Incontinence Associated Dermatitis (IAD) is a form of contact dermatitis stemming from extended contact with urine and faeces and common in those who suffer from incontinence. Of those who experience incontinence, 1 in 4 will also suffer from IAD.
IAD affects a significant number of incontinent clients, making proper skincare and management essential in caregiving settings. This article will explore the causes, prevention strategies, and treatment options for IAD to help caregivers provide the best care possible.
What is Incontinence-Associated Dermatitis?
As a caregiver, it’s important to understand the difference between nappy rash and pressure ulcers, as both can affect people who are incontinent or have limited mobility.
Nappy rash is usually caused by prolonged exposure to moisture from urine or faeces, as well as friction and irritation from the nappy itself. It appears as red, inflamed skin in the nappy area, such as the buttocks, genitals, and inner thighs, and is generally mild. Frequent nappy changes, gentle cleansing, and barrier creams like zinc oxide are effective for treatment and prevention.
On the other hand, pressure ulcers (also known as bedsores) develop from continuous pressure on bony areas of the body, such as the sacrum, heels, hips, or elbows, which reduces blood flow and causes tissue damage. These can range from mild redness to deep, open wounds and may become serious if not treated. Preventing pressure ulcers involves regularly repositioning the person, using pressure-relieving mattresses or cushions, and ensuring good nutrition and skin care.
While nappy rash is common and usually easy to manage, pressure ulcers require more intensive care and monitoring. Recognising the differences early helps you provide more effective, compassionate care and prevent complications.
Causes & Risk Factors
Incontinence-Associated Dermatitis (IAD) is caused by a combination of chemical and physical stressors that compromise the skin's natural barrier. Prolonged exposure to urine and faeces raises the skin’s pH, disrupting its protective acid mantle and increasing susceptibility to irritation and infection. Occlusion from incontinence products that trap heat and moisture can lead to maceration, while friction, especially during cleaning or movement, exacerbates skin breakdown.
Immobility increases the likelihood of prolonged skin contact with irritants, and malnutrition can impair the skin's ability to repair itself. These risk factors often work together, making early prevention and proper skincare essential to maintaining skin health in at-risk individuals.
Recognise Early Signs & Symptoms
Early identification of Incontinence-Associated Dermatitis (IAD) is essential to prevent further skin damage and complications. Key indicators include noticeable changes in skin colour, such as redness or inflammation, often accompanied by pain, burning or discomfort in the affected area. Maceration, where the skin appears soft, white or wrinkled due to excessive moisture, is another common sign. The GLOBIAD (Global IAD Categorisation Tool) provides a structured framework for assessing and staging IAD severity, helping carers and clinicians differentiate between mild redness and more advanced cases involving skin breakdown. Recognising these symptoms early supports timely intervention and improved skin outcomes.
The 3-Step Prevention & Care Routine
Preventing incontinence-associated dermatitis (IAD) starts with using breathable continence products that help maintain a dry, healthy skin environment. A structured skincare regimen is essential, including cleansing the skin without water using gentle, pH-neutral (around 5.0) products to avoid disrupting the skin’s natural barrier. Regular skin assessments should be conducted to check for early signs of redness, inflammation, rash, pain, or itching. It’s also important to minimise friction around the perineal area to reduce the risk of irritation.
Step 1 - Breathable Protection
It's best to choose an incontinence product that is as small as possible but still provides the necessary protection. This applies to both the size and absorbency. Bigger isn’t always better, a large product may be uncomfortable, cover too much skin, and trap heat and moisture, which can irritate the skin. If it doesn’t fit well, it may also leak.
When selecting a pad, consider how much and how often the person leaks, but also think about their daily routine, activity level, and personal comfort. Many people use different products depending on the time of day or activity.
Most importantly, pick a product that lets the skin breathe to help keep it dry. It should also absorb urine quickly and keep moisture away from the skin, even after several leaks.
Step 2 - Gentle Cleansing
Gentle skin cleaning is very important for preventing Incontinence-Associated Dermatitis (IAD). Regular soap and water can dry out the skin, and rubbing with a towel can cause irritation in sensitive areas.
Instead, it's better to use wet wash gloves or wet wipes, as they are gentler and more efficient for daily care.
When choosing a cleansing product, check the pH level. For the perineal area, a pH between 4 and 4.5 is ideal. Products with a higher pH can damage the skin’s natural barrier and allow bacteria in.
Always check the skin during cleaning for any signs of damage, such as redness or rashes. This helps monitor the severity of IAD and check for pressure ulcers.
Step 3 - Moisture and Barrier Application
After gently cleaning the skin, it's important to apply a moisturizer and barrier cream to protect and help it heal. Always make sure the skin is clean and fully dry before applying any products.
Choose skincare based on the condition of the skin:
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For healthy or mildly red skin, use products with allantoin and dimethicone, like ABENA’s skincare ointment. Allantoin soothes and moisturizes, while dimethicone creates a protective barrier that helps keep the skin calm and hydrated.
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For broken skin or stronger redness, use products with zinc. Zinc forms a barrier to lock in moisture and protect against bacteria. Use a zinc paste around wounds and a lighter zinc spray (like ABENA’s) to guard against urine and feces.
When applying creams, use only a small amount. Too much can block the skin from breathing and may soak into the incontinence product, reducing its effectiveness.
IAD vs Pressure Injuries: Spot the Difference
Incontinence‑Associated Dermatitis (IAD) is a form of moisture‑related skin damage caused by prolonged exposure to urine or feces, resulting in skin that appears pink to bright red, is often warmer and firmer, and has frayed edges with possible blistering. It typically occurs in areas like skin folds, inner thighs, groin, or buttocks. In contrast, pressure injuries, resulting from sustained pressure and impaired circulation, often appear over bony prominences in shades of red to bluish-purple and can vary from partial to full-thickness wounds, sometimes with necrosis. Importantly, IAD is driven by surface damage from moisture and pH changes (a “top‑down” injury), while pressure injuries stem from prolonged pressure impairing blood flow beneath the skin (a “bottom‑up” injury). Misdiagnosis can lead to incorrect treatment and avoidable costs, so correctly distinguishing between these conditions is critical for effective care.
Product Checklist for Carers
| Managing IAD with ABENA Skincare | Normal Skin
Healthy skin with no redness or irritation, but at risk of developing IAD. |
First Signs of IAD
Redness, with or without swelling. The skin is still unbroken. |
Mild Degree of IAD
Skin starts to break down with redness and swelling. Small wounds may form.
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Gently clean by wiping from front to back. |
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Apply gently and wipe off extra lotion with a soft cloth or wash glove.
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Skin Care Lotion 14% Lipid - ABE6653 Apply and distribute carefully. |
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Zinc Oxide 10% Spray-on - SA1999905321A Shake well before use. Spray a thin layer from 5 to 10 cm away. Do not rub it in.
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Skin Care Ointment 41% Lipid - ABE6659 Apply a thin, even layer carefully.
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Funding Skincare Supplies via the NDIS
Under the NDIS, daily-use skincare products such as wash creams, barrier creams, and body lotions are considered consumables, and can be funded if they meet the criterion of being “reasonable and necessary” for a participant’s disability-related needs. Abena offers a comprehensive range of dermatologically tested skincare solutions, including gentle wash creams, barrier ointments, and lotions suitable for sensitive or fragile skin. NDIS participants, especially those who are self- or plan-managed, can include these Abena products in their plan to help maintain skin integrity, prevent complications like incontinence-associated dermatitis, and support overall daily care.
When to Call a Healthcare Professional
While early-stage Incontinence-Associated Dermatitis (IAD) can often be managed with appropriate skincare routines and barrier products, it’s important to seek medical attention if symptoms worsen or fail to improve within a few days. Signs that warrant professional assessment include skin that becomes increasingly red, swollen, or painful; the presence of open sores, blisters, or bleeding; or signs of infection such as warmth, pus, or foul odour. Individuals with underlying health conditions, reduced mobility, or compromised immune systems should also be monitored closely, as untreated IAD can lead to secondary infections or be mistaken for pressure injuries. A healthcare professional can provide a proper diagnosis, recommend tailored treatment, and help adjust continence care plans to prevent recurrence.
Final Thoughts
Incontinence-Associated Dermatitis (IAD) is a common yet often preventable condition that can significantly impact comfort, dignity, and overall skin health, particularly in individuals managing incontinence. By understanding the causes of IAD and recognising the signs early, caregivers and healthcare professionals can take proactive steps to protect the skin. Implementing a simple three-step routine, breathable protection, gentle cleansing, and proper moisture and barrier application, can go a long way in preventing and managing IAD effectively.
Distinguishing IAD from pressure injuries is also critical, as accurate diagnosis ensures appropriate treatment and avoids unnecessary complications. For those supported by the NDIS, skincare supplies like wash creams and barrier products are accessible and fundable under consumables, helping participants maintain daily care routines. And, as with any skin condition, don’t hesitate to seek professional advice if symptoms worsen or don’t improve.
With the right approach, tools, and support, managing IAD can be straightforward, and lead to healthier skin and improved quality of life.