A Novel Approach to Incontinent Associate Dermatitis in Pediatric Patients

Problem:  Incontinence associate dermatitis is a common problem among the neonatal and pediatric populations. Frequent use of diapers and the dependent nature of an infant or child make this a day to day problem.  Additional factors of gastrointestinal infections or disease processes, antibiotics, and chemotherapy medication quickly lead to perianal maceration and denudement. Barrier cream is used prophylactically or as a treatment for IAD.  In the most severe cases, perianal bleeding and pain begin and the open skin increases the risk for infection.

Project Objective: The goal was to prevent the stool from coming into contact with the skin and therefor allow it to heal.   An alternative to standard barrier creams was used on the most severe cases of IAD.

Case Series: Alcohol free ostomy paste was added to the area of skin breakdown, followed by stoma protective powder and a barrier cream. Original developed at a Canadian pediatric facility and instructions transitioned to a USA pediatric facility.  This case series shows the improvement over time using the alcohol free ostomy paste regimen.

Outcome: The alcohol free ostomy paste was thick and could be difficult to apply, however, once on the skin the paste covered the entire wound and allowed the skin beneath it to heal.  A step by step regimen was provided to each patient. Product choices of stoma powder, barrier cream and adhesive remover differed slightly related to the each hospital’s stock, but results were similar. Paste was applied; follow by stoma powder and a barrier cream of choice. Reapplication provided as needed in the same order. After three days all products were cleaned off with adhesive remover. The process was repeated until epithelial migration had occurred. Improvements were observed within three days, and all families reported decreases pain and improvements in skin condition.