What is the Difference Between IAD and Pressure Injury

IAD and pressure injury are two different types of skin damage. However, IAD (Incontinence-Associated Dermatitis) starts on the surface of the skin, while pressure injury starts in the soft tissue beneath and within the skin.

The key difference between IAD and pressure injury is their cause. IAD is skin damage caused by prolonged exposure to urine or feces, while pressure injury is localized skin damage, usually over a bony area, caused by prolonged pressure combined with shear or friction.

CONTENTS

1. Overview and Key Difference
2. What is IAD (Incontinence-Associated Dermatitis)
3. What is Pressure Injury
4. Similarities – IAD and Pressure Injury
5. IAD vs Pressure Injury in Tabular Form
6. Summary – IAD vs Pressure Injury
7. FAQ: IAD and Pressure Injury

What is IAD?

Incontinence-associated dermatitis or IAD is a skin damage associated with exposure to urine or faeces. IAD causes patients significant discomfort. It can be difficult and time-consuming to manage properly. The area affected by IAD appears diffuse with poorly defined edges and may look blotchy. Symptoms can include pain, burning, itching, and tingling. Commonly affected areas are the buttocks, gluteal fold, inner and back parts of the upper thighs, and lower back.

IAD can be diagnosed through reviewing the affected areas and discussing the medical history. Furthermore, IAD can be treated using gentle linens to clean the area, washing the area with a cleanser, adding moisture back into the skin with hydrogel, protecting the area with products containing zinc oxide, and wearing containment pads.

What is Pressure Injury?

Pressure injury is a type of injury to the skin and the tissue below the skin. It occurs due to pressure on the skin for a long time. The symptoms of pressure injury may include changes in the skin color or texture, pus-like draining, an area of skin that feels warmer or cooler swelling, and a sore area. Moreover, it may affect areas like the tailbone or buttocks, shoulder blades and spine, back of the arm and legs, backside of the head, hip, lower back, heels, ankles, and skin behind the knees.

Figure 01: Pressure Injury

Pressure injury can be diagnosed through questionnaires, reviewing the affected area, and blood tests. Furthermore, treatment options for pressure injuries may include changing positions, using support surfaces, cleaning the area with a gentle cleanser and patting it dry, applying a bandage, removing damaged tissue, taking pain-relief medication, and, in severe cases, undergoing surgery.

Similarities Between IAD and Pressure Injury

1. IAD and pressure injury are two types of skin damage.
2. Both can cause red color sores in the affected area.
3. These conditions can be diagnosed by reviewing the affected area.
4. Both conditions can be treated by taking pain-relieving medicines and therapies.

Difference Between IAD and Pressure Injury

Definition

1. IAD (Incontinence-Associated Dermatitis) is a perineal rash caused by skin damage from exposure to urine or feces.
2. Pressure injury is an injury to the skin and underlying tissue due to prolonged pressure on the skin.

Commonly Affected Areas in the Body

1. IAD commonly affects the buttocks, gluteal fold, inner and back parts of the upper thighs, and lower back.
2. Pressure injuries commonly affect the tailbone or buttocks, shoulder blades, spine, back of the arms and legs, back of the head, hips, lower back, heels, ankles, and skin behind the knees.

Symptoms

1. IAD symptoms include redness, patches of inflammation or large continuous areas of inflammation, warm and firm skin, lesions, pain or tenderness, burning, and itching.
2. Pressure injury symptoms include changes in skin color or texture, swelling, pus-like drainage, areas of skin that feel cooler or warmer than surrounding skin, and sore areas.

Diagnosis

1. IAD is diagnosed through medical history and physical examination findings in people with urine or fecal incontinence.
2. Pressure injuries are diagnosed using questionnaires, physical examination of the affected area, and blood tests.

Treatment

1. IAD treatment includes protecting the skin from further exposure to urine and feces using cleansing and moisturizing agents, creating a healing environment, and managing secondary infections with antibacterial and antifungal agents.
2. Pressure injury treatment includes cleaning the wound with soap, water, or saline, applying a dressing over the sores, taking antibiotics, NSAIDs, pain relievers, and, in severe cases, skin grafting.

The following table summarizes the difference between IAD and pressure injury.

Summary – IAD vs Pressure Injury

IAD and pressure injury two types of skin damages. However, IAD occurs due to exposure to urine or faecal matter while pressure injury occurs due to pressure or shear. IAD presents with intact skin with erythema to partial skin loss whereas pressure injury presents with intact skin with non-blanchable erythema to full-thickness skin loss. This is the summary of the difference between IAD and pressure injury.

FAQ: IAD and Pressure Injury

1. What is the main cause of incontinence-associated dermatitis?

• IAD is caused by exposure to feces or urine. It occurs because skin bacteria convert the substance urea to ammonia, which is alkaline. People with fecal incontinence or urinary incontinence are at higher risk of developing IAD than those with urinary incontinence alone.

2. What are the areas affected by incontinence-associated dermatitis?

• IAD can affect different areas in the body. The affected areas of the body include the gluteal fold, inner and back parts of the upper thighs, lower back, perianal area, abdomen, and back.

3. What is the best choice to treat incontinence dermatitis?

• IAD can be treated by using a skin sealant or moisture barrier. Creams or ointments with zinc oxide, lanolin, or petrolatum can form a protective barrier on the skin.

4. What are three forces that cause pressure injuries?

• Pressure injuries are areas of necrosis and often ulceration caused by long term exposure to pressure/ shear. In pressure injuries soft tissues are compressed between bony prominences and external hard surfaces. So, it can be caused by unrelieved mechanical pressure in combination with friction, shearing forces, and moisture.

5. What is the best treatment for pressure wounds?

• The treatments for pressure injury include pressure reduction, avoiding friction and shearing forces, and diligent wound care. Moreover, advanced treatments include negative-pressure wound therapy, cellular and tissue-based products, and surgical intervention.

Reference:

1. “Incontinence-Associated Dermatitis.” DermNet®.
2. “Bedsores (Pressure Ulcers): Symptoms, Staging & Treatment.” Cleveland Clinic.

Image Courtesy:

1. “Pressure ulcer in foot” By Ashashyou – Own work (CC BY-SA 4.0) via Commons Wikimedia

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