Understanding It
What IAD Is
Incontinence-associated dermatitis is damage to the surface of the skin caused by moisture, specifically by urine and faeces sitting against the skin.
Urine raises the skin's pH and softens the outer layer. Faeces adds digestive enzymes that break the skin down directly. Together they are considerably more damaging than either alone, which is why people with both urinary and faecal incontinence are at highest risk.
IAD is a skin problem caused by moisture. It is not a pressure injury.
How does it usually present?
- Redness over the buttocks, groin, perineum or inner thighs.
- On darker skin tones the area may look purple, grey, ashen or darker than surrounding skin rather than red: assess for warmth, firmness, swelling and pain rather than relying on redness alone
- Skin that looks shiny, soggy or waterlogged
- Burning, stinging or itching, and pain during washing or changing
- Weeping or oozing
- Loss of the top layer of skin, leaving shallow, raw, moist areas
- Blurred, uneven edges rather than a defined wound
- Small spots or pustules around the edges, which suggests thrush or another fungal infection
- Distress, agitation or resistance during personal care: often the first thing a family or support worker notices in someone who cannot report pain
Understanding It
IAD or a Pressure Injury?
The two are confused as they can look similar at a glance, and they frequently occur at the same time.
The differences matter because a pressure injury needs pressure relief and repositioning, while IAD needs moisture control and skin protection.
IAD typically:
- Affects the buttocks, groin, perineum, inner thighs, the natal cleft and skin folds: wherever urine or faeces sits
- Is diffuse, with blurred or irregular edges rather than a clear outline
- Is often symmetrical, sometimes with matching "kissing" areas where two skin surfaces touch
- Involves the surface of the skin: redness, weeping, shininess, or shallow loss of the top layer
- Is described as burning, stinging or itching, and is painful when cleaned
- May show small spots or pustules spreading out from the main area, which suggests a fungal infection
A pressure injury typically:
- Sits over a bony point: tailbone, hips, heels, elbows
- Has a more defined edge
- Can be deep, involving tissue beneath the surface
- Begins as redness that does not blanch when pressed
Both can be present at once, and IAD increases the risk of a pressure injury developing.
When to Act
When to Seek Help
Arrange a nursing assessment for any persistent redness or soreness in the incontinence area. Early IAD reverses quickly with the right routine.
Seek urgent medical care if there is:
- Fever, shivering, confusion, or the person becoming generally unwell — possible systemic infection
- Spreading redness, warmth or swelling beyond the affected area, or a red line tracking away from it — possible cellulitis
- Pus, foul odour, or rapid deterioration
- Increasing pain out of proportion to how the skin looks
- Black, grey or dark tissue in the area
- A wound that is deepening, or where fat, muscle or bone becomes visible
Arrange an assessment within a day or two if there is:
- Non-blanching redness over a bony area — this suggests a pressure injury alongside the IAD and needs pressure relief now, not just barrier cream
- Broken or open skin — which needs wound management rather than skin care alone
- Spots or pustules spreading from the edges — likely fungal, and it will not settle with barrier products alone. A barrier cream applied over an untreated fungal infection traps it
- Skin not improving after several days of a proper routine
- Any skin breakdown in someone with diabetes
- New or suddenly worse incontinence — new incontinence can indicate infection, constipation with overflow, medication effects, or a neurological cause
How We Help
How Our Team Can Help
Nursing leads. Support may include a structured skin care routine built on the three steps that work — cleanse, moisturise, protect — selection of the right barrier product, guidance on containment products, continence assessment to address the cause, wound management where the skin has broken, and recognition and escalation of fungal infection, cellulitis and pressure injury.
Nursing
Structured cleanse-moisturise-protect routine, barrier product selection, containment product guidance, continence assessment, wound management, photography and measurement, and escalation of infection and pressure injury.
Occupational Therapy
Toileting equipment, commodes, transfers, seating, and pressure-relieving equipment where a pressure injury risk sits alongside the IAD.
Physiotherapy
Mobility and transfers, where getting to the toilet in time is part of the problem.
Dietetics
Hydration, fibre and nutrition, particularly where loose stools are driving the exposure, and where poor protein intake is slowing skin repair.
Education for family and support workers is where most of the result comes from. The routine happens several times a day, and almost all of it happens when we are not there.
Early IAD often settles within days once the routine is right.
Starting Out
What to Expect at Your First Appointment
A Registered Nurse visits at home. They will look at the affected skin and the whole surrounding area, check bony points for pressure damage, and assess whether infection is present.
They will ask about the pattern of incontinence, what products are being used and how often they are changed, what is currently being applied to the skin, how personal care is carried out and by whom, and about mobility, diet, fluids, bowels and medications.
You will receive a written skin care plan (what to use, in what order, how often), plus product recommendations, guidance for whoever provides daily care, and referrals where continence assessment, occupational therapy or medical review is needed.
Progress is photographed and measured, and reported to your GP.
Ready to book?
Ready to get started?
Contact inOne Healthcare on 1300 765 456 or submit a referral online. IAD is managed by our Nursing team, with Occupational Therapy and Dietetics where equipment, pressure care or nutrition are involved.
info@inonehealthcare.com.au
Flexible Options
Funding we accept.
Support at Home
Continence Aids Payment Scheme (CAPS)
NDIS
Home Care Packages and CHSP
Medicare
DVA
Private
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