Maintaining healthy skin is a critical part of caring for older adults, people living with disability and anyone experiencing reduced mobility or incontinence. However, not all forms of skin damage are the same. One of the most common clinical challenges is distinguishing between pressure injuries and incontinence-associated dermatitis (IAD).
Although these conditions can occur in similar areas of the body and may initially appear alike, they have different causes, progression patterns and care requirements. Understanding the differences between Pressure Injuries vs. IAD is essential for effective prevention, early intervention and improved skin health outcomes.
This practical guide explains how to identify each condition, recognise risk factors and apply appropriate care strategies to support healthier skin and better quality of life.
Understanding Pressure Injuries and Incontinence-Associated Dermatitis
Pressure injuries and IAD both compromise skin integrity, but they develop for very different reasons.
A pressure injury occurs when prolonged pressure or pressure combined with shear forces restricts blood flow to the skin and underlying tissues. Over time, this can result in tissue damage ranging from mild skin changes to deep wounds involving muscle and bone. Pressure injuries commonly develop over bony prominences such as the heels, sacrum, hips, elbows and ankles.
IAD, by contrast, is a form of moisture-associated skin damage. It develops when the skin is repeatedly exposed to urine, faeces or both. This exposure weakens the skin's protective barrier, causing inflammation, irritation and an increased risk of breakdown.
While both conditions affect skin health, their causes differ significantly. Individuals with mobility limitations, chronic illness or incontinence may be at greater risk of developing one or both conditions.
Recognising the early signs of skin damage allows caregivers and healthcare professionals to implement appropriate interventions before complications develop.
Key Differences Between Pressure Injuries and IAD
Correct identification is one of the most important aspects of skin care management. Although pressure injuries and IAD can occur in nearby anatomical regions, several distinguishing features can help differentiate them.
Location
Pressure injuries most commonly develop over bony prominences where pressure is concentrated. The sacrum, coccyx, heels, hips and elbows are particularly vulnerable.
IAD develops in areas exposed to moisture from incontinence, including the buttocks, perineum, groin, genital region and inner thighs.
Appearance
Pressure injuries often present as localised areas of skin damage with clearly defined edges. Depending on severity, they may appear as persistent redness, blisters, open wounds or deeper tissue injury.
IAD generally appears as diffuse redness, inflammation or superficial skin erosion. The affected area often has irregular borders and may cover a larger surface area.
Depth of Damage
Pressure injuries can extend beneath the skin surface and affect underlying tissue layers.
IAD is usually limited to the superficial layers of the skin, although prolonged exposure can lead to significant skin breakdown.
Cause of Injury
Pressure injuries result primarily from pressure and shear forces.
IAD develops due to moisture exposure, friction, chemical irritation and disruption of the skin barrier.
Because the underlying causes differ, prevention and management approaches must also differ.
Causes and Risk Factors of Pressure Injuries and IAD
Understanding why these conditions occur helps support effective prevention strategies.
Pressure Injury Risk Factors
The primary causes of pressure injuries include prolonged pressure and shear forces that reduce blood flow to tissues.
Common risk factors include:
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Limited mobility or immobility
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Reduced sensation or inability to reposition independently
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Advanced age
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Poor nutrition and hydration
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Chronic health conditions affecting circulation
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Medical devices that create pressure on the skin
IAD Risk Factors
The primary cause of IAD is prolonged exposure to urine, faeces or both.
Additional contributing factors include:
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Frequent episodes of incontinence
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Inadequate cleansing practices
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Increased skin moisture
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Friction during cleansing or movement
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Elevated skin pH
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Existing skin fragility
Understanding the relationship between Skin PH & incontinence can help caregivers appreciate how moisture exposure alters the skin's natural protective barrier and increases vulnerability to damage.
Many risk factors overlap. Ageing skin, poor nutritional status and chronic illness can increase susceptibility to both pressure injuries and IAD.
Assessment, Identification and Potential Complications
Accurate assessment is essential because misidentification can delay appropriate care and worsen outcomes.
When assessing skin damage, healthcare professionals typically consider:
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The location of the affected area
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The appearance of the skin
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Patient history and risk factors
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Presence of pressure, moisture exposure, or both
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Associated symptoms such as pain or discomfort
Persistent localised redness over a bony prominence that does not blanch may indicate a pressure injury. In more advanced cases, tissue loss, blistering or deeper wounds may be present.
IAD often presents as widespread redness, inflammation, tenderness and superficial skin erosion in areas exposed to moisture. Individuals may also experience burning, itching or discomfort.
Recognising the early signs of IAD can help prevent progression to more severe skin damage.
Potential Complications
Without appropriate intervention, both conditions can lead to significant complications.
Pressure injuries may progress to deeper tissue damage, infection, delayed healing and prolonged recovery.
Untreated IAD can result in persistent inflammation, skin breakdown, secondary infection and increased discomfort.
In both cases, skin damage can negatively affect quality of life, mobility, independence and overall wellbeing.
Care Strategies That Differ Between Pressure Injuries and IAD
Because pressure injuries and IAD arise from different causes, their care strategies must address different underlying factors.
Addressing the Underlying Cause
For pressure injuries, the primary goal is reducing pressure and minimising shear forces.
Strategies may include:
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Regular repositioning schedules
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Pressure redistribution mattresses and cushions
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Mobility support where appropriate
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Ongoing pressure risk assessments
For IAD, the focus shifts to moisture management and protecting the skin from irritants.
Strategies include:
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Prompt cleansing after episodes of incontinence
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Use of appropriate absorbent products
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Moisture management protocols
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Continence care planning
Selecting suitable Incontinence Aids can play an important role in reducing prolonged moisture exposure and supporting skin protection.
Skin Protection and Daily Care
Daily skin care is important for both conditions but involves different priorities.
For pressure injury prevention:
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Inspect skin regularly
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Maintain hydration and nutrition
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Protect vulnerable pressure points
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Encourage movement where possible
ABENA’s 500mL Skincare Lotion is formulated to strengthen the skin barrier and protect against dryness. This lotion is clinically proven to protect against (*Carville K et al 2014) to be effective in reducing the incidence of skin tears when used twice-daily as part of skin-moisturising regimen.
ABENA Skincare Lotion, 500mL,
SKU: SA1999905322B
For IAD management:
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Use gentle, pH-balanced cleansers
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Apply barrier creams or protective films
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Avoid harsh rubbing during cleansing
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Keep the skin clean and dry
Maintaining the integrity of the skin barrier remains a central goal for both conditions.
ABENA’s Skincare Ointment is formulated to deliver a long-lasting barrier, shielding the skin from moisture for up to eight hours. This barrier cream improves and repairs skin texture.
ABENA Skincare Ointment, 150mL,
SKU: ABE6659
Monitoring Progress and Preventing Complications
Ongoing monitoring helps ensure interventions remain effective.
For pressure injuries, monitoring focuses on:
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Changes in wound appearance
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Tissue healing
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New areas of pressure damage
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Signs of infection
For IAD, monitoring focuses on:
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Reduction in redness and irritation
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Improved skin integrity
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Moisture control effectiveness
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Early signs of secondary infection
Regular reassessment allows care plans to be adjusted as patient needs change.
When Pressure Injuries and IAD Occur Together
In some situations, pressure injuries and IAD may develop simultaneously.
Individuals experiencing both incontinence and reduced mobility are particularly vulnerable. Moisture-damaged skin may be less resilient and more susceptible to pressure-related injury.
This overlap can complicate assessment because symptoms may appear similar, particularly in the sacral and buttock regions.
When both conditions are present, prevention and management strategies should address:
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Pressure redistribution
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Moisture management
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Skin barrier protection
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Regular skin assessment
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Nutritional support
A comprehensive approach helps reduce the risk of further skin damage and supports better long-term outcomes.
Conclusion
Understanding the differences between Pressure Injuries vs. Incontinence-Associated Dermatitis is essential for effective skin care. Although both conditions affect skin integrity, they develop through different mechanisms and require different prevention and management strategies.
Pressure injuries are primarily caused by prolonged pressure and shear, while IAD results from repeated exposure to moisture and irritants. Careful assessment of location, appearance and contributing factors can help distinguish between the two.
Early recognition, appropriate intervention, and ongoing monitoring support healthier skin, reduce complications and improve quality of life for individuals at risk.
FAQs
Can IAD increase the risk of pressure injuries?
Yes. Skin affected by IAD is often weakened and more vulnerable to additional damage. Moisture-associated skin breakdown can increase susceptibility to pressure-related injury, particularly in individuals with limited mobility.
What areas of the body are most commonly affected?
Pressure injuries commonly develop over bony prominences such as the heels, sacrum, hips and elbows. IAD most often affects areas exposed to urine or faeces, including the buttocks, groin, perineum and inner thighs.
Can pressure injuries develop without visible skin breakdown?
Yes. Some pressure injuries begin beneath the skin surface, causing deeper tissue damage before visible skin breakdown occurs. Early signs may include persistent discolouration, pain or changes in skin temperature.
Can pressure injuries and IAD occur at the same time?
Yes. Individuals who experience both incontinence and limited mobility may develop pressure injuries and IAD simultaneously. Comprehensive assessment is important to ensure both conditions are identified and managed appropriately.
Sources
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Australian Commission on Safety and Quality in Health Care. Incontinence-Associated Dermatitis and Pressure Injury Clinical Alert. https://www.agedcarequality.gov.au/news-publications/clinical-alerts/incontinence-associated-dermatitis-and-pressure-injury
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Skin and Skin Structure Australia (SSSA). Incontinence-Associated Dermatitis and Pressure Injuries in Aged Care. https://www.sssaustralia.com.au/incontinence-associated-dermatitis-and-pressure-injuries-in-aged-care
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Wounds International. Best Practice Principles: Incontinence-Associated Dermatitis and Skin Health.
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International Guideline: Prevention and Treatment of Pressure Ulcers/Injuries (EPUAP/NPIAP/PPPIA).