Conquering the Cleft (Intergluteal Cleft): Finding a Clinically Effective yet Cost-Effective Solution

Managing partial thickness lesions in the intergluteal cleft area can often be a challenge to the healthcare team. To further complicate this issue, there is a lack of consensus on how to classify lesions affecting the intergluteal cleft and fleshy buttocks.  Recent literature supports the concept that superficial skin lesions are primarily caused by moisture and friction instead of pressure.  It is intertriginous dermatitis (ITD) not incontinence-associated dermatitis (IAD) that is responsible for the linear breaks in skin that occurs spontaneously in overhydrated skin.  The team of certified wound care nurses at this large integrated health system recognized that there was a 2-fold problem associated with their current protocol used to treat intergluteal cleft lesions. 1) Cost – Twice-a-day application of a topical ointment containing balsam peru, castor oil and trypsin (BCT) at $48.10 for a 60/gm tube. 2) Complications – Increased breakdown from moisture with and without candidiasis was noted in the intergluteal cleft area

Understanding the problems associated with the BCT ointment, the team set out to find a clinically effective alternative.  After evaluating a zinc oxide-based hydrophilic paste on intergluteal cleft lesions the institiution's value analysis team added the hydrophilic paste to the wound care formulary. Dressing protocols were re-written to include: Apply zinc oxide-based hydrophilic paste at least the thickness of a dime, once-a-day and PRN to the gluteal cleft.  The use of zinc oxide-based hydrophilic paste, as part of a comprehensive wound management program, played an integral part in reducing costs and decreasing complications in the intergluteal cleft area.