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Troublesome and Concerning

    It’s irritating. It’s persistent. Despite your best efforts it still occurs. Fortunately, you can overcome the majority of your rash incidents by following some basic steps and using a medicated cream.

    Almost everyone gets a rash at least once while using absorbent products. The first case can come as soon as the first month.

    When a protective garment is on trapped moisture and friction from movement can irritate the skin, causing redness and inflammation in the perineal area. Once the skin is compromised, chemicals in your urine and feces can cause further irritation.

    In reality, adult rash is a complex of symptoms – redness, sores, dry or weeping areas – that can signal many different conditions from psoriasis to intertrigo.

    However, the most common type, a friction rash, is an irritation caused by prolonged contact with urine and feces. In some cases it is accompanied by a secondary yeast infection called candida.

    With age your skin tends to become harder to moisturize because it has fewer glands to secrete oil.

Especially in the perineal area, the skin is under a great deal of stress and prone to irritation and chaffing, because of frequent wiping and washing.

    Unfortunately, many of the things we do with good intentions – daily bathing, using lots of suds and wiping with moist towelettes – actually dry out the natural protection our skin needs.

    The result: The body can’t produce enough oils to protect its skin, making it susceptible to perineal rash.

    Skin is quite strong, but here’s how an incontinence rash, known as adult incontinence dermatitis, breaks it down.

    Urinary wetness increases skin friction, raises the skin pH, makes the skin less cohesive, and makes it more permeable. These effects combine to intensify the action of stool enzymes or other irritants that then inflame the skin.

    When the outermost layer of skin has been damaged, it is easy for microorganisms such as yeast or bacteria to invade the inflamed skin.

    In addition to enhancing the activity of other irritants, urine acts as a direct irritant. When the skin is moist it is also more conducive to bacterial growth.

    Yeast is by far the most common type of organism found in a perineal rash. Yeast involvement should be suspected in any perineal rash that has not improved dramatically with 72 hours of appropriate therapy.

    Current or recent antibiotic use makes a yeast infection even more likely, since this reduces the amount of the skin's 'good' bacteria that fight infection.

    Healthy skin is clean, dry skin. As long as there is a need for a protective undergarment, maintaining clean, dry skin is a challenge.

Following these steps can help:

¨ Check skin every day for signs of rash or skin breakdown. Learn to use fingers to feel for unusual bumps, ulcers, or rashes.

¨ Change protective pads/undergarments as soon as they are soiled. If you are caring for someone who attends an adult daycare, remind the staff to do the same.

¨ Always wipe from front to back. Warm water is all you need to wash the area.

¨ No rinse perineal washes are another option. These washes save time and work well to remove urine without discomfort.

¨ Pay special attention to skin folds and creases, make sure they are thoroughly rinsed and dried.

¨ After washing, blot the area dry with a clean towel.

¨ Give your bottom a little breathing room. Consider using a larger-sized protective garment until the rash goes away.

¨ At the first sign of redness apply an adult rash cream. Continue to apply at each undergarment change until the rash is cleared. Only use products that designed for use on the perineal area.

¨ After changing protective garments, wash your hands thoroughly.

    Just as important as the actions you take are the actions and products you avoid.

Here are some useful tips:

¨ Use plain water instead of incontinent wipes.

¨ Use a mild non-irritating soap only when necessary and always rinse thoroughly with warm water. Even mild soaps remove natural oils that protect your skin.

¨ Don’t scrub your perineal area. Scrubbing can lead to further skin breakdown.

¨ Avoid protective garments with elastic bands. Also avoid using plastic pants when a rash is present.

¨ Skip the powder. Once it becomes wet, powder is useless. Also, talc when used on the genital area has been implicated to the development of ovarian cancer.

    If you follow the above guidelines and the rash persists or worsens, call your doctor. Your healthcare provider is the best source for continuing your health. Also contact them whenever these situations occur:

¨ A mild perineal rash turns the skin slightly red and spotty. As it becomes worse, the redness becomes brighter and tiny blisters might develop. The blisters can grow, blending together, to eventually form a crust on your skin. A weeping, crusty rash might indicate a bacterial or yeast infection and should be treated by your doctor.

¨ If the rash does not improve after three days of treatment, see your doctor – the problem may be caused by another skin disorder. In some cases, a very short course of topical corticosteroids is prescribed.

¨ Have an examination if the rash occurs along with a fever, blisters, boils or draining pus. These might signal a secondary infection that requires further treatment.

    Some worry about what kind of protective garments to use. Neither cloth nor disposable garments are more likely to cause a rash in most cases. Both cloth and disposable garments inhibit evaporation of moisture from the surface of the skin, creating the environment for a rash.

    When using cloth protective garments, make sure any detergent residues are rinsed away. Otherwise, these chemicals or fragrances can irritate your skin either causing a rash or making an existing rash or infection worse.

    As always, the best medicine is prevention. By following the proven guidelines presented in this brochure you will practice good skin care. This will help you avoid many cases of perineal rash.

    Despite your efforts, there may still be times when a rash occurs. Using a medicated adult rash and irritation cream can soothe your skin during these occurrences.

    You don’t have to wait until a perineal rash develops to use a adult rash cream. Some products can prevent a rash by creating a protective barrier on the skin to help seal out wetness and irritants.

    For best results apply with each protective garment change, especially at bedtime and anytime when exposure to wet garments is prolonged.

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