with extensive IAD related to liquid fecal incontinence related to Clostridium difficile colitis.  Patient A was anuric. Treatment at referring facility was trypsin and balsam peru ointment¹.

Patient B was admitted 7/18 with IAD related to liquid fecal incontinence.  Patient B had an indwelling urinary catheter.  Treatment at referring facility was an unknown zinc oxide barrier ointment.

Patient C was admitted 8/11 with extensive IAD related to fecal incontinence.  Patient C had an indwelling urinary catheter and an unstageable sacral pressure ulcer.  Treatment at referring facility was unknown barrier ointment.

Patient D was admitted 8/27 with IAD related to fecal incontinence.  Treatment at referring facility was unknown.

Current Approach:  Patient A had fecal management device² and initiation of a three step process utilizing ostomy powder³, non-alcohol skin sealant⁴, and barrier ointment⁵.  This was supplemented by trypsin and balsam peru ointment¹.

Patient B had antifungal barrier ointment⁶ initiated 7/18.  On 7/22, the three step process using antifungal powder⁷ , non-alcohol skin sealant⁴, and antifungal barrier ointment⁶ was initiated.  An indwelling fecal management device was utilized to divert stool.  By 8/9 the fungal component of Patient B’s dermatitis had resolved and the three step process was continued using ostomy powder³ and standard barrier ointment⁵.

Patient C and Patient D had the three step process initiated using ostomy powder³, non-alcohol skin sealant⁴, and antifungal barrier ointment⁶.  Patient D also had an indwelling fecal management device utilized to divert stool.

Patient Outcomes:  Although Patient A’s IAD was so severe there were resultant full thickness wounds, consistent use of the three step process supplemented by tyrpsin & balsam peru ointment¹ allowed complete epithelialization by 6/16 (2 months).  Patient A remained incontinent of stool and was transitioned to an external collection device⁸. 

Patient B had resolution of dermatitis by 8/17 (1 month) although his fecal incontinence persisted.  Patient C had significant improvement by 8/16 (5 days) and near resolution by 8/23 (12 days).  Patient D had significant improvement in 2 days and complete resolution by 9/20 (24 days).

Conclusion:  Consistent use of a three step process utilizing powder, skin sealant and barrier ointment can promote healing of IAD.

¹Xenaderm (Healthpoint)

²Zassi (now ActiFlo) (Hollister, Inc.)

³Adapt Ostomy Powder (Hollister, Inc.)

⁴Cavilon No Sting (3M)

⁵Baza Protect (Coloplast)

⁶Baza Antifungal (Coloplast)

7Nystatin Powder

⁸Fecal Incontinence Collector (Hollister, Inc.)