title: Improving diaper design to address incontinence associated dermatitis.
abstract: BACKGROUND
  Incontinence associated dermatitis (IAD) is an inflammatory skin disease mainly triggered by prolonged skin contact with urine, feces but also liberal detergent use when cleansing the skin. To minimize the epidermal barrier challenge we optimized the design of adult incontinence briefs. In the fluid absorption area we interposed a special type of acidic, curled-type of cellulose between the top sheet in contact with the skin and the absorption core beneath containing the polyacrylate superabsorber. The intention was to minimize disturbance of the already weak acid mantle of aged skin. We also employed air-permeable side panels to minimize skin occlusion and swelling of the stratum corneum.
  
  
  METHODS
  The surface pH of diapers was measured after repeated wetting with a urine substitute fluid at the level of the top sheet. Occlusive effects and hydration of the stratum corneum were measured after a 4 hour application of different side panel materials by corneometry on human volunteers. Finally, we evaluated skin symptoms in 12 patients with preexisting IAD for 21 days following the institutional switch to the optimized diaper design. Local skin care protocols remained in place unchanged.
  
  
  RESULTS
  The improved design created a surface pH of 4.6 which was stable even after repeated wetting throughout a 5 hour period. The "standard design" briefs had values of 7.1, which is alkaline compared to the acidic surface of normal skin. Side panels made from non-woven material with an air-permeability of more than 1200 l/m2/s avoided excessive hydration of the stratum corneum when compared to the commonly employed air-impermeable plastic films. Resolution of pre-existing IAD skin lesions was noted in 8 out of 12 patients after the switch to the optimized brief design.
  
  
  CONCLUSIONS
  An improved design of adult-type briefs can create an acidic pH on the surface and breathable side panels avoid over-hydration of the stratum corneum and occlusion. This may support the epidermal barrier function and may help to reduce the occurrence of IAD.
authors.affiliation: Hôpital C. Celton (APHP), 4 Parvis C. Celton 9, F-2130 Issy les Moulineaux, France.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Beguin
authors.forename: Evelyne
authors.initials: E
authors.lastname: Malaquin-Pavan
authors.forename: Claudine
authors.initials: C
authors.lastname: Guihaire
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Hallet-Lezy
authors.forename: Sandrine
authors.initials: S
authors.lastname: Souchon
authors.forename: Vanessa
authors.initials: V
authors.lastname: Homann
authors.forename: Petra
authors.initials: P
authors.lastname: Zöllner
authors.forename: Maximilian
authors.initials: M
authors.lastname: Swerev
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Kesselmeier
authors.forename: Fridmann
authors.initials: F
authors.lastname: Hornung
authors.forename: Hans
authors.initials: H
authors.lastname: Smola
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003963:Diaper Rash / Q000209:etiology / Q000517:prevention & control*; D041382:Diapers, Adult / Q000592:standards* / Q000639:trends; D004867:Equipment Design; D005242:Fecal Incontinence / Q000150:complications / Q000517:prevention & control; D005260:Female; D006801:Humans; D016496:Incontinence Pads / Q000592:standards* / Q000639:trends; D008297:Male; D014549:Urinary Incontinence / Q000150:complications / Q000517:prevention & control