Understanding the effects of Incontinence-Associated Dermatitis


What is it?

Incontinence-associated dermatitis (IAD) refers to skin irritation and breakdown due to an increase in moisture on the skin from incontinence. IAD is an indication of the disruption to the skin’s natural barrier triggering inflammation. An increase in moisture and pH levels breaks the skin barrier.

A study by Bliss and Mathiason et al. 2017 found that individuals with pre-existing skin damage to the perianal area such as pressure injuries increase the likelihood of IAD.


IAD has three categories for staging

  • No redness and skin intact
  • Red or discomfort but skin intact
  • Skin breakdown and surrounding redness


IAD is often misdiagnosed as a pressure injury as the staging appears similar on the skin. It can be identified through understanding the cause and characteristics.

IAD is:

  • The result of moisture and friction
  • Is most common in the perianal region
  • Appears in a diffused shape or mirror image
  • Superficial (unless untreated, then IADs get deeper as more tissue breakdowns)
  • No necrotic tissue evident
  • Edges are diffused and irregular
  • The colour will be organic and not uniform in distribution and shape

The Skin Barrier

The skin barrier is the outermost layer of the skin. To protect the body from external environments the cells are structured like a brick wall with fat cells acting as the mortar.

Two things are key in maintaining its integrity; perfusion and hydration.


Long periods of pressure or lack of movement to the area affect perfusion. This is a concern for individuals in hospitals, aged care or those with decreased mobility due to long periods of inactivity.


Epidermal (skin) cells are 70% water. Excess moisture increases the water content of the cell beyond its capacity and reduces the cell’s integrity, opening the skin up to inflammation and irritation. Dehydration also reduces the amount of water content in a cell by minimising its elasticity causing microscopic “cracks” in the skin surface.

Fixing the Barrier


Bliss, Mathiason, Gurvich et al. 2017, ‘Incidence and Predictors of Incontinence Associated Skin Damage in Nursing Home Residents with New Onset Incontinence’, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5341379/