Managing Intertrigo and Urinary Incontinence: Preventing Skin Breakdown and Enhancing Care

Although intertrigo and incontinence-associated dermatitis (IAD) are well-documented, their management in male populations remains under-addressed. According to one study, male-specific continence challenges are often overlooked, and current skin care protocols inadequately reflect the anatomical and functional needs of men. 

Given the increasing recognition of this dual burden, a focused, proactive approach to prevention and care is essential. This article outlines evidence-based, practical strategies to manage intertrigo and UI in men—aiming to prevent skin breakdown, reduce complications, and support caregivers in delivering male-specific skin care.

2. Risk Factors and Contributing Elements in Men 

In men, the development of intertrigo is influenced by several unique anatomical and physiological factors. Male genitalia present distinct challenges, including deep skin folds, scrotal mobility, and the presence of penile tissues that are highly susceptible to friction and moisture. Use of external collection devices, such as condom catheters, further elevates the risk by trapping urine and heat against the skin, contributing to maceration. Shy et al. (2020) highlighted that male patients often receive poorly fitted continence products and face barriers to individualized skin care, increasing their vulnerability to skin breakdown.

Etiologically, heat, friction, and moisture play central roles in the onset of intertrigo, with secondary infections by Candida and bacterial pathogens commonly compounding the issue. Men with diabetes are particularly prone due to elevated skin pH and impaired immune response. Limited mobility and hygiene challenges—especially in older or bedbound men—exacerbate these risks.

Epidemiologically, a 2019 study reported a 40% prevalence of intertriginous dermatitis (ITD) on admission among acutely ill adults, with a 33% incidence rate during hospitalization. Older, obese men were disproportionately affected, particularly in the gluteal cleft. These findings underscore the need for male-specific assessment tools and tailored skin care protocols distinct from those used in female populations.

In a study of 499 participants with intertrigo, the total number of lesions observed was 1,038, with each participant having between 1 and 8 lesions. The inguinal area was the most frequently affected, followed by the breast area (31%) and the gluteal cleft (14.6%). Notably, 64.3% of these lesions persisted for more than two weeks.

This pattern emphasizes the need for targeted interventions, particularly for areas like the inguinal and gluteal regions, which are common sites of concern for male patients. These findings further underscore the importance of male-specific assessment tools and tailored skin care protocols, distinct from those typically used in female populations.

Skin Assessment and Early Detection 

In terms of pathophysiology, friction between skin surfaces and moisture accumulation create the perfect environment for bacterial and fungal infections, particularly Candida. The histopathology of intertrigo typically reveals no specific histological changes, but a mild spongiosis may occur in some cases.

Regular skin checks are essential for high-risk male patients, especially those with urinary incontinence (UI), as early detection of intertrigo can significantly improve outcomes. Early signs include erythema, localized irritation, and mild pruritus (itching) within skin folds, such as the inguinal and scrotal areas. These areas are particularly vulnerable due to friction, moisture, and heat buildup. Identifying these initial symptoms early can prevent the progression of intertrigo into more severe stages, such as maceration, fissuring, and infection.

To diagnose intertrigo, a thorough clinical assessment is essential, focusing on erythematous patches and signs of maceration, fissures, or crusting. Secondary infections should be suspected if pustules, vesicles, or a bluish-green tint are present. Further tests, including skin scraping, culture, or a Wood lamp, help identify fungal or bacterial infections and guide treatment.

4. Prevention and Management Strategies

Hygiene and Skin Cleansing

For male patients, maintaining proper hygiene is essential in preventing intertrigo, especially in areas prone to moisture and friction. Using pH-balanced cleansers instead of soaps is recommended, as soaps can disrupt the skin’s natural barrier, worsening irritation. Gentle cleansing of the genital area, particularly in the penile and scrotal folds, helps reduce the accumulation of sweat and bodily fluids. Protocols recommend the use of barrier products like zinc oxide and dimethicone, which protect the skin from irritants while allowing it to heal. 

When cleaning, men should focus on thoroughly drying the skin folds, as moisture left in these areas can exacerbate intertrigo. Additionally, using non-abrasive towels or air-drying can minimize the risk of further skin damage. Avoiding vigorous scrubbing or harsh chemicals ensures that the skin remains intact and less prone to secondary infections. This routine reduces irritation and helps in the prevention of skin breakdown.

It is essential to apply these barrier products after thorough drying, as excess moisture can lead to maceration and infection. For the scrotal area, ensuring that the skin is completely dry before applying the product is vital to prevent irritation. Furthermore, Gray et al. (2019) emphasize the importance of using a combination of barrier creams and drying agents, especially in warmer or humid environments, to protect the skin and reduce the risk of intertrigo recurrence.

Incontinence Management and Containment Products

Effective management of urinary incontinence (UI) is vital in preventing and managing intertrigo in male patients. External collection devices like condom catheters and absorbent products and wraps, like QuickChange Wraps, are commonly used to contain urine and reduce moisture exposure. However, improper sizing or inadequate securement of these devices can cause friction, leading to irritation or skin breakdown. One study highlights the challenges of fitting male-specific devices, particularly external catheters, which often do not provide a snug, secure fit for all patients, leading to leakage and skin irritation. It is crucial to assess the fit of these devices regularly, adjusting them as necessary to avoid pressure points and friction. Additionally, absorbent products like incontinence pads should be chosen based on the patient's individual needs, ensuring they are absorbent enough to prevent moisture buildup. 

Regular skin assessments, in conjunction with the use of high-quality products, can minimize the risk of intertrigo and promote skin health. Proper education on device use and hygiene routines, such as frequent changing of absorbent pads, further supports skin integrity and reduces the risk of secondary infections.

Staff Education and Protocol Development 

Effective staff education is essential for improving outcomes in the prevention and management of intertrigo, particularly among male patients. Nurses and caregivers should receive specialized training on conducting male-specific skin assessments, with a focus on areas vulnerable to friction and moisture, such as the genital folds and scrotal region. Early identification of intertrigo signs—such as erythema, maceration, and irritation—is crucial for prompt intervention. Protocol standardization within healthcare facilities can help ensure that these early signs are not overlooked, leading to timely treatment and reduced complications. Many analyses stress the importance of a male-centered approach to care, which includes tailored assessment protocols and product choices specific to male anatomy.

Clinicians should provide education to patients and families on key preventative measures, including proper hygiene, weight management, and glycemic control, as these factors contribute to minimizing friction and moisture buildup. 

Step-by-Step Care Plan

• Skin Cleaning: Use pH-balanced, fragrance-free cleansers and avoid irritating soaps. Thoroughly dry skin folds with a towel or air dry to reduce moisture.

• Moisture and Friction Control: Apply barrier creams like zinc oxide or dimethicone, and use moisture-absorbing powders (e.g., Zeasorb AF) to reduce perspiration.

• Incontinence Management: Use appropriately sized absorbent products and ensure proper fit of external collection devices like condom catheters.

• Environmental Modifications: Control temperature and humidity with air conditioning or a dehumidifier. Encourage breathable clothing and well-padded wheelchairs.

• Monitoring: Regularly assess skin for signs of intertrigo and adjust care accordingly.

Conclusion 

Managing intertrigo in men with urinary incontinence requires a proactive approach that combines effective skin care, moisture control, and proper incontinence management. Regular skin checks, hygiene routines, and barrier products are essential to prevent skin breakdown and secondary infections. Early detection and tailored interventions can significantly improve patient outcomes.

For a reliable solution, consider QuickChange Wraps, designed to reduce moisture and friction while providing comfort and skin protection.

For those seeking support, we invite you to purchase a 10 Count Trial Pack here or request a professional-use sample pack for healthcare institutions here.

References:

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