A carer's guide to skin integrity with an incontinent patient

With ageing, there is a decreased production and function of both the sweat and sebaceous glands leading to an impaired acid protection mantle, and the skin to become dry, fragile, and more likely to break. This leads to an increased risk of infection. (1)(2)
The acid protection mantle is an invisible, very fine, slightly acidic film at pH 4.5-5.5 on the surface of human skin acting as a barrier that is formed by the mix of sebum and sweat. This is a barrier that deflects outside influences such as bacteria, viruses, fungi and other potential contaminants that might penetrate the skin.
The pH of the acid protection mantle layer keeps the body’s natural flora within its limits by maintaining the pH at 4.5-5.5. If this pH level is altered for more than a short period of time, it will affect the efficiency of how the flora and microbes are kept out.
In fact, after washing, ageing skin requires more than 6 hoursto restore its acid protection mantle and normal pH while younger skin requires only 2 hours!(3)
For all these reasons, ageing skin is more prone to wounding and heals more slowly when a wound does occur (4). Therefore, the mature skin requires high attention a special skin care regimen (5) with gentle cleansing, skin protection and moisturizing:
(1) Marieb E and Hoehn K; 2007 Human Anatomy & physiology 7th edition Chapter 5 The Integumentary System pages 151-168, Pearson
(2) Benjamin Cummings Carville K 2017; Wound Care Manual 7th edition – Chapter 1 Anatomy of the skin pages 8-14, Silver Chain Foundation
(3) Ghadially et al., J Clin Invest. 1995:2281-90
(4) Extracted Ausmed 2005; Wound Care Nursing: a guide to practice 2005 page 19. Ausmed Publications Pty Ltd, Melbourne
(5) Beeckman, D. (2015) Proceeding of the Global IAS Expert Panel. Incontinence associated dermatitis: moving prevention forward. Wounds International 2015. www.wounds international.com
(6) Gray M., Beeckman D., Bliss D. Z., Fader M., Logan S., Junkin J., Selekof J., Doughty D., Kurz P.; Incontinence-associated dermatitis: a comprehensive review and update; J Wound Ostomy Continence Nurs. 2012 Jan–Feb, 39(1): 61–74.
(7) Gray et al. Incontinence-Associated Dermatitis: A Comprehensive Review and Update. CONTINENCE CARE. J Wound Ostomy Continence Nurs. 2012;39(1):61-74.