Twenty five relevant studies (n=2,822) were identified: nine randomised controlled trials (RCTs) (n=881) (three were double blind); one cross-over study (n=12); five pre-post studies (n=356); one retrospective pre-post study (n=64); four observational comparative studies (n=352); one observational study (n=92); one prospective descriptive study (n=32); one post test only study (n=19); and two descriptive studies (n=1014).
The mean Research Appraisal Checklist score of the included studies was relatively high; details were reported in the review. Five studies had no control group (two pre-post studies, one observational comparative study, one post test only study and one descriptive study). In half of the studies a baseline comparison of patient characteristics was performed. A prospective power analysis was carried out in three RCTs. Randomisation procedure was not described in one RCT.
Zinc oxide-based products (six study arms): One RCT found that a topical zinc oxide preparation with antiseptic properties (Sudocrem) was superior to traditional zinc cream for the treatment of incontinence-associated dermatitis.
No-sting barrier film (eight study arms): Two studies (one observational comparative and one descriptive) compared a no-sting barrier film with a petrolatum-based ointment in patients with incontinence-associated dermatitis and found a reduction in erythema, skin maceration and stripping with the no-sting film. One RCT found reduced erythema and denudation with barrier film compared to zinc oxide. One retrospective pre-post study found a statistically significant reduction in pressure ulcer incidence in incontinent patients when a skin protectant (thick disposable washcloth with the active agent, dimethicone 3% incorporated into it) was used.
Moisturisers (one study): An RCT found a reduction in erythema, roughness and desquamation of the skin with use of a hydrogel/barrier repair cream versus a petrolatum-based moisturising cream in the treatment of incontinence-associated dermatitis.
Perineal skin cleansers (seven studies): Two studies (one RCT and one cross-over study) found skin cleansers were more effective than soap and water in preventing incontinence-related skin problems. Four studies (including one RCT) found reduced skin erythema with the combined use of a perineal skin cleanser and a skin protectant compared to controls. The result was not confirmed in the results table for one observational comparative study.
Use of specific skin care and/or incontinence care regime (three studies): A pre-post study found that the use of a structured skin care protocol combined with a pressure ulcer prevention protocol versus an unstructured protocol gave a statistically significant lower incontinence-associated dermatitis incidence (4.7% versus 25.3%), fewer grade 1 pressure ulcers and reduced severity of skin lesions. An RCT with an exercise and incontinence intervention gave a significant improvement in urinary and faecal incontinence and skin wetness (limited to the back distal perineal area) when compared to usual care.
Use of diapers and/or underpads (three studies): One RCT compared non-polymer diaper/underpads versus polymer diaper/underpads versus cloth underpads for the outcome perineal dermatitis. There were no statistical differences in skin alteration (colour, integrity or symptoms) between patients wearing diapers and those managed with underpads. Polymer products were more effective in preventing skin breakdown (skin colour change, tingling, itching, burning, pain) than non-polymer products. Another RCT found that underpads with a more absorbent capacity and a higher ability to keep the skin dry improved skin condition when compared to underpads with low absorbance.