Operative Intervention for Urinary and Fecal Incontinence-Associated Dermatitis

Incontinence-associated dermatitis (IAD) is a type of moisture-associated skin damage (MASD) that involves partial-thickness (PT) skin loss with surrounding maceration after prolonged exposure to urinary and fecal incontinence. While deep partial-thickness and full-thickness burn injuries often require surgical excision and, ultimately, grafting, partial-thickness burns can often be managed with topical therapies such as daily dressing changes, patient positioning, hydration, nutrition, and pain management.

The elderly and young and those with medical comorbidities can present with urinary and fecal incontinence. One incapacitated 65-year-old male presented with a partial-thickness, 14% total body surface area (% TBSA) wound, and an 85-year-old female sustained a 4% TBSA full-thickness burn-like injury after a prolonged interval of urinary and fecal incontinence. The patient with the partial-thickness wound recovered with topical therapies, which provided a moist and antimicrobial environment and this chemical burn-like wound healed. The patient with the full-thickness wound required skin grafting.

Both patients recovered well. Nursing played an important role in the treatment and care of these patients, besides treatment with topical therapies. These two cases illustrate the rare association of an IAD as a chemical burn, which may require skin grafting, an approach that does not differ significantly from the more typical partial and full-thickness burn treatment.