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The development of the GLOBIAD is a major step towards a better systematic assessment of IAD in clinical practice and research worldwide. However, further validation is needed.

Incontinence-associated dermatitis (IAD) is a common type of irritant contact dermatitis, seen in patients with urinary or faecal incontinence. Mechanical factors such as traumata and friction may aggravate the lesions. The fragile skin in elderly patients is more prone to developing IAD. The clinical picture of IAD consists of persistent redness on the one hand and skin loss on the other. Both categories may be associated with clinical signs of major colonisation or infection. It is important to distinguish IAD from pressure ulcers and other dermatoses in the genital region. Due to the lack of well-established clinical trials, recommendations about prevention and treatment are based on expert opinion and best practice. Gentle cleansing, use of hydrating topical agents and application of barrier products are the main elements in the prevention and treatment of IAD. It is important to translate these recommendations and general guidelines into ready-to-use protocols that can be implemented for each specific clinical manifestation of IAD.

Funding sourcesThe Belgian Health Care Knowledge Centre (KCE) funded and sponsored the trial via the KCE Trials Programme (study ID KCE16012), a national public funding programme of noncommercial trials. No funding from the manufacturers of the study devices was received. Involvement of the sponsor included refinement of the study design and statistical analyses but they were not involved in data collection. KCE members reviewed the manuscript for statistical correctness and interpretation. The corresponding author had the final responsibility for the decision to publish.

Summary The best way to prevent and treat diaper dermatitis (nappy rash) in babies has been the topic of research for decades. However this skin problem can also occur in adults, where it is known as incontinence‐associated dermatitis (IAD). It is a specific type of irritant contact dermatitis ‐ a type of eczema caused when contact with something causes irritation (rather than an allergy), in this case prolonged contact of the skin with urine or faeces. It is hard to know exactly how many people suffer from IAD as there is not one set of internationally agreed diagnostic criteria (e.g. a list of specific symptoms and criteria that identify the disease) that help differentiate it from other skin disorders with similar symptoms, such as pressure ulcers. Ten different instruments / tools (meaning ways of diagnosing and ranking the severity of the disease) exist, but some are complex, and a single one is needed to make sure study results are comparable. Therefore, a group of 34 experts in 13 countries worked together to develop a tool that was started in 2015, called GLOBIAD. It was then translated into 14 different languages. Its accuracy was tested by asking 823 experts in 30 countries to categorize 34 photos of IAD using GLOBIAD to see if their results matched. The study found that the development of the GLOBIAD is a major step towards a better systematic assessment of IAD in clinical practice and research worldwide. However, further validation is needed.