Incontinence Induces Stratum Corneum Vulnerability and Impairs the Skin Barrier Function in the Perianal Region

Abstract

Background: Incontinence leads to a reduced skin barrier function, while also increasing the risk of skin breakdown. Aim: To investigate the perianal skin barrier function of elderly patients with or without incontinence. Methods: We compared the skin barrier function by investigating the skin hydration, the skin pH, the amount of ceramide and by making a dermatological skin inspection of the perianal region in patients with and without incontinence. Results: Twenty-one incontinent patients (70.0%) showed a glossy skin, which indicates impairment of the skin barrier while none of the patients in the continence group did so. In the incontinence group, those who had a glossy skin showed a significantly greater skin pH and total amount of ceramide than those with a normal skin (p = 0.0099, p = 0.0179, respectively). Conclusions: These results demonstrate that a glossy skin may be a useful indicator of a reduced perianal skin barrier function.

Age-Related Changes of Stratum Corneum Functions of Skin on the Trunk and the Limbs

“…Despite our understanding that the care of back and buttock skin is important for elderly nursing patients, and despite the fact that the itchiness and/or dryness of the skin occurs mainly on the trunk skin in the elderly, the SC functions of skin on the trunk have not been well investigated. Nakagami et al [4] compared the SC functions in perianal sites of elderly patients with or without incontinence, and found that the SC capacitance, skin pH and the amount of SC ceramide were greater in the incontinence group than in the healthy group. However, these results were obtained only from elderly patients, and therefore it is insufficient to understand the SC functions of skin on the trunk at different ages.…”

pH-Wert und mikrobielle Infektionen

“…6,5-7,5 dazu bei, dass der pH-Wert im Windelbereich auf 6,8-7,15 steigt [22]. Ein mittlerer Haut-pH-Wert von 7,15 wurde auch bei älteren Personen mit Inkontinenzvorlagen und Anzeichen von Hautschädigung festgestellt, verglichen mit einem pH-Wert von 6,35 auf ungeschädigter Haut und 6,03 bei Kontrollpersonen ohne Inkontinenz [26]. Der Anstieg des pH-Wertes ist unter anderem dadurch bedingt, dass Bakterien der Mikroflora, insbesondere Bacillus ammoniagenes , Harnstoff in Ammoniak umwandeln, und dass verschiedene Fäkalbakterien Ureasen produzieren.…”

Aging enhances maceration-induced ultrastructural alteration of the epidermis and impairment of skin barrier function

“…Noninvasive measures commonly used to evaluate skin maceration, including skin microscopy and measurements of TEWL, skin hydration, and skin pH [9][10][11][12], were applied to human skin. These measurements were not applied in the rat experiments because the measuring probes of these instruments were too large for the rat foot sole.…”

“…The measurement of TEWL is widely used to evaluate skin barrier function, even in macerated skin [9,12]. However, we experienced difficulty accurately measuring TEWL in hydrated skin.…”

“…The skin barrier function is often measured by transepidermal water loss (TEWL) [9][10][11][12], which is a parameter of water penetration from the inside to the outside of the body. However, the transdermal penetration of chemical irritants and macromolecules from the outside to the inside should be considered direct evidence for the development of maceration-induced skin lesions.…”