Why This Matters 

• IAD is common among patients with incontinence, but reported prevalence varies substantially by population and care setting. Contemporary studies demonstrate particularly important burdens in older adults, critically ill patients, and individuals with fecal or dual incontinence. 

• IAD and pressure injury risk frequently intersect. Moisture exposure, impaired mobility, critical illness, and other patient-level vulnerabilities create overlapping threats to skin integrity, making IAD highly relevant to wound care professionals. 

• The burden extends beyond the skin. IAD is associated with pain, poorer quality of life, increased nursing workload, health care resource use, and costs, while recent reviews continue to identify important evidence gaps. 

What Is Incontinence-Associated Dermatitis—and Why Is It a Wound Care Issue? 

Incontinence-associated dermatitis is an irritant contact dermatitis resulting from repeated or prolonged exposure of the skin to urine and/or feces. It falls within the broader category of moisture-associated skin damage (MASD), in which exposure to bodily secretions or effluent compromises the skin barrier and produces inflammation, sometimes accompanied by erosion or denudation.¹ 

That definition immediately places IAD within the wound care professional's sphere of concern. Patients at risk for IAD frequently possess many of the same vulnerabilities encountered in wound care populations: advanced age, immobility, critical illness, dependency, impaired cognition, and pressure injury risk.^2,3 

The Epidemiologic Burden of IAD Is Significant 

The prevalence of IAD varies considerably depending on the population studied, definition used, assessment methodology, and clinical setting. This variability is itself important: it suggests that wound care professionals may encounter very different levels of disease burden across the continuum of care. 

A large US and Canadian analysis of the International Pressure Ulcer Prevalence Survey found an overall IAD prevalence of 4.3%, but nearly 1 in 5 patients with incontinence had documented IAD. Prevalence among incontinent patients ranged from 8.4% in long-term care to 19% in acute care. Among different forms of incontinence, IAD prevalence ranged from 12% in patients with urinary incontinence to 26% among patients with fecal management systems.⁴ 

Other populations demonstrate an even greater burden. A study of hospitalized older adults reported an IAD prevalence of 36.2%.⁵ More recent research in residential care found IAD in 11.5% of the overall study population and 13.3% of residents with incontinence.⁶ 

The wide range across studies should discourage reliance on a single prevalence estimate. Rather, it demonstrates how strongly IAD burden depends on patient characteristics, setting, and surveillance methods. 

Critically Ill Patients Face a Convergence of Risk Factors 

IAD deserves particular attention in populations where multiple skin-integrity threats coexist. 

A 2024 systematic review and meta-analysis examining critically ill patients with incontinence identified numerous factors significantly associated with IAD. Liquid stool was associated with more than a sixfold increase in odds of IAD (OR, 6.55; 95% CI, 4.12-10.41), while consciousness disorders were associated with an OR of 5.70 (95% CI, 2.28-14.22). Dual urinary and fecal incontinence were associated with approximately fourfold higher odds (OR, 4.10; 95% CI, 2.34-7.17). Other significant factors included older age, fever, higher APACHE II scores, lower Braden Scale scores, lower oxygen saturation, and more frequent incontinence.² 

A broader 2025 systematic review and meta-analysis likewise identified multiple patient- and care-related risk factors for IAD in adults.³ 

These data make IAD especially relevant to wound clinicians because the patients most vulnerable to moisture-associated skin damage often simultaneously carry substantial overall acuity and skin-integrity risk. 

IAD and Pressure Injury Represent an Important Clinical Intersection 

One of the most consequential reasons for wound care professionals to understand IAD is its relationship with pressure injury. 

A large multisite epidemiologic study involving 5,342 hospitalized adults found IAD in 45.7% of patients with incontinence. Among patients with IAD, 27.9% had moderate disease and 9.2% had severe disease. The presence of IAD was independently associated with substantially greater odds of sacral pressure injury (OR, 4.56; 95% CI, 3.68-5.65), even after accounting for immobility. IAD was also associated with increased odds of full-thickness sacral pressure injury (OR, 2.65; 95% CI, 1.74-4.03).⁷ 

Earlier systematic-review evidence similarly demonstrated an association among incontinence, moisture, IAD, and pressure ulcer development.⁸ While association does not prove that IAD directly causes pressure injury, the overlap is highly consequential from a wound care perspective: clinicians evaluating skin integrity frequently encounter multiple mechanisms of tissue damage in the same anatomical region and in the same high-risk patient. 

IAD Is Also a Patient-Experience and Health System Concern 

The consequences of IAD extend beyond visible dermatitis. A 2022 systematic review characterized IAD as a painful and underrecognized condition associated with poorer quality of life, increased nursing workload, and health care costs. However, the review also highlighted how incompletely the economic and patient-reported burden has been quantified.⁹ 

Large-scale US health care data reinforce the broader consequences associated with incontinence and IAD-related populations. An analysis encompassing more than 15 million adult admissions from 937 hospitals found that patients with documented incontinence experienced longer average hospital stays than continent patients (6.4 vs 4.4 days), were 1.4 times more likely to experience 30-day readmission, 5.1 times more likely to have a sacral hospital-acquired pressure injury, and 5.8 times more likely to experience progression of a sacral pressure injury to a more severe stage.¹⁰ Importantly, the investigators noted limitations in identifying IAD through administrative data, illustrating another challenge in accurately quantifying its burden. 

For wound care professionals and health systems alike, these findings place moisture-associated skin damage within a larger conversation about patient outcomes, nursing resources, documentation, quality measurement, and skin-integrity complications. 

Why Greater Understanding of IAD Matters Now 

IAD occupies a complicated intersection of continence care, wound care, dermatology, nursing, and patient safety. It occurs disproportionately among patients who may already be medically complex, dependent on caregivers, immobile, critically ill, or at elevated risk for pressure injury. 

At the same time, significant knowledge gaps remain. Economic reviews have found limited high-quality evidence evaluating the full costs and health outcomes associated with IAD, while systematic reviews continue to refine understanding of its risk factors.^2,3,9 

That combination—a meaningful clinical burden, vulnerable patient populations, overlap with pressure injury risk, and an evolving evidence base—makes IAD an important subject for continuing professional education. 

For wound care professionals, the question is therefore larger than dermatitis alone. IAD represents a visible manifestation of compromised skin integrity within some of the most vulnerable patient populations clinicians encounter. Understanding the scale of that burden and its relationship to broader wound and patient outcomes provides an important foundation for interpreting emerging evidence and appreciating why IAD deserves focused attention within contemporary wound care education. 

References 

1. Gray M, Bliss DZ, McNichol L. Moisture-associated skin damage: expanding and updating practice based on the newest ICD-10-CM codes. J Wound Ostomy Continence Nurs. 2022;49(2):143-151. doi:10.1097/WON.0000000000000865. 

2. Wang G, Wang X, Wang H, Wang L, Li W. Risk factors for incontinence-associated dermatitis in critically ill patients with incontinence: a systematic review and meta-analysis. J Wound Ostomy Continence Nurs. 2024;51(4):313-323. doi:10.1097/WON.0000000000001090. 

3. Jiang T, Zhang X, Wu J, Gao L, Tung TH. Risk factors for incontinence-associated dermatitis in adults: a systematic review and meta-analysis. J Wound Ostomy Continence Nurs. 2025;52(1):66-75. doi:10.1097/WON.0000000000001146. 

4. Kayser SA, Phipps L, VanGilder CA, Lachenbruch C. Examining prevalence and risk factors of incontinence-associated dermatitis using the International Pressure Ulcer Prevalence Survey. J Wound Ostomy Continence Nurs. 2019;46(4):285-290. 

5. Ferreira M, Abbade L, Bocchi SCM, Miot HA, Boas PV, Guimaraes HQCP. Incontinence-associated dermatitis in elderly patients: prevalence and risk factors. Rev Bras Enferm. 2020;73 Suppl 3:e20180475. Portuguese, English. doi: 10.1590/0034-7167-2018-0475. Epub 2020 Jul 13. PMID: 32696899. 

6. Wall B, Kelly AM, White P, McCann M. Incontinence-associated dermatitis in older adults in residential care settings: a point prevalence study. Br J Nurs. 2024;33(9):S16-S28. doi:10.12968/bjon.2024.33.9.S16. PMID: 38722011. 

7. Gray M, Giuliano KK. Incontinence-associated dermatitis, characteristics and relationship to pressure injury: a multisite epidemiologic analysis. J Wound Ostomy Continence Nurs. 2018;45(1):63-67. doi:10.1097/WON.0000000000000390. 

8. Beeckman D, Van Lancker A, Van Hecke A, Verhaeghe S. A systematic review and meta-analysis of incontinence-associated dermatitis, incontinence, and moisture as risk factors for pressure ulcer development. Res Nurs Health. 2014;37(3):204-218. doi:10.1002/nur.21593. 

9. Cunich M, Barakat-Johnson M, Lai M, et al. The costs, health outcomes and cost-effectiveness of interventions for the prevention and treatment of incontinence-associated dermatitis: a systematic review. Int J Nurs Stud. 2022;129:104216. doi:10.1016/j.ijnurstu.2022.104216. 

10. Kayser SA, Koloms K, Murray A, Khawar W, Gray M. Incontinence and incontinence-associated dermatitis in acute care: a retrospective analysis of total cost of care and patient outcomes from the Premier Healthcare Database. J Wound Ostomy Continence Nurs. 2021;48(6):545-552. doi:10.1097/WON.0000000000000818.