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Barrier Creams and Incontinence-Associated Dermatitis Prevention

Barrier products are topical skin protectants applied to perineal and perigenital skin to help prevent or manage incontinence-associated dermatitis (IAD): irritant contact dermatitis associated with prolonged exposure to urine, feces or both. The AUA/SUFU 2024 OAB Guideline includes barrier creams among incontinence-management strategies to discuss with patients with urgency urinary incontinence .[3][1][2][3][4]

For absorbent-product selection and changes, see Absorbent Products & the Pad Test. A condom catheter may reduce urine contact in a selected man with adequate emptying. The EAUN guideline advises keeping creams and powders off the adhesive sheath site because they impair adhesion (level 4, grade C).[16]

Definition and Concept​

Barrier creams belong to the broader class of leave-on products: formulations of lipophilic ingredients (petrolatum, wax) and hydrophilic ingredients (water, glycerin) applied after cleansing. The protective effect comes from a hydrophobic film that reduces direct contact between urine or feces and the epidermis, reduces transepidermal water loss, and minimizes friction against absorbent products. Comparative evidence does not show that any single ingredient is more effective than another.[4][5]

Categories of Barrier Products​

CategoryKey ingredientsMechanismExamples
Traditional creams / ointmentsZinc oxide, petrolatum, lanolinPhysical occlusive barrier; zinc oxide adds mild astringent / antimicrobial actionSudocrem (15.25% zinc oxide), standard zinc oxide cream (32%), Desitin, A+D ointment[1]
Dimethicone (silicone) productsDimethicone 1–3%, silicone polymersTransparent water-insoluble protective film; breathableComfort Shield perineal washcloth (3% dimethicone); dimethicone silicone oil[1]
Film-forming polymersAcrylate terpolymers; silicone-based spraysThin transparent film resistant to wash-off; does not interfere with pad adhesionCavilon No Sting Barrier Film; 3M skin protective film spray[1][2]
Cyanoacrylate-based protectantsProduct-specific polymer/cyanoacrylate formulationDurable transparent film; some products are indicated for superficial damaged skin; follow each product's instructionsCavilon Advanced Skin Protectant (2-octyl cyanoacrylate plus acrylic tetrapolymer and solvent)[6][11]
Combination / multi-step bundlesCleanser + moisturizer + protectantCleansing and barrier in one workflowComfort Shield (cleanser + moisturizer + dimethicone); Cavilon cleanser + barrier-cream bundles[1]

Mechanism — How Barrier Creams Protect​

IAD develops through a cascade:[1][2]

  1. Skin bacteria can convert urinary urea to ammonia, raising skin pH from its usual mildly acidic level and weakening the stratum corneum; when stool is also present, digestive enzymes add tissue injury.[2][14]
  2. Overhydration (maceration) further weakens the barrier.
  3. Friction from absorbent products compounds damage.

Barrier products counter this by:

  • A hydrophobic layer reduces direct urine and fecal contact with the epidermis.
  • Shielding skin from external urine and fecal moisture helps limit overhydration.[2][14] Transepidermal water loss is a measure of barrier function.[2][14]
  • Skin–pad friction varies by formulation: in a small forearm experiment, one cream reduced friction against a wet pad while another cream and a spray increased it.[17]
  • Some formulations (for example zinc oxide) add a mild antimicrobial or astringent action.[1][5]

Clinical Evidence​

The 2025 Cochrane review (Graham et al.) evaluated 15 prevention trials (1,020 participants; 13 small, high overall risk of bias, too heterogeneous to pool). All comparisons were very low certainty, and the authors could not draw meaningful conclusions about which interventions prevent IAD. Its treatment review is separate.[4]

Leave-on vs leave-on (selected comparisons from Cochrane 2025)[4]​

ComparisonnIAD rateEffect
Petroleum jelly vs zinc oxide powder2060% vs 40%RR 1.50 (95% CI 0.60–3.74), NS
Sudocrem vs standard zinc oxide cream2718.75% vs 18.18%RR 1.03 (95% CI 0.20–5.19), NS
Dimethicone silicone oil vs acrylate terpolymer film spray5617.9% vs 42.85%RR 0.42 (95% CI 0.17–1.03), trend favoring dimethicone
3M skin protective film vs IV3000 semipermeable film7420.6% vs 47.5%RR 0.43 (95% CI 0.21–0.90); single-trial, very-low-certainty result

Bundle vs single product​

  • Cavilon Advanced plus routine cleansing versus routine cleansing alone: 2/15 (13.3%) versus 3/16 (18.8%) developed IAD in the Coyer ICU pilot; RR 0.71 (95% CI 0.14–3.68), very low certainty.[4]
  • In 180 older inpatients at moderate to high risk of IAD, a structured cleansing plus topical-product protocol in Gaspar 2016 yielded 0/90 versus 15/90 incident IAD at day 3 under conventional care (RR 0.03, 95% CI 0.00–0.53); very low certainty.[4]
  • Cambel/Brava colostomy powder plus 3M film-forming product versus warm-water cleansing plus zinc oxide: 7/32 (21.9%) versus 26/31 (83.9%); RR 0.26 (95% CI 0.13–0.51), very low certainty in one trial.[4]

Umbrella review​

The 2023 nursing-practice umbrella review (12 systematic reviews) found that reviews of leave-on products indicated effectiveness of barrier films and lipophilic products for preventing and treating IAD, without establishing that any product is superior. The authors noted that most systematic reviews in the field are at high risk of bias.[7]

Cyanoacrylate-Based Protectants — Emerging Category​

Cyanoacrylate-based protectants form a durable, transparent barrier. The manufacturer IFU for Cavilon Advanced permits use on intact or superficially damaged skin and excludes full-thickness wounds. Its ampule liquid is nonsterile and must not be used for surgical-site protection or other applications requiring a sterile product. Avoid use with ingredient allergy and discard each applicator after one use. Other creams can impair the film; the wet product is highly flammable, so allow at least 90 seconds before heat or ignition devices.[11] The IFU specifies reapplication one to three times weekly rather than after each cleansing; local product IFUs govern.[11] Comparative data are limited:[5][6]

  • A Medline-funded comparison favored its solvent-free 100% cyanoacrylate over solvent-containing Cavilon Advanced in an ex-vivo porcine-skin moisture/abrasion model.[6]
  • In healthy volunteers, both products maintained barrier function over the eight-day observation period without a clear clinical difference in wear duration.
  • On superficial denudation, select a product specifically indicated for damaged skin, and assess infection or deeper injury separately.[11]

Wash-Off Resistance​

A head-to-head study of five silicone-containing barrier creams in 36 healthy volunteers found that Medi Derma-S, Cavilon Barrier Cream and LBF Barrier Cream gave significantly better moisture-barrier protection and wash-off resistance than Medihoney, Remedy Barrier Cream and untreated skin (p < 0.001).[8]

Guideline Position​

SourceStatement
AUA/SUFU 2024 OAB (Statement 10)Discuss incontinence-management strategies, including barrier creams, with all patients with urgency urinary incontinence . The guideline notes no RCTs comparing these management strategies; small randomized comparisons of barrier products exist, but the 2025 Cochrane review rates the comparative evidence very low certainty.[3][4]
Wund-D.A.CH best-practice consensusContinence management, efficient absorbent aids with good retention, consistent skin protection with barrier products, and adequate skin care are the effective strategies for IAD prevention[9]
General expert consensusThree pillars of IAD prevention / treatment: (1) gentle cleansing; (2) hydrating topical agents; (3) barrier products. Recommendations remain largely expert-opinion-based[1]

Structured Skin-Care Protocol​

First identify whether urine, stool or both drive exposure and address treatable causes of incontinence.[2] Then use a structured skin-care regimen:[1][2][4]

  1. Cleanse. Gently remove urine or stool after incontinence episodes; consider a low-irritant, pH-compatible cleanser. One small trial favored a foam cleanser over soap and water (RR 0.35, 65 participants) and another found no clear difference, so certainty is very low.[4] Avoid harsh soap, friction and vigorous scrubbing.
  2. Moisturize when appropriate. Address xerosis with a hydrating leave-on agent, particularly in older patients with xerotic skin. If using Cavilon Advanced, avoid layering other barrier products, ointments, creams or lotions on the same area; its IFU warns that they may significantly reduce the film's effectiveness.[11]
  3. Protect. Apply a suitable barrier product (cream, ointment or film), avoiding ingredients to which the patient has a known allergy (for example, lanolin, parabens or fragrances).[2] Reapplication and compatibility depend on the formulation; follow the actual product IFU. For Cavilon Advanced, allow at least 30 seconds to dry, keeping skin folds apart until dry, and about 1 minute before placing adhesive products. Routine cleansing does not require reapplication; its IFU specifies one to three applications per week.[11]
  4. Change absorbent products regularly. High-absorbency products with superabsorbent polymers reduce skin moisture exposure.

Treating Established IAD​

SeverityManagement
Mild (erythema only)Maintain a suitable lipophilic or film-forming leave-on protectant on intact skin, reduce prolonged occlusion, and select absorbent products that limit overhydration.[2]
Moderate (erosion / denudation)Protect from further irritant exposure; a cyanoacrylate-based protectant indicated for damaged skin can be used, following its IFU[10][11]
Severe or atypicalAssess for pressure injury, allergic contact dermatitis, intertrigo and infection; arrange wound or dermatology assessment when indicated.[2] A 2025 review describes short-term topical corticosteroids under dermatology supervision for very severe inflammation, not routine IAD treatment; the Cochrane prevention trials did not test them.[2][4][10]
Secondary infectionAssess and treat diagnosed fungal or bacterial infection. Cavilon No Sting Barrier Film is contraindicated on infected skin; Cavilon Advanced can reduce absorption of topical antimicrobials, so check the specific IFU and sequence treatment accordingly.[2][11][15]
RefractoryReassess continence care, product fit, skin diagnosis and exposure; consider an external collection device in a suitable patient. Do not place an indwelling urinary catheter solely to manage incontinence (CDC Category IB). The CDC lists assistance with healing an open sacral or perineal wound in an incontinent patient as an appropriate indication; leave a catheter in place only while needed.[2][12]

Confluent erythema with satellite lesions, sometimes with small vesicles, has been described as suggestive of cutaneous candidiasis in skin affected by IAD. Once candidiasis is clinically identified, a topical azole such as miconazole or clotrimazole has been described as treatment, separate from the barrier product itself.[13]

Limitations of the Evidence​

Across all comparisons the evidence is very low certainty, with small samples, heterogeneous interventions and inconsistent endpoints. The 2025 Cochrane review could not draw meaningful conclusions about the effectiveness of the tested interventions. Single small trials favored a foam cleanser over soap and water and a structured cleansing-plus-leave-on protocol over cleansing alone, but each result is very low certainty.[4]

Key Principles​

  • Barrier products can help protect skin as part of structured prevention and care for IAD.[1][2][4]
  • The AUA/SUFU 2024 OAB guideline states that clinicians should discuss incontinence management strategies, including barrier creams, with all patients who have urgency urinary incontinence .[3]
  • The evidence base does not show that any product is superior.[4][7]
  • The Cavilon Advanced IFU allows superficial damaged-skin use, carries flammability and topical-drug compatibility precautions, and specifies one to three reapplications per week. Other formulations have their own IFUs.[11]
  • Wash-off resistance differed between brands in healthy volunteers: Medi Derma-S, Cavilon Barrier Cream and LBF Barrier Cream outperformed Medihoney and Remedy.[8]
  • A structured regimen (gentle cleansing, suitable leave-on protection, timely absorbent-product changes) is practical, but comparative effects remain very uncertain.[4]
  • Harsh soap and friction are avoided.[4]
  • For refractory IAD, reassess the cause and exposure; consider appropriate external collection without using an indwelling catheter for incontinence alone.[2][12]

References​

1. Beele H, Smet S, Van Damme N, Beeckman D. Incontinence-associated dermatitis: pathogenesis, contributing factors, prevention and management options. Drugs Aging. 2018;35(1):1-10. doi:10.1007/s40266-017-0507-1.

2. Kottner J, Dissemond J. Incontinence-associated dermatitis in older adults: a critical review of risk factors, prevention and management. Drugs Aging. 2025;42(8):745-754. doi:10.1007/s40266-025-01227-z.

3. Cameron AP, Chung DE, Dielubanza EJ, et al. The AUA/SUFU guideline on the diagnosis and treatment of idiopathic overactive bladder. J Urol. 2024;212(1):11-20. doi:10.1097/JU.0000000000003985.

4. Graham T, Beeckman D, Kottner J, et al. Skin cleansers and leave-on product interventions for preventing incontinence-associated dermatitis in adults. Cochrane Database Syst Rev. 2025;7(7):CD011627. doi:10.1002/14651858.CD011627.pub3.

5. Woo K, Hill R, LeBlanc K, et al. Technological features of advanced skin protectants and an examination of the evidence base. J Wound Care. 2019;28(2):110-125. doi:10.12968/jowc.2019.28.2.110.

6. Pradhan MA, Nicholson LM, Coles LS, Campbell JJ, Curtis BJ. Comparative analyses of cyanoacrylates for barrier protection and incontinence-related wash-off resistance. Int Wound J. 2026;23(1):e70807. doi:10.1111/iwj.70807.

7. Fastner A, Hauss A, Kottner J. Skin assessments and interventions for maintaining skin integrity in nursing practice: an umbrella review. Int J Nurs Stud. 2023;143:104495. doi:10.1016/j.ijnurstu.2023.104495.

8. Dykes P, Bradbury S. Comparing the effectiveness and wash-off resistance of skin barrier creams: a healthy volunteer study. J Wound Care. 2017;26(9):552-557. doi:10.12968/jowc.2017.26.9.552.

9. Dissemond J, Assenheimer B, Gerber V, et al. Moisture-associated skin damage (MASD): a best practice recommendation from Wund-D.A.CH. J Dtsch Dermatol Ges. 2021;19(6):815-825. doi:10.1111/ddg.14388.

10. Sparling K, Frieden IJ, Butler DC. Incontinence-associated dermatitis: not just babies. J Am Acad Dermatol. 2026;94(3):903-913. doi:10.1016/j.jaad.2025.08.051.

11. 3M. Cavilon Advanced Skin Protectant: Instructions for Use (5050G/5051G; regional IFU). Manufacturer PDF. Instructions may vary by product and region.

12. CDC. Guideline for Prevention of Catheter-Associated Urinary Tract Infections: Summary of Recommendations. Appropriate catheter use.

13. Cwach K, Rovner ES. Catheters, Pads, and Pants. In: Cardozo L, Staskin D, eds. Textbook of Female Urology and Urogynecology. Vol 1: Clinical Perspectives. 5th ed. CRC Press; 2023:441-456. doi:10.1201/9781003144236-49

14. Mugita Y, Minematsu T, Nakagami G, Sanada H. "Influence of digestive enzymes on development of incontinence-associated dermatitis: Inner tissue damage and skin barrier impairment caused by lipidolytic enzymes and proteases in rat macerated skin." Int Wound J. 2018;15(4):623-632. doi:10.1111/iwj.12906

15. 3M. Cavilon No Sting Barrier Film: Instructions for Use (3100025826). Manufacturer PDF.

16. Geng V, Cobussen-Boekhorst H, Lurvink H, Pearce I, Vahr S. Evidence-Based Guidelines for Best Practice in Urological Health Care: Male External Catheters in Adults—Urinary Catheter Management. European Association of Urology Nurses; 2016. Guideline.

17. Morecroft R, Tomlinson K, Lewis R, Carré M. "Friction between human skin and incontinence pads in the presence of barrier protection products." Proc Inst Mech Eng H. 2024;238(6):644-654. doi:10.1177/09544119231178477.