Distinguishing Perineal Dermatitis From a Pressure Ulcer

Can you tell the difference between perineal dermatitis and a pressure ulcer? Distinguishing between the two conditions can be tricky!

Perineal Dermatitis

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Perineal dermatitis can be defined as moisture-associated skin damage and is often the result of urine or fecal incontinence (or both). Patients who wear incontinence pads or briefs may be at higher risk for the condition, as these garments hold moisture against the skin, increasing surface temperature and humidity. These conditions can lead to maceration of the skin.

Perineal dermatitis may show itself as an area of redness on the skin. You may also see scaling of the skin. Papule and vesicle formation may take place. Weeping vesicles may contribute to skin damage. Keeping patients clean and dry is the key to prevention of this condition.

Irritant-Associated Dermatitis

This type of dermatitis is thought to be caused by the skin's prolonged contact with urine and/or stool, which may result in the release of inflammatory cytokines. Signs and symptoms include:

-redness, which may spread to skin folds of the buttocks and inner thighs

-edema

-blistering

-skin erosion

-weeping

-itching and/or pain in the area

Allergic Contact Dermatitis

This condition may be caused by residue from laundry detergent in patients who wear washable incontinence products. It can also occur from contact with an allergen from a cream or ointment applied to the skin. It may appear rather quickly and spread rapidly. Skin will have a similar appearance to that of irritant-associated dermatitis; however, the key to treating this type of dermatitis is to discover the cause and remove the causative agent.

Treating perineal dermatitis includes treating incontinence and protecting the skin from further irritation. Frequent cleansing of the skin with mild soap and water and applying a barrier cream to protect the skin from moisture are sound treatments which should improve the patient's skin quickly and effectively. If the area becomes infected with yeast or bacteria, use of an appropriate antifungal or antibiotic will be necessary.

Pressure Ulcers

A pressure ulcer is a localized area of injury to the skin, usually over a bony prominence, as a result of pressure by itself or in combination with friction or shear. Stage I or II ulcers can form in the same areas as perineal dermatitis, making an accurate diagnosis difficult. Stage I pressure ulcers usually involve an area of nonblanchable redness over a bony prominence. The skin is intact in Stage I ulcers. Stage II ulcers present as a shallow open area in which the wound bed is pink or red. There is no slough. Alternately, stage II ulcers may present as intact or open serum-filled blisters. In pressure ulcers, pressure and not moisture is the defining element.

Care of the patient with a pressure ulcer involves employing methods to relieve pressure and allow healing of the ulcer by:

-using pressure-reducing beds, chairs, and other equipment

-providing optimal nutrition for wound healing

-turning and frequent repositioning to relieve pressure

-treating pain

Of course, both of these conditions can occur together. Patients who develop perineal dermatitis are at higher risk of developing a pressure ulcer to the same area, as the skin is already compromised. Prevention of both of the conditions is key to management, and instituting appropriate and rapid treatment once one of these conditions is recognized will produce the best patient outcome.

Wound Education

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Distinguishing Perineal Dermatitis From a Pressure Ulcer

PRESSURE SORES STAGES