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Intertrigo (or intertriginous dermatitis) is a rash that can develop in a skin fold. The condition is common and may affect people from infancy to adulthood. Certain factors increase your risk, such as having diabetes, being overweight, incontinence (unable to control bladder or bowels), wearing incontinence briefs, or being on bed rest.

Perspiration, warmth and friction may cause a skin fold to become red and inflamed. Symptoms such as itching, burning, odor and pain can accompany the redness. These symptoms can also occur under medical devices such as braces or splints, or adjacent to artificial limbs.

Common areas for intertrigo

Intertrigo may potentially develop in any skin fold or in areas where there is constant skin-on-skin friction (cf. ^1). It may be found: 
 

• Between thighs
• Under the armpit
• Under breasts
• Around belly folds
• Between fingers and toes
• In groin folds
• In neck creases
• Behind the knee
• Adjacent to an artificial limb
• Under a brace or splint

Other problems in skin folds

In someone who is incontinent, moisture from urine and stool can get trapped in skin creases. This may be found especially under the buttocks. The condition that develops is not intertrigo, but it is a type of dermatitis that can cause similar problems. When skin or a skin fold is moist and/or damaged, it is prone to infection from bacteria or fungus (cf. ¹⁾

How to minimize the risk

For general prevention, patients should try to keep skin folds clean and dry, decreasing moisture and rubbing between folds of skin with a wicking fabric containing silver (cf. ^2). InterDry® Ag Textile with Antimicrobial Silver Complex is a wicking textile that removes excess moisture, reduces friction and contains silver to help manage fungal or bacterial infections (cf. ^3). It is also recommended that one wear lightweight, loose and absorbent clothing (cf. ^4).

Caring for your skin 

If intertrigo does develop, consider taking the following steps until the rash disappears:

Step 1: Wash the skin fold

1. Wash gently, using a pH-balanced skin cleanser. Some options include a no-rinse body wash or no-rinse incontinence cleanser.
2. Pat your skin dry. Do not rub.

Step 2: Protect your skin

1. Cut the appropriate size textile with scissors, allowing for a minimum of 2 inches of textile exposure outside the skin fold.
2. Lay a single layer of textile into the base of the skin fold or under a medical
device such as a brace or splint. Leave at least 2 inches of the textile exposed outside the skin fold or brace/splint. This allows the excess 
moisture to wick away from the skin fold and evaporate.
3. Secure the textile in one of several ways: with the weight of the skin fold, with a small amount of tape or tucked into clothing.
4. Remove the textile before bathing and replace it when finished.
5. Replace the textile in 5 days or if it becomes soiled with urine or stool.
    

Patients should be sure to check their skin every day. They should look for rashes, redness, open areas; and inspect all skin folds, or under devices that rub against the skin.

Coloplast products for intertrigo 

• Bedside-Care® Foam – pH-balanced, no-rinse cleanser
• InterDry® Ag Textile with Antimicrobial Silver Complex – The first effective solution for skin fold management. A wicking textile impregnated with silver to manage moisture, friction and fungal or bacterial infections³ in skin folds.

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Dry skin is a common problem caused by loss of the skin’s natural moisturizers, leading to epidermal water loss. The environment plays an important role in this water loss. During winter, or with the use of central heating or air conditioning, skin loses moisture more readily. Similarly, frequent bathing or using harsh soap product may increase the risk of dry skin.

Dry skin is most often found on the lower legs and feet and less often on the trunk of the body or hands. The skin may be scaling and flaking, it may appear dull with a grey whitish discoloration, or you may see increased skin markings or lines. In severe cases, deep cracks, warmth, pain and redness may be evident. The presence of rough, uneven or cracked skin indicates a need for intervention.

Dry skin can be classified as mild, moderate, or severe.  It is more easily eliminated or controlled when in the mild to moderate stages.

Caring for dry skin

Dry skin, or xerosis, requires proper care just as moist skin does. Choosing the best type of moisturizer is important. For instance, water-based moisturizers require frequent application and often with little improvement.  More effective oil-based creams and lotions trap moisture in the skin and require less frequent application.
Follow the steps below to care for your dry skin:

Step 1: Wash your skin 

1. Gently cleanse the skin with a mild, pH-balanced skin cleanser and a soft cloth or disposable washcloth.
2. Pat your skin dry. Do not rub.

Step 2: Moisturize your skin

1. Apply moisturizing creams or lotions after bathing as needed.

Coloplast products for treating dry skin

• Sween® 24 Cream – Once-a-day moisturizing cream
• Critic-Aid® Clear – Clear moisture barrier ointment
• Critic-Aid Skin Paste – Thick moisture barrier paste

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A pressure ulcer, also called a bedsore or pressure sore, is an injury to the skin caused by constant pressure. Pressure ulcers form when blood flow to the area slows or stops. This causes small portions of the tissue to die, and an ulcer develops.

Pressure ulcers typically form over bony parts of the body. Damage to skin can occur when these bony parts of the body press against a hard surface. Hard surfaces include beds, chairs or even medical devices, such as a brace or splint.

Where do pressure ulcers occur?

• Head
• Shoulder
• Base of spine
• Bottom
• Heels
• Toes

© NPUAP 2008. Used with permission.

What are the risk factors?

There are a variety of risk factors:

• Limited mobility
• Lying in a bed or sitting in a chair for long periods of time
• Frequently sliding down in bed
• Being pulled across a bed during position change
• Dry skin
• Skin exposed to urine, stool or perspiration
• Decreased mental awareness
• Decreased feeling or sensation
• Poor nutrition
• Blood flow problems

How to minimize the risk

Follow the few basic steps below to help prevent pressure ulcers from occurring. 

Step 1: Protect your skin

1. Check your skin every day, including skin folds. Look for any areas of redness and irritation. Use a mirror to view areas that are hard to see, such as the bottom of the feet.
2. Use moisturizers to prevent dry skin.
3. Do not massage bony areas. This may damage the skin.
4. If skin is wet or soiled from urine or stool:
   – Wash your skin immediately with a pH-balanced, no-rinse skin cleanser. Pat skin dry.
   – Apply a moisture barrier ointment, cream or paste to protect the skin.
5. If using an absorbent pad or brief for incontinence, change it when it becomes soiled or wet. Avoid products with a plastic lining.

Step 2: Prevent pressure

For people confined to bed: 

1. Use a mattress specially made to reduce pressure.
2. Turn or reposition often.
3. Do not lie on a reddened area of skin, or on medical devices, such as tubes or drainage systems.
4. Raise the head of the bed as little as possible, since a steeper angle can put more pressure on the tailbone area. Avoid slouched positions.
5. Avoid being positioned directly on bony areas.
6. Make sure you’re lifted, not dragged, when changing positions. Sliding or dragging can injure the skin.
7. Keep clothing and bed linens dry, smooth and wrinkle-free.
8. Protect your elbows and heels. Use a pillow under the calves to lift your heels up off of the mattress.
    

For someone in a chair or wheelchair:

1. Use a cushion specially made to reduce pressure.
2. Shift your weight often by doing small lifts, leaning forward and shifting your weight from side to side.

Step 3: Eat well

Nutrition is important.

1. Calories, protein and fluids all help to keep you healthy and to protect your skin from injury.
2. Let your doctor or nurse know if you are having problems eating or if you notice that you’re losing weight. They may suggest liquid nutritional supplements.

Caring for pressure ulcers

For pressure ulcers to heal, the wound must be kept clean, free of dead tissue and covered with a special dressing. Dead tissue is yellow, black or brown in color and can lead to infection.

Step 1: Clean the wound

Regular cleaning of the wound is important to aid in healing.

1. Wash and dry your hands.
2. Gently clean the wound with each dressing change using a saline solution or wound cleanser.
3. Rinse the area well to remove any loose material or dead tissue.
    

Step 2: Cover the wound

Special wound care dressings are used to cover and protect the wound. Wound care dressings either keep the wound moist or absorb drainage, or both.

1. Apply a dressing to the wound.
2. The type of dressing can vary: some dressings cover the wound and some are used to fill deep wounds. Your nurse or doctor will give you specific instructions.
3. Wash and dry your hands.

How do I know if my pressure ulcer is getting better?

The wound will begin to get smaller as it heals. You should begin to see new tissue, which is shiny red or pink in color. If your wound had any drainage, there will be less drainage as it heals.

When should I call my doctor or nurse?

Call your doctor or nurse immediately if you notice any signs or symptoms of infection.

Signs of an infected wound include:

• Redness or warmth near the wound
• Swelling and tenderness near the wound
• Thick, yellow or green drainage
• Strong odor coming from the wound
• Fever
• Chills
• Weakness
• Lack of energy 
   

Coloplast products for pressure ulcers

• Bedside-Care® Foam – pH-balanced, no-rinse cleanser
• Sween® 24 Cream – Once-a-day moisturizing cream
• Critic-Aid® Clear – Clear moisture barrier ointment
• Critic-Aid Skin Paste – Thick moisture barrier paste
• Sea-Clens® – Saline wound cleanser
• Biatain® – Foam dressings
• SeaSorb® – Soft alginate dressings
• Comfeel® – Hydrocolloid dressings

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Incontinence is the difficulty or inability to control your bladder (urine) or bowel (stool). The ailment is common, but those who experience it are often too embarrassed to ask for help.

Although incontinence is more common in the elderly population, it is not part of the normal aging process. Urinary incontinence may be caused by medical problems such as weak pelvic muscles, diabetes or an enlarged prostate gland. It can also be caused by certain medications. Common causes of fecal incontinence include constipation, diarrhea or damage to the anal sphincter muscles from giving birth. It can also be caused by an improper diet or certain medications.

Whatever the cause, see your doctor or nurse if you experience incontinence. Treatments are available that may help address the impact incontinence may have on your skin.

How incontinence affects the skin

If you ever experience incontinence, it is very important to know how to protect your skin from damage. Skin provides our first line of defense against germs and infection. Long-term exposure to moisture from urine or stool can cause the skin to soften, weakening the skin’s ability to serve as a protective barrier.

With frequent incontinence, skin problems may occur. Typical symptoms are redness, burning and irritation around the buttocks, rectum, groin or between the thighs. If there is persistent moisture from urine and stool, it increases the risk for infection or skin breakdown.

Caring for your skin

If you experience incontinence-related skin problems, follow the steps below to ensure proper skin care.

Step 1: Clean your skin

1. Remove and throw away the briefs, pad or other soiled material.
2. Wash your skin each time it has been soiled. Use a pH-balanced, no-rinse skin cleanser.
   TIP: Avoid harsh soaps like bar soap and antimicrobial hand-washing soaps. These can dry the skin and lead to skin breakdown. (cf. ¹⁾
3. Gently clean the area from front to back using a soft washcloth or disposable soft cloth.
4. Pat your skin dry. Do not rub.

Step 2: Protect your skin

A skin protectant is a moisture barrier cream, ointment or paste. It is used to protect your skin from urine and stool.  Most skin protectant ointments contain petrolatum, dimethicone, zinc oxide or a combination of these ingredients. (cf. ²⁾

1. Apply a thin, even layer of skin protectant.
2. Some people use absorbent underpads, or briefs. Change pad or brief after it has been soiled. Avoid products that have a plastic lining.

Contact your doctor or nurse if symptoms do not improve or your condition worsens.

Coloplast products for incontinence-related skin ailments

• Bedside-Care® Foam – pH-balanced, no-rinse cleanser
• Critic-Aid® Clear – Clear moisture barrier ointment 
• Critic-Aid Skin Paste – Thick moisture barrier paste