icon

Intertrigo (or intertriginous dermatitis) is a rash that can develop in a skin fold. The condition is common and may affect people from infancy to adulthood. Certain factors increase your risk, such as having diabetes, being overweight, incontinence (unable to control bladder or bowels), wearing incontinence briefs or being on bed rest.

Perspiration, warmth and friction can cause a skin fold to become red and inflamed. Symptoms such as itching, burning, odor and pain can accompany the redness. These symptoms can also occur under medical devices such as braces or splints, or adjacent to artificial limbs.

Common areas for intertrigo

Intertrigo may potentially develop in any skin fold or in areas where there is constant skin-on-skin friction (1)^. It may be found: 

• Between thighs
• Under the armpit
• Under breasts
• Around belly folds
• Between fingers and toes
• In groin folds
• In neck creases
• Behind the knee
• Adjacent to an artificial limb
• Under a brace or splint

Other problems in skin folds

In someone who is incontinent, moisture from urine and stool can get trapped in skin creases. This may be found especially under the buttocks. The condition that develops is not intertrigo, but it is a type of dermatitis that can cause similar problems. When skin or a skin fold is moist and/or damaged, it is prone to infection from bacteria or fungus (^1).

How to minimize the risk 

For general prevention, patients should try to keep skin folds clean and dry, decreasing moisture and rubbing between folds of skin with a wicking fabric containing silver (^2). InterDry® Textile with Antimicrobial Silver Complex is a wicking textile that removes excess moisture, reduces friction and contains silver to help manage fungal or bacterial infections (^3). It’s also a good idea to wear lightweight, loose and absorbent clothing (^4).

Caring for your skin 

If intertrigo does develop, consider following these recommended steps until the rash disappears.

Step 1: Wash the skin fold

1. Wash gently, using a pH-balanced skin cleanser. Some options include a no-rinse body wash or no-rinse incontinence cleanser.
2. Pat your skin dry. Do not rub.

Step 2: Protect your skin

1. Cut the appropriate size textile with scissors, allowing for a minimum of 2 inches of textile exposure outside the skin fold.
2. Lay a single layer of textile into the base of the skin fold or under a medical device such as a brace or splint. Leave at least 2 inches of the textile exposed outside the skin fold or brace/splint. This allows the excess moisture to wick away from the skin fold and evaporate.
3. Secure the textile in one of several ways: with the weight of the skin fold, with a small amount of tape or tucked into clothing.
4. Remove the textile before bathing and insert back when when finished.
5. Replace the textile in 5 days or if it becomes soiled with urine or stool.

Patients should be sure to check their skin every day. They should look for rashes, redness or open areas and inspect all skin folds, or under devices that rub against the skin.

Coloplast products for intertrigo

• Bedside-Care® Foam – pH-balanced, no-rinse cleanser
•  InterDry® Textile with Antimicrobial Silver Complex– The first effective solution for skin fold management. A wicking textile impregnated with silver to manage moisture, friction and fungal or bacterial infections in skin folds (3).

icon

Dry skin is a common problem caused by loss of the skin’s natural moisturisers, leading to epidermal water loss. The environment plays an important role in this water loss. During winter, or with the use of central heating or air conditioning, skin loses moisture more readily. Similarly, frequent bathing or using harsh soap product may increase the risk of dry skin.

Dry skin is most often found on the lower legs and feet and less often on the trunk of the body or hands. The skin may be scaling and flaking, it may appear dull with a grey or whitish discoloration, or you may see increased skin markings or lines. In severe cases, deep cracks, warmth, pain and redness may be evident. The presence of rough, uneven or cracked skin indicates a need for intervention.

Dry skin can be classified as mild, moderate, or severe.  It is more easily eliminated or controlled when in the mild to moderate stages. 

Caring for dry skin 

Dry skin, or xerosis, requires proper care just as moist skin does. Choosing the best type of moisturiser is important. For instance, water-based moisturisers require frequent application, often with little improvement. Oil-based creams and lotions that trap moisture in the skin and require less frequent application are more effective.

Follow these steps to care for dry skin:

1. Cleanse - gently cleanse the skin with a mild, pH-balanced skin cleanser and a soft cloth or disposable washcloth.
2. Pat skin dry. Do not rub.
3. Moisturise the skin - apply moisturising creams or lotions after bathing as needed. 

Coloplast products for treating dry skin

• Sween® 24 Cream – Once-a-day long lasting 24 hour moisturizing cream
• Sween® Cream – Moisturizing cream designed to hydrate moderately dry skin
• Sween® Lotion - An everyday all over body lotion for normal maintenance of healthy skin
• Atrac-Tain® - Advance moisturizing relief for afflicted dry, scaly, cracked skin (ideal for heals)
• Critic-Aid® Clear – Clear moisture ointment that provides a protective skin barrier

icon

A pressure ulcer, also called a bedsore or pressure sore, is an injury to the skin due to constant pressure. Pressure ulcers form when blood flow to the area slows or stops. This causes small portions of the tissue to die, and an ulcer develops.

Pressure ulcers typically form over bony parts of the body. Damage to skin can occur when these bony parts of the body press against a hard surface. Hard surfaces include beds, chairs or even medical devices, such as a brace or splint.

Where do pressure ulcers occur?

• Head
• Shoulder
• Base of spine
• Bottom
• Heels
• Toes

© NPUAP 2008. Used with permission.

What are the risk factors?

There are a variety of risk factors:

• Limited mobility
• Lying in a bed or sitting in a chair for long periods of time
• Frequently sliding down in bed
• Being pulled across a bed during position change
• Dry skin
• Skin exposed to urine, stool or perspiration
• Decreased mental awareness
• Decreased feeling or sensation
• Poor nutrition
• Blood flow problems

How patients can minimize their risk

Patients should follow the few basic steps below to help prevent pressure ulcers from occurring. 

Step 1: Protect the skin

1. Check your skin every day, including skin folds. Look for any areas of redness and irritation. Use a mirror to view areas that are hard to see, such as the bottom of the feet.
2. Use moisturisers to prevent dry skin. 
3. Do not massage bony areas. This may damage the skin. 
4. If skin is wet or soiled from urine or stool:
   – Wash your skin immediately with a pH-balanced, no-rinse skin cleanser. Pat skin dry.
   – Apply a moisture barrier ointment, cream or paste to protect the skin.
5. If using an absorbent pad or brief for incontinence, change it when it becomes soiled or wet. Avoid products with a plastic lining.

Step 2: Prevent pressure

For people confined to bed:

1. Use a mattress specially made to reduce pressure.
2. Turn or reposition often.
3. Do not lie on a reddened area of skin, or on medical devices, such as tubes or drainage systems.
4. Raise the head of the bed as little as possible, since a steeper angle can put more pressure on the tailbone area. Avoid slouched positions.
5. Lift, don’t drag, when changing positions across a surface. Sliding or dragging can injure the skin.
6. Avoid positioning patient directly on bony areas.
7. Keep clothing and bed linens dry, smooth and wrinkle-free.
8. Protect your elbows and heels. Use a pillow under the calves to lift the heels up off of the mattress.

For patients in a chair or wheelchair:

1. Use a cushion specially made to reduce pressure.
2. Shift your weight often by doing small lifts, leaning forward and shifting your weight from side to side.

Step 3: Eat well

Nutrition is important.

1. Calories, protein and fluids all help to keep you healthy and to protect your skin from injury.
2. Let your doctor or nurse know if you are having problems eating or if you notice that you’re losing weight. They may suggest liquid nutritional supplements.

Caring for pressure ulcers

For pressure ulcers to heal, the wound must be kept clean, free of dead tissue and covered with a special dressing. Dead tissue is yellow, black or brown in colour and can lead to infection.

Step 1: Clean the wound

Regular cleaning of the wound is important to aid in healing.

1. Gently clean the wound with each dressing change using a saline solution or wound cleanser.
2. Rinse the area well to remove any loose material or dead tissue.

Step 2: Cover the wound

Special wound care dressings are used to cover and protect the wound. Wound care dressings either keep the wound moist or absorb drainage, or both.

1. Apply a dressing to the wound.
2. The type of dressing can vary: some dressings cover the wound and some are used to fill deep wounds.

How to tell if a pressure ulcer is getting better

The wound will begin to get smaller as it heals. You should begin to see new tissue, which is shiny red or pink in colour. If your wound had any drainage, there will be less drainage as it heals.

What are the signs of infection?

• Redness or warmth near the wound
• Swelling and tenderness near the wound
• Thick, yellow or green drainage
• Strong odour coming from the wound
• Fever
• Chills
• Weakness
• Lack of energy

If signs or symptoms of infection are detected, refer to the pressure ulcer protocol at your institution or the National Pressure Ulcer Panel Guidelines (NPUAP). 

Coloplast products for pressure ulcers

• Sproam® - No rinse cleanser
• Bedside-Care® – pH-balanced, no-rinse cleanser
• Sween® 24 Cream – Once-a-day moisturising cream
• Critic-Aid® Clear – Clear moisture barrier ointment
• Sea-Clens® – Saline wound cleanser
• Biatain® – Wound dressings
• Comfeel® – Hydrocolloid dressings

icon

Incontinence is the difficulty or inability to control your bladder (urine) or bowel (stool). The ailment is common, but those who experience it are often too embarrassed to ask for help.

Although incontinence is more common in the elderly population, it is not part of the normal aging process. Urinary incontinence may be caused by medical problems such as weak pelvic muscles, diabetes or an enlarged prostate gland. It can also be caused by certain medications. Common causes of faecal incontinence include constipation, diarrhoea or damage to the anal sphincter muscles from giving birth. It can also be caused by an improper diet or certain medications. 

How incontinence affects the skin

If your patient experiences incontinence, it is very important that they know how to protect their skin from damage. Skin provides the first line of defence against germs and infection, and long-term exposure to moisture from urine or stool can cause the skin to soften, weakening the skin’s ability to serve as a protective barrier.

With frequent incontinence, skin problems can occur. Typical symptoms are redness, burning and irritation around the buttocks, rectum, groin, or between the thighs. If there is persistent moisture from urine and stool, it increases the risk of infection and/or skin breakdown.

Caring for the skin

If your patient does suffer from incontinence-related skin problems, they should follow the steps below to ensure proper skin care.

Step 1: Clean your skin

1. Remove and throw away the brief, pad or other soiled material.
2. Wash your skin each time it has been soiled. Use a pH-balanced, no-rinse skin cleanser.
   TIP:  Avoid harsh soaps like bar soap and antimicrobial hand-washing soaps. These can dry the skin and lead to skin breakdown. (¹⁾
3. Gently clean the area from front to back using a soft washcloth or disposable soft cloth.
4. Pat your skin dry. Do not rub.

Step 2: Protect your skin

A skin protectant is a moisture barrier cream, ointment or paste. It is used to protect your skin from urine and stool. Most skin protectant ointments contain petrolatum, dimethicone, zinc oxide or a combination of these ingredients. (²⁾

1. Apply a thin, even layer of skin protectant.
2. Some people use absorbent underpads, or briefs. Change pad or briefs after it has been soiled. Avoid products that have a plastic lining.

Coloplast products for incontinence-related skin ailments

• Sproam® - No rinse cleanser
• Bedside-Care® – pH-balanced, no-rinse cleanser
• Critic-Aid® Clear – Clear moisture barrier ointment

The guide below will help you distinguish IAD from a pressure ulcer.

IAD

© 2007 Coloplast Corp. Used with permission.

Appearance: Spread-out irregular edges, may include denuded areas. Located in perineal area, inner thighs, buttocks, and adjacent skin folds.

Injury: Starts at the top layer of skin and works inward.

Cause: Moisture and friction.

Color: Red or shiny red.

Odor: Skin may smell of ammonia.

Depth: Partial thickness damage.

Tissue: No necrotic tissue.

Symptoms: Pain and/or itching.

Treatment: Apply moisture barrier ointment, paste, or cream to prevent skin injury and protect from irritants

Pressure ulcers

© NPUAP. Used with permission.

Appearance: Defined area of injury, usually over a bony prominence.

Injury: Starts on the inside and moves outward.

Cause: Pressure and shear.

Color: Red, yellow, brown, black, or purple.

Odor: Foul smelling when bacteria present.

Depth: Partial or full thickness damage.

Tissue: If full-thickness, may have necrotic tissue – slough or eschar.

Symptoms: Pain and/or itching.

Treatment: Provide pressure redistribution and moist wound healing dressings.

icon

Moisture-associated skin damage 

Moisture-associated skin damage (MASD) is an injury to the skin by repeated or sustained exposure to moisture. There are four common types of MASD:

• Intertriginous dermatitis
• Incontinence-associated skin dermatitis
• Periwound moisture-associated dermatitis
• Peristomal moisture-associated dermatitis

For any of these four types of skin damage, long-term exposure to moisture can lead not only to redness and inflammation, but also to skin erosion and/or infection.

Intertriginous dermatitis (ITD)

Non-caustic moisture damage: perspiration

Inflammation in skin-to-skin or skin-to-device related to perspiration, friction and bacterial/fungal bioburden. Characteristics include erythema, itching, maceration, erosion and odor (possible satellite lesions).

Interventions

1. Assess and treat the cause. 
2. Gently cleanse the skin fold daily with a pH-balanced, no-rinse skin cleanser. (Bedside® Care Foam)
3. Pat dry or air dry.
4. Place InterDry® in the skin fold or under the medical device.
5. Allow 2 inches to be exposed to the air.
6. Date and initial the InterDry textile.
7. Reposition as needed.
8. Replace if soiled with urine, stool or blood.
9. Discard after 5 days of use.

Incontinence-associated dermatitis (IAD)

Caustic moisture damage: stool/urine

(More commonly known as diaper rash). Inflammation of the skin that occurs when urine or stool comes into contact with perineal/perigenital area, inner thighs, buttocks, or adjacent skin folds. Characteristics include inflammation and erythema with or without erosion or denudation.

Interventions

1. Assess and treat cause of incontinence.
2. Use a urinary and/or fecal containment device. Consider using a Male External Catheter (Conveen® Optima) for men.
3. Offer toileting at least every 2 hours, as appropriate.
4. Cleanse skin at time of soiling with a gentle no-rinse cleanser (Bedside-Care® Foam).
5. Apply a protective moisture barrier ointment (Critic-Aid® Clear or Baza Cleanse & Protect® Lotion) to the affected area.
6. Apply a topical antifungal treatment, if needed.
7. Consider using underpads or absorbent briefs.

Periwound moisture-associated dermatitis

Caustic moisture damage: wound exudates

When wound exudate has sustained contact with the skin, skin damage is the likely outcome. Characteristics include inflammation and erythema with or without erosion.

Interventions

1. Assess cause of periwound damage. If wound is exuding large amounts of exudate, consider using an absorbent dressing (Biatain Family of dressings)  
2. Cleanse the wound at time of each dressing change with a saline-based wound cleanser (Sea-Clens® Wound Cleanser). Pat the periwound edges dry.
3. Apply protective skin barrier to the periwound edges.
4. Let dry and then re-apply.

Peristomal moisture-associated dermatitis

Caustic moisture damage: stoma effluent

Inflammation around a stoma due to sustained contact of stool or urine on the peristomal skin.

Interventions

1. Assess cause of peristomal damage.
2. Prevent any further damage (i.e., cut ostomy barrier to size, change pouch according to schedule, change pouch immediately for burning or irritation).
3. Gently wash the peristomal skin before applying a new pouching system. Pat dry.
4. If skin is moist and weepy, consider managing with crusting technique  (Ostomy Powder).

Candidiasis

Yeast infection

A yeast infection of the skin caused by candida fungus. Commonly found in warm, moist areas, such as skin folds. Characteristics include small pustules and a macerated beefy red rash with satellite lesions.

Interventions

1. Assess and treat cause.
2. Gently wash with a pH-balanced skin cleanser.  (Bedside-Care® Foam)
3. Management options:

• May use a topical antifungal.
• When incontinence is present: apply antifungal moisture barrier.
• For skin folds: use InterDry® to eliminate friction, moisture & bacterial/fungal bioburden.

Xerosis

Dry skin:

An abnormal dryness of the skin. Characteristics include dry, scaly, itchy, red skin. May have fissures and cracks. Arms, legs and heels are commonly affected. Pruritus may be present.

Interventions

1. Assess and treat cause of dry skin.
2. Gently wash with a pH-balanced cleanser (Bedside-Care® Foam).
3. Apply moisturiser to skin at least daily (Sween Lotion Unscented).
4. To exfoliate extremely dry/fissured skin, such as heels use moisturiser with urea and lactic acid (Atrac-Tain® Cream).

Erythrasma

A bacterial infection caused by corynebacterium minutissimum. Characteristics include a reddish-brown, slightly scaly patch with sharp borders, occurring in moist areas such as the groin, axilla, and skin folds. Pruritus may be present.

Interventions 

1. Assess for cause of skin irritation.
2. Gently wash with a pH-balanced cleanser.  (Bedside-Care® Foam)
3. Management options:

• May treat with a topical antibacterial.
• For skin fold/under medical device: use InterDry® to eliminate friction, moisture & bacterial/fungal bioburden.

Tinea Cruris

Jock itch 

A fungal infection of the groin caused by friction and perspiration. Characteristics include an itchy, red, scaly rash that can spread from the groin to the genitals, inner thighs, buttocks and anus.

Interventions

1.  Assess and treat cause.

2.  Gently wash with a pH-balanced cleanser.  (Bedside-Care® Foam)

3.  Management options:

• May use a topical antifungal.

• When incontinence is present: use antifungal moisture barrier.

• For skin folds: use InterDry® to eliminate friction, moisture & bacterial/fungal bioburden.

Tinea Pedis

Athlete’s foot 

A fungal infection in the foot. Characteristics include fissuring, maceration, scaling and burning between the toes.

Interventions

1. Assess and treat cause.
2. Gently wash with a pH-balanced skin cleanser (Bedside Care® Foam).
3. Management options:

• Use InterDry® between toes to eliminate friction, moisture & bacterial/fungal bioburden.
• May use topical antifungals.

Pruritus ani

Chronic itching 

An intensely itchy rash around the anus caused by exposure to irritants in the stool.  Rash is worsened by vigorous use of toilet tissue or scrubbing with soap and water.

Interventions

1. Assess for cause of skin irritation. 
2. Gently cleanse skin after each bowel movement with a pH-balanced, no-rinse perineal/skin cleanser (Bedside® Care foam, or Baza Cleanse & Protect®). 
3. Apply skin protectant (Critic-Aid® Clear).