Barrier Cream Guide: Picking the Right Formula for Incontinence-Exposed Skin

In a study conducted in an Australian teaching hospital, 10% of the sample group had incontinence-associated dermatitis (IAD). IAD is a form of skin inflammation and damage caused by prolonged exposure to urine and/or faeces. Continuous moisture and irritants break down the skin’s natural protective barrier, resulting in redness, discomfort, pain, and an increased risk of infection. IAD is a type of moisture-associated skin damage (MASD) and can affect people of any age living with incontinence, most commonly in the perineal and surrounding areas.

Barrier creams are an essential part of preventing and managing IAD. Without protection, ongoing exposure leads to redness, pain, and a higher risk of infection. Barrier creams also help balance skin moisture, reducing the risk of both dryness and over-hydration, which can cause maceration and further damage.

What Is Barrier Cream?

Barrier creams create a protective layer over the skin, shielding it from urine and faeces, which contain irritants and enzymes that can quickly break down the skin’s natural barrier. By doing so, they help prevent irritation, breakdown, and IAD, creating a water-resistant layer that supports the skin’s natural defence system and promotes healing. When skin is already compromised, regular use supports healing and helps maintain comfort and dignity.

For carers, understanding when and how to use barrier creams is vital. Good skin care involves gentle cleansing with pH-appropriate products, thorough drying, and consistent application of barrier preparations. Apply a thin, even layer so protection is effective without interfering with absorbent continence products. Reapply regularly, especially after each episode of incontinence, and monitor the skin for improvement or worsening. Using these products correctly improves comfort and quality of life and reduces complications, time, and cost.

How Do Barrier Creams Work?

Healthy skin has a surface layer called the stratum corneum made up of corneocytes (dead skin cells) embedded in lipids. Think of bricks (cells) held together by mortar (lipids). This barrier prevents excessive water loss, protects against irritants such as bacteria, enzymes, urine and faeces, and maintains the skin’s natural acidic pH (around 4.5–5.5). When intact, the skin resists damage from moisture, microorganisms, friction, and chemical irritants.

In IAD this barrier is compromised. Prolonged exposure to urine or faeces causes over-hydration (maceration) of the stratum corneum. Enzymes and higher pH from faecal matter, and ammonia formed when urea in urine is converted by skin bacteria, disrupt the acid mantle. The skin then becomes more permeable to irritants, friction damage increases, and microbes can enter more easily, triggering inflammation, pain, and infection risk.

Barrier creams restore or reinforce protective functions. They often contain occlusive agents such as dimethicone, petrolatum, and zinc oxide that form a film which repels moisture and reduces water loss. Some include moisturising or lipid-replenishing components to help rebuild intercellular lipids. Because they resist wash-off better than unprotected skin, the barrier stays in place after cleansing, helping maintain a lower pH, reducing contact with irritants and friction, and giving the skin time to heal.

When Should You Use Barrier Cream?

Use barrier cream regularly for anyone experiencing incontinence, ideally after each episode and whenever the skin is cleansed. Carers play a central role in applying it at the right times and in the right way, and in reapplying often enough to maintain protection.

After every episode of incontinence: Cleanse gently and dry thoroughly, then apply the barrier cream to maintain the protective layer and prevent further breakdown.
When skin is at risk: Even if skin looks intact, apply for anyone who is incontinent and uses continence pads, catheters, or faecal management systems to prevent redness, maceration, or pain.

At early signs of IAD: If redness, irritation, or tenderness appears in the perineal or surrounding areas, consistent use can reduce progression to breakdown or infection.
During routine care: Include barrier cream in morning and evening care. Reapply throughout the day as needed, depending on product longevity.
Before friction-prone activities: When repositioning or mobilising someone with fragile skin, barrier creams can reduce shear and friction.

Key Ingredients and Formulations

Barrier creams use specific ingredients that protect and restore skin in different ways. Choice depends on IAD severity, frequency of incontinence, and the person’s skin condition. Common components are zinc oxide, dimethicone, and petrolatum with lanolin.

Zinc oxide

A physical protectant that creates an opaque layer to block urine, faeces, and moisture. It has mild antiseptic and soothing properties and is useful for moderate to severe IAD. Apply thinly to avoid interfering with pad absorbency.

Dimethicone

A silicone that provides a transparent, breathable barrier. It is lighter and less occlusive than zinc oxide, resists wash-off, and suits mild to moderate IAD or prevention, especially with frequent cleansing in aged care or hospital settings.

Petrolatum and lanolin

Petrolatum seals the skin and locks in moisture, preventing transepidermal water loss. Lanolin softens and conditions. Together they protect and help restore very dry or fragile skin. Balance protection with comfort and product absorbency.

Barrier Cream vs Barrier Film vs Barrier Cloths

Barrier creams are thicker emulsions that form semi-occlusive or occlusive layers and can stay longer under pads when applied thinly and reapplied as required.

Barrier films are lighter, transparent products applied as sprays or wipes. They dry quickly to form a thin, breathable coating and suit situations with frequent cleansing or sensitivity to heavier creams.

Barrier cloths are pre-moistened wipes that cleanse, moisturise, and apply a barrier in one step. They can save carer time and reduce handling of fragile skin, and some products with built-in barrier agents have shown reduced IAD prevalence and better wash-off resistance than standard creams alone.

How to Apply Barrier Cream: Step-by-Step

Prepare and assess: Perform hand hygiene and wear gloves. Remove soiled products and inspect the skin for redness, maceration, denudation, or signs of fungal or bacterial infection. Escalate if infection is suspected.

Cleanse gently: As soon as possible after each incontinent episode, use a pH-friendly, soap-free cleanser or no-rinse perineal wipes. Avoid scrubbing. Pat dry rather than rubbing.

Use other topical creams if prescribed: If antifungal or steroid treatments are ordered, apply those first after cleansing and allow time to absorb before the barrier product. Follow local guidance on timing.

Apply correctly: Use a small amount and spread a thin, even layer over all at-risk and affected areas. Follow product instructions. If using pads, rub creams fully into the skin so residue does not reduce absorbency. Avoid powders.

Help adhesion on very fragile skin: If creams do not adhere on denuded skin, a light dusting of stoma or hydrocolloid powder after cleansing can help. Do not use alcohol-containing products on broken skin.

Reapply as needed: Reapply after each incontinent episode and as part of routine care. Structured regimens that combine gentle cleansing with skin protectants reduce IAD incidence and support healing.

Fit and change continence products appropriately: Ensure pads or devices fit well and are changed frequently. Choose products that wick moisture and do not trap faeces against the skin.

Monitor and document: Look for reduced pain and visible improvement within one to two days, and expect resolution within one to two weeks with appropriate care. Document skin status and interventions.

Choosing the Right Barrier Cream

Base your choice on the care recipient’s needs and skin assessment. If skin is intact but at risk, a lighter protectant such as a dimethicone-based cream or a barrier film may be sufficient. If redness, irritation, or early breakdown is present, a more occlusive product such as zinc oxide or a petrolatum/lanolin-based cream is often recommended. For severely damaged or denuded skin, consult a wound care nurse or specialist before applying any product.

If a client needs frequent pad changes, a wash-resistant product such as dimethicone or a barrier film may be more practical. Thicker creams can be highly protective but may rub off with repeated cleansing. Comfort should always be a priority, so choose the product that best suits the person’s needs.

Product Recommendations from AMH Community

Abena Skincare Ointment (150 mL): Forms a long-lasting water-in-oil barrier that protects against moisture, urine, and faecal irritants. Dimethicone adds wash-off resistance, while allantoin and chamomile soothe irritation. Fragrance- and colourant-free, suitable for sensitive skin. Apply thinly to avoid affecting pad absorbency.

Abena 10% Zinc Oxide Spray: Delivers a thin, even layer of zinc oxide via spray to reduce friction and contamination risk. Contains calendula and chamomile extracts to soothe and support recovery. Free of colourants and perfume, suitable for sensitive skin. Useful for early redness or moderate IAD when frequent application is needed and the skin is not broken.

Sudocrem Healing Cream (15.25% zinc oxide): Provides a strong protective barrier against urine and faeces, helping prevent moisture-induced damage and promote healing. Emollients soothe and soften, while benzyl alcohol and benzyl benzoate offer antiseptic and mild anaesthetic effects. Apply a thin film and reapply at pad changes as required.

3M Cavilon Durable Barrier Cream: A concentrated polymer-based formula that resists wash-off and supports adhesion of dressings. Dimethicone forms a moisture barrier and conditioning agents keep skin moisturised during frequent exposure. Fragrance-free and breathable, designed not to clog pads. Longer-lasting protection may reduce application frequency.

MoliCare Skin Barrier Cream (200 mL): Forms a transparent, zinc-oxide-free film that does not affect pad absorbency. The Nutriskin Protection Complex (essential fatty acids, amino acids, creatine, almond oil) helps strengthen and regenerate the skin barrier. With a skin-friendly pH of about 5.5, it supports the acid mantle and is suitable for frequent use.

Final Thoughts

Barrier creams are a cornerstone of protecting and supporting skin exposed to incontinence. By creating a protective layer, they reduce the risk of irritation, breakdown and infection, while also helping damaged skin recover. Choosing the right skincare products — whether cream, film or cloth — depends on the individual’s skin condition, frequency of incontinence and overall comfort. For carers, consistent and correct use is essential, as early intervention can prevent complications, improve quality of life and save valuable time and resources. With the right knowledge and products, skin health can be maintained even in the presence of ongoing incontinence challenges.

Sources

1. Junkin, J., & Selekof, J. L. (2014). Prevalence of incontinence and associated skin injury in the acute care inpatient. Journal of Wound, Ostomy, and Continence Nursing, 41(3), 233–238. https://pubmed.ncbi.nlm.nih.gov/24974872/

2. Gray, M., Bliss, D. Z., Doughty, D. B., Ermer-Seltun, J., Kennedy-Evans, K. L., & Palmer, M. H. (2022). Moisture-associated skin damage: Overview and pathophysiology. Journal of Wound, Ostomy, and Continence Nursing, 49(3), 233–239. https://pmc.ncbi.nlm.nih.gov/articles/PMC9093722/

3. Lichterfeld-Kottner, A., et al. (2025). Effectiveness of a standardized skin care protocol in reducing incontinence-associated dermatitis in older patients: A pragmatic trial. Journal of Tissue Viability, 34(1), 65–72. https://www.sciencedirect.com/science/article/pii/S0965206X25000725

4. South Eastern Sydney Local Health District. (2020). Wound – Incontinence associated dermatitis (IAD) procedure (SESLHDPR/205). NSW Health. https://www.seslhd.health.nsw.gov.au/sites/default/files/documents/SESLHDPR%20205%20-%20Wound%20-%20Incontinence%20Associated%20Dermatitis%20%28IAD%29.pdf

5. Clinical Excellence Commission. (2014). Incontinence-associated dermatitis (IAD) best practice principles. NSW Health. https://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0015/424401/Incontinence-Associated-Dermatitis-IAD-Best-Practice-Principles.pdf

6. Wounds International. (2018). Incontinence-associated dermatitis (IAD): Optimising skin barrier function – A 3-step approach. Wounds International Made Easy Series. https://woundsinternational.com/made-easy/incontinence-associated-dermatitis-iad-optimising-skin-barrier-function-a-3-step-approach/
   

7.  SSS Australia. (2022). Treatment and prevention of incontinence-associated dermatitis in aged care. https://www.sssaustralia.com.au/treatment-prevention-of-incontinence-associated-dermatitis-in-aged-care