InterDry® Case Studies The challenges of skin fold management Intertriginous dermatitis (intertrigo) is a common International Consensus Panel for Intertrigo1 agreed inflammatory skin condition. Skin-to-skin or skin-to-device powders such as cornstarch may encourage fungal contact may cause friction and can hold moisture against growth and have no proven benefit. Linen, gauze and the skin’s surface. This puts patients at risk for skin paper towels placed between skin folds are usually complications such as maceration, erythema, erosion, ineffective. These textiles absorb moisture; however, itching/burning, odor and pain. they do not allow the moisture to evaporate, thereby promoting skin damage. As a result, resolution is often Current treatments attempt to manage the symptoms not achieved and symptoms persist leading to more but do not solve the underlying cause. The 2013 serious complications.2 FIGURE 13 FIGURE 23 Candidal intertrigo Week 3 resolution of beneath both breasts candidal intertrigo at initial visit. beneath both breasts. Manage the cause, not only the symptoms By addressing the causes of skin fold maladies, InterDry® moisture-wicking fabric with antimicrobial silver is the first effective solution for managing complications associated with skin folds. MOISTURE FRICTION FUNGAL & BACTERIAL The soft, knitted 100% The polyurethane coating ORGANISMS polyester fabric wicks and reduces friction in skin folds. Ionic silver provides effective translocates excess moisture, broad-spectrum antimicrobial keeping the skin dry. action within the fabric for up to 5 days. References 1. Sibbald RG, Kelly J, Kennedy-Evans KL, Labrecque C, Waters N. A practical approach to the prevention and management of intertrigo, or moisture-associated skin damage, due to perspiration: expert consensus on best practice. Wound Care Canada - Supplement. 2013;11(2)1-21 2. Black JM, Gray M, Bliss DZ, Kennedy Evans KL, Logan S, Baharestani M, Colwell JC, Goldberg M, Ratcliff CR. MASD part 2: incontinence-associated dermatitis and intertriginous dermatitis: a consensus. J Wound Ostomy Continence Nurs. 2011;38(4):359-70 3. Vorbeck E. Evaluation of a skin fold management textile with antimicrobial silver in a variety of clinical situations. Unpublished case studies. 2007 2 InterDry® improves clinical outcomes Kennedy-Evans and colleagues1 performed a clinical study to determine the efficacy of the moisture-wicking fabric with silver in place of standard treatments. Twenty-one (21) subjects with intertriginous dermatitis from two long-term care centers were enrolled in the study. Reduction in itching/burning: Fifteen (15) subjects had 2 itching/burning on Day 1. On Day 5, zero (0) subjects 1.8 had itching/burning. There was a statistically significant reduction in itching/burning (P = .0001) by Day 3 and 1.6 (P < .0001) by Day 5. 1.416 Mean Score Day 1 Number of Patients 1.214 Day 3 Reduction in maceration: Ten (10) subjects had 1 Day 1 12 Day 5 maceration on Day 1. One (1) subject had maceration on Day 3 0.810 Day 3 and Day 5 resulting from textile becoming soiled Day 5 0.6 with urine and not removed immediately. 8 0.46 Reduction in denudement: Seven (7) subjects had 0.24 0 denudement on Day 1. On Day 5, two (2) subjects had 2 Erythema Odor denudement that was improving. There was a significant 0 reduction on Day 3 (P = .125) and on Day 5 (P = .062). 2 Itching/ Maceration Denudement Satellite Burning Lesions 1.8 Reduction in satellite lesions: Five (5) subjects had 1.6 satellite lesions on Day 1. On Day 3 and Day 5, one (1) subject had satellite lesions that were improving. 1.4 2 Mean Score 1.2 1.8 Day 1 Day 3 Reduction in erythema: All of the subjects (21) entered 1 1.6 Day 5 the study with erythema. There was a statistically 0.8 1.4 significant reduction in erythema P( < .0001) by Day 3 0.6 Mean Score 1.2 Day 1 and Day 5. Day 3 0.4 1 Day 5 Reduction in odor 0.2 0.8 Separated odor: Twelve (12) subjects had odor on Day 1. 0 0.6 Erythema Odor There was a statistically significant reduction in separated 0.4 odor (P = .0020) by Day 3 and (P = .0034) by Day 5. Two 0.2 (2) subjects with odor on Day 5 had improved significantly 0 from Day 1. Note: One (1) subject had no odor on Day 1 Erythema Odor and Day 3 and minimal odor (scarcely noticeable) on Day 5 due to the textile being soiled with urine and left in place. Closed odor: Closed odor was not statistically analyzed. One (1) subject had closed odor on Day 1. On Day 3 and Day 5, zero (0) subjects had closed odor. References 1. Kennedy-Evans KL, Viggiano B, Henn T, Smith D. Multi-site feasibility study using a new textile with silver for management of skin conditions located in skin folds. Poster presented at: 20th Annual Symposium on Advanced Wound Care; April 28 - May 1, 2007; Tampa, FL and 39th WOCN® Society Annual Conference; June 9-13, 2007; Salt Lake City, UT 3 Introduction to skin fold management Author: Susan Gallagher, PhD, MSN, MA, RN, CBN, HCRM, CSPHP Sponsored by Coloplast Historical challenges antibiotic use; immunosuppression; example, McMahon and others Over the past few decades healthcare immobility; and diabetes, especially in reported that in a survey of 1116 providers have struggled to address the presence of excess moisture. hospitalized female patients 11.2% issues of skin fold management. had active or resolved inframammary Powders and creams have been the Most agree a gender or ethnic/racial lesions. Researchers found the mainstay of treatment. More creative component doesn’t exist; however, prevalence was higher among elderly processes have included taping skin age may be a factor. The very old individuals or those with mental folds apart or placing flannel or cotton and very young typically are affected illness. Mathur and others describe a fabric between skin folds to more often because of reduced higher rate of ITD among obese discourage skin-to-skin contact. immunity, immobilization, and adolescents. Although the numbers Resolution of skin injury may be moisture. Further, in the aging of critically ill patients who achieved; however, the process has population, age-related tissue loss is experience ITD is not clear, been time consuming and costly. associated with ITD. For instance, as anecdotally, providers understand Historically, a solution to skin fold the mandible shrinks in elderly this is a high-risk group for several management had been elusive. persons and the vertical dimensions reasons. For instance, in the intensive decrease around the mouth, care areas patients generally Special patient populations inflammation and ITD can occur experience an increased exposure to From a clinical perspective, excess under and within the accentuated moisture due to increased moisture often leads to intertriginous nasolabial folds. ITD manifests in a perspiration associated with illness/ dermatitis (ITD), especially in the number of areas over the aging body. diseases, fever or medications. There presence of deep cutaneous folds. Digital ITD is not uncommon among is more opportunity for skin-to-skin Obesity is thought to be a primary individuals who have contractures contact while in the lying position and factor in the development of ITD due to stroke or any other condition an increase in skin friction with because the presence of skin folds that impairs use of the hands and movement in bed or perhaps places the patient at greater risk for fingers. Any area of the body where restriction of movement because of prolonged skin-to-skin contact. ITD there is prolonged skin-to-skin hemodynamic instability or often occurs among adults, children contact is vulnerable. All risk factors reluctance to move a complex, or infants who are obese or who are aggravated by hot and humid critically ill individual. have a weight maldistribution. conditions. Thus a regional factor Inflammation may develop under or exists as well as a patient population Clinical and economic concerns within abdominal folds, in neck component. Some experts contend that creases, or in popliteal or antecubital prevention is a more appropriate fossae. However, a number of Unfortunately, the true prevalence of alternative to treatment and different types of individuals can ITD in unknown in a general sense, recommend a number of preventive develop this condition. For example, research suggests that the issue is strategies. For example, patients are in addition to obesity, risk factors for pervasive among certain populations, advised to control blood sugar, use ITD include: hyperhidrosis; systemic and affected individuals do not cotton undergarments, lose weight, infection; chronic steroid and always seek medical treatment. For avoid tight clothing and avoid 4 unnecessary antibiotic or steroid use. improve. However, recurrence of ITD might include dressings, antibiotics, Experts suggest keeping the area dry is common. Recurrences lead to laboratory studies, home health or and exposed to the air as much as direct and indirect costs. Indirect acute care expenses not covered by possible to prevent recurrences. costs include time from work, home the patient’s insurance carrier and and family; travel time to providers; more. Skin fold management has As indicated in the McMahon study, embarrassment from odor; threats to become an ongoing struggle for many individuals have resolution of productivity due to discomfort; many individuals from a humanistic, the ITD once their general conditions frustration and more. Direct costs clinical and economic perspective. References 1. Del Rosso JQ, Draelos ZD, Jorizzo JL, Joseph WS, Ribotsky BM, Rich P. Modern methods to treat superficial fungal disease.Cutis . 2007;79(2 suppl):6-29 2. Guitart J, Woodley DT. Intertrigo: a practical approach. Compr Ther. 1994;20(7):402-409 3. Scott TD. Intertrigo.