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Knowledge gaps in the etiology and pathophysiology of incontinence-associated dermatitis: A scoping review

Knowledge gaps in the etiology and pathophysiology of incontinence-associated dermatitis: A scoping review
Knowledge gaps in the etiology and pathophysiology of incontinence-associated dermatitis: A scoping review
PURPOSE:
Incontinence-associated dermatitis (IAD) due to the prolonged exposure of the skin to urinary, fecal, or double incontinence represents a major clinical practice challenge. The aim of this review was to identify and critically appraise the results of published studies on the etiology and pathophysiology of IAD and highlight the current gaps in empirical evidence.

METHODS:
Scoping literature review.

SEARCH STRATEGY:
The electronic databases PubMed, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, and Embase were searched for relevant articles published from 1996 to April 2018. Thirteen studies and review articles related to the etiology and pathophysiology of IAD were identified in our initial review, and 3 studies published subsequent to our initial review were evaluated and included in our final review.

FINDINGS:
These studies suggest that several etiologic factors contribute to the development of IAD including exposure to urine, stool, or a combination of these substances (dual incontinence), the duration and frequency of exposure, frequent cleaning, and inflammatory responses. Results from the current scoping review showed that despite the increasing interest in IAD, evidence related to the underlying mechanisms causing IAD remains sparse. This paucity represents a clear gap in knowledge and indicates a need for additional research.

IMPLICATIONS:
Future studies should aim at elucidating: (1) the role of urine and its inherent pH on skin integrity, (2) the role of stool, specific digestive enzymes, and fecal bacteria on skin integrity, (3) the permeability and susceptibility of the skin to damage following frequent cleansing activities and occlusion, and (4) the specific inflammatory response triggered following exposure to urine and fecal matter.
Incontinence, Incontinence-associated dermatitis, Irritant dermatitis, Moisture-associated skin damage, Nursing, Pathophysiology, Perineal dermatitis, Scoping review, Skin integrity
1071-5754
388-395
Koudounas, Sofoklis
052f50e1-2ef7-487d-8ba2-a60048bae0fc
Bader, Dan L.
9884d4f6-2607-4d48-bf0c-62bdcc0d1dbf
Voegeli, David
e6f5d112-55b0-40c1-a6ad-8929a2d84a10
Koudounas, Sofoklis
052f50e1-2ef7-487d-8ba2-a60048bae0fc
Bader, Dan L.
9884d4f6-2607-4d48-bf0c-62bdcc0d1dbf
Voegeli, David
e6f5d112-55b0-40c1-a6ad-8929a2d84a10

Koudounas, Sofoklis, Bader, Dan L. and Voegeli, David (2020) Knowledge gaps in the etiology and pathophysiology of incontinence-associated dermatitis: A scoping review. Journal of Wound, Ostomy and Continence Nursing, 47 (4), 388-395. (doi:10.1097/WON.0000000000000656).

Record type: Article

Abstract

PURPOSE:
Incontinence-associated dermatitis (IAD) due to the prolonged exposure of the skin to urinary, fecal, or double incontinence represents a major clinical practice challenge. The aim of this review was to identify and critically appraise the results of published studies on the etiology and pathophysiology of IAD and highlight the current gaps in empirical evidence.

METHODS:
Scoping literature review.

SEARCH STRATEGY:
The electronic databases PubMed, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, and Embase were searched for relevant articles published from 1996 to April 2018. Thirteen studies and review articles related to the etiology and pathophysiology of IAD were identified in our initial review, and 3 studies published subsequent to our initial review were evaluated and included in our final review.

FINDINGS:
These studies suggest that several etiologic factors contribute to the development of IAD including exposure to urine, stool, or a combination of these substances (dual incontinence), the duration and frequency of exposure, frequent cleaning, and inflammatory responses. Results from the current scoping review showed that despite the increasing interest in IAD, evidence related to the underlying mechanisms causing IAD remains sparse. This paucity represents a clear gap in knowledge and indicates a need for additional research.

IMPLICATIONS:
Future studies should aim at elucidating: (1) the role of urine and its inherent pH on skin integrity, (2) the role of stool, specific digestive enzymes, and fecal bacteria on skin integrity, (3) the permeability and susceptibility of the skin to damage following frequent cleansing activities and occlusion, and (4) the specific inflammatory response triggered following exposure to urine and fecal matter.

Text
Accepted manuscript_Koudounas et al., 2020 - Accepted Manuscript
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More information

Published date: 1 July 2020
Keywords: Incontinence, Incontinence-associated dermatitis, Irritant dermatitis, Moisture-associated skin damage, Nursing, Pathophysiology, Perineal dermatitis, Scoping review, Skin integrity

Identifiers

Local EPrints ID: 443839
URI: http://eprints.soton.ac.uk/id/eprint/443839
ISSN: 1071-5754
PURE UUID: 872775d7-046e-41da-a0bd-1efd451b792c
ORCID for Dan L. Bader: ORCID iD orcid.org/0000-0002-1208-3507
ORCID for David Voegeli: ORCID iD orcid.org/0000-0003-3457-7177

Catalogue record

Date deposited: 14 Sep 2020 16:36
Last modified: 26 Nov 2021 05:39

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Contributors

Author: Sofoklis Koudounas
Author: Dan L. Bader ORCID iD
Author: David Voegeli ORCID iD

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