Treatment Options for Moderate to Severe Incontinence-Associated Dermatitis (IAD) and Intertriginous Dermatitis (ITD)

Statement of Clinical Problem 

Some adult patients with moderate to severe incontinence associated dermatitis (IAD) or intertriginous dermatitis(ITD) require aggressive treatment to manage pain and facilitate healing.  There is little evidence in the literature regarding how to treat moderate to severe IAD/ITD symptoms that are not responding to routine treatments specified in nursing guidelines.  

Description of Past Management 

Past treatment included the use of skin cleansers and moisture barrier ointments to prevent and manage IAD. Antifungal powder was used in the presence of candidiasis.  

Current Clinical Approach 

In the literature, different authors make treatment recommendations which collectively include two or more of the following: using topical steroid-based anti-inflammatory products, antifungal products when cutaneous rash is present, antimicrobials or antibiotics. 

The medical clinical nurse specialist (CNS) partnered with dermatology physicians to develop skin treatment options using different combinations of 1% hydrocortisone cream, anti-fungal cream, and 0.25% acetic acid–moist dressings two - three times a day based on patient’s IAD/ITD symptoms.  Treatment options evolved on evaluation of each patient case study. 

Patient Outcomes 

Over 21 months, 30 patients were treated using the noted treatments. Twenty-nine patients had significant symptom improvement or had healed skin in a short period of time (average four to eight days).  One patient had partial improvement.  Findings indicated improved clinical outcomes where skin integrity was restored, resulting in decreased risk for infections, enhanced quality of life, reduced pain, and decreased potential for pressure ulcer development. 

Conclusions 

It was concluded that utilizing this combination of medications was an effective treatment plan for the patients with moderate to severe IAD/ITD that had not responded to routine treatment options. The standardized treatment plan has been shared with all CNSs in the medical center for use on patients with similar symptoms.