Introduction

Incontinence-Associated Dermatitis, or IAD, is a type of moisture-associated skin damage (MASD). It has been said that the prevention and management strategies for moisture-associated skin damage should not be considered independently of the issues that lead to a risk for incontinence-associated dermatitis (IAD). A good example of this are pressure ulcers. We will discuss some of the relationships these risk factors have with IAD and pressure ulcers. Our focus today will be on the characteristics and issues surrounding the development, diagnosis, and treatment of IAD. And while IAD has historically been difficult for Medicare, and payors in general, to separate out from other conditions due to it not having its own diagnostic code, the introduction of a specific ICD-10-CM code for 2022 will allow for tracking the prevalence, consequences and costs, as well as some successful prevention and management strategies specifically for IAD.

Assess moisture-associated skin damage (MASD) with an eye towards risk factors for incontinence-associated dermatitis (IAD) IAD has new ICD-10-CM code for 2022 Today’s focus on IAD: development   diagnosis   treatment

 

Getting to Know Our Skin

Before we get into the issues, let’s quickly solidify your background knowledge by reviewing some of the features of our skin so we can have a better understanding of why IAD happens.

First off, you may remember that the structure of the skin is a series of layers, including the epidermis and dermis that cover a subcutaneous fat layer, or hypodermis. You can see that in this slide’s graphic. In these layers, we can find sweat glands, nerves, capillaries, hair down to the follicle, and blood vessels. Concentrating on the surface, we find the “stratum corneum”, which includes corneocytes, or the dead cells that keep the skin hydrated and enhance skin flexibility and elasticity. When exposed to the moisture of incontinence, the excess water is absorbed into these corneocytes, which leads to overhydrated, or waterlogged, and macerated skin.

 

Features and Functions of Our Skin

Another characteristic of skin that is important to understand is that it is usually acidic, with a pH of 4.6 to 5.5. This helps to protect the skin and body against infections. When the skin is exposed to urine, the urea is converted to alkaline ammonia, which makes the skin more susceptible to breakdown and infection. Bacterial infection can ensue, exposing the skin to the bacteria from urine. And the cracks and fissures that form in dry skin only aid in bacterial growth. Meanwhile, the warm and chronically damp skin that is associated with incontinence also favors the growth of pathogenic fungi.

And finally, liquid feces have higher levels of some digestive enzymes which can damage the skin further.