These are lesions where a combination of pressure and moisture contribute to the tissue breakdown. They still need to be graded as pressure damage but awareness of other causes and treatments is needed.

See Pressure Ulcer Grading Tool.

Mild

Erythema (redness) of skin only. No broken areas present.

Moderate

Erythema (redness), with less than 50% broken skin. Oozing and/or bleeding may be present.

Severe

Erythema (redness), with more than 50% broken skin. Oozing and/or bleeding may be present.

Treatment

Prevention/Mild IRD

Cleanse skin e.g. foam cleanser or pH balanced product. Apply Moisturiser +/or skin protectant e.g. barrier cream/film which does not affect absorbency of continence products.

Moderate-Severe IRD

Cleanse skin e.g. foam cleanser or pH balanced product. Apply liquid/spray skin protectant, OR barrier preparation, if no improvement refer to local guidelines or seek specialist advice.

NB: Observe for signs of skin infection, e.g. candidiasis, and treat accordingly (do not use barrier films as this will reduce effectiveness of treatment).

Location

• Located in peri-anal, gluteal, cleft, groin or buttock area
• Not usually over a bony prominence

Shape

• Diffuse often multiple lesions
• May be ‘copy’, ‘mirror’ or ’kissing’ lesion on adjacent buttock or anal-cleft
• Linear

Edges

• Diffuse irregular edges

Necrosis

• No necrosis or slough
• May develop slough if infection present

Depth

• Superficial partial thickness skin loss
• Can enlarge or deepen if infection present

Colour

• Colour of redness may not be uniform
• May have pink or white surrounding skin (maceration)
• Peri-anal redness may be present