title: Physiological and appearance characteristics of skin maceration in elderly women with incontinence.
abstract: OBJECTIVE
  To identify the physiological and appearance characteristics of skin maceration caused by urine and/or faeces and determine their suitability as risk indicators for incontinence-associated dermatitis.
  
  
  METHODS
  This cross-sectional, comparative study involved sixty-nine elderly women with urinary and/or faecal incontinence who provided informed consent to participate. Exclusion criteria included serious medical problems, acute illness and the presence of damaged skin on the buttocks. The physiological and appearance characteristics of macerated skin on the buttocks of the patients were examined. Stratum corneum and dermis hydration levels, transepidermal water loss and skin pH were used to assess skin condition. Skin morphology (sulcus cutis) was confirmed using images at x15 magnification. The erythema index and white index were used to evaluate colour in the macerated skin areas.
  
  
  RESULTS
  Forty-four patients exhibited skin maceration. Stratum corneum and dermis hydration levels were significantly greater in the maceration group than in the non-maceration group, as were transepidermal water loss, skin pH and differences in sulcus cutis interval between the buttock of interest and the subumbilical region. Furthermore, differences in the erythema and white indices between these two regions were significantly higher and lower, respectively, in the maceration group than in the non-maceration group.
  
  
  CONCLUSIONS
  To our knowledge, this is the first report to note that there are interesting changes not only in the epidermal layer but also in the dermis layer in patients with skin maceration. This finding confirmed that skin maceration caused by incontinence is a severe condition. Moreover, the erythema index was the best index for identifying skin maceration caused by incontinence, indicating that it can be used for precise and easy identification of the condition in clinical practice.
authors: Y
authors: Y
authors: Ichikawa-Shigeta
authors: J
authors: J
authors: Sugama
authors: H
authors: H
authors: Sanada
authors: T
authors: T
authors: Nakatani
authors: C
authors: C
authors: Konya
authors: G
authors: G
authors: Nakagami
authors: T
authors: T
authors: Minematsu
authors: S
authors: S
authors: Yusuf
authors: Supriadi
authors: Y
authors: Y
authors: Mugita
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003872:Dermatitis / Q000209:etiology / Q000503:physiopathology* / Q000517:prevention & control; D020405:Dermis / Q000503:physiopathology; D004817:Epidermis / Q000503:physiopathology; D005242:Fecal Incontinence / Q000150:complications*; D005260:Female; D006801:Humans; D007564:Japan; D011237:Predictive Value of Tests; D012869:Skin Absorption; D012871:Skin Diseases / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology*; D014549:Urinary Incontinence / Q000150:complications*