The effects of incontinence pad application on loaded skin with reference to biophysical and biochemical parameters: an exploratory cohort study using a repeated measure design

Purpose: the purpose of this study was to evaluate temporal changes in skin responses following exposure to moisture alone or moisture in combination with mechanical loading.Design: exploratory cohort study to evaluate the effects of incontinence pad application using a repeated measure design on individuals of two different age groups Subjects and Settings: the sample comprised 12 healthy volunteers. Participants were purposely sampled from two different age groups; 50% were 32 to 39 years and 50% were from 50 to 62 years old. Participants identified as white, black or mixed; 83% (n= 10); 8 (67%) were female.Methods: four sites at the sacrum were challenged with application of specimens taken from two absorbent products; the pad specimens were applied dry or saturated with synthetic urine (SU, pH=8); a further site from the sacral skin was also selected and used as a control. Skin assessments were performed at different points in time: 1.) 60 minutes after exposure to dry or SU saturated pad specimens, 2.) 60 minutes after exposure to pads and mechanical loading (application of pressure in the form of 45⁰C high sitting), and 3.) 30 minutes after removal of all pads (recovery period). Outcome measures were Transepidermal water loss (TEWL), Stratum Corneum (SC) hydration, erythema, pH and skin inflammatory biomarkers measured at each of the time points described above. Results: The control site and those exposed to dry pads showed minimal time-dependent changes irrespective of the parameter investigated. By contrast, significant increases in TEWL (p=0.0000007) and SC hydration responses (p= 0.0000007) were detected at the sites under absorbent pads specimens after saturation with SU (exposure to moisture). In some participants, TEWL and SC hydration parameters were significantly higher during pressure application. Skin pH remained in the mildly acidic range throughout the test session and no consistent trends were observed with erythema. Skin inflammatory biomarkers also exhibited considerable variability across participants with none of the analysed biomarkers presenting significant temporal or spatial changes (p> 0.05). Conclusion: we evaluated an array of parameters to identify changes following skin exposure to two absorbent pads in the presence and absence of synthetic urine and mechanical loading. Analysis revealed changes in skin barrier properties in the presence of moisture and/or pressure. Statistical significant differences (p=0.02) were also detected following the exposure of moisture in combination with pressure. This observation suggests a need for frequent pad changing as well as periods of skin offloading to protect the skin health of individuals with incontinence.