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Jak odróżnić odleżynę od zapalenia skóry związanego z nietrzymaniem moczu? 3 ważne zasady

Marta2 218 komentarzy
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Trudno gojące się rany to u pacjentów długotrwale hospitalizowanych, leżących, w podeszłym wieku częsty i poważny problem zdrowotny. Prawidłowa diagnoza rany to w takim przypadku kluczowy element skutecznego procesu terapeutycznego.

Zapalenie skóry związane z nietrzymaniem moczu lub stolca (ang. incontinence-associated dermatitis, IAD) to rodzaj trudno gojącej się zmiany skórnej, która często występuje u pacjentów w podeszłym wieku, z ograniczoną zdolnością ruchu i długotrwale hospitalizowanych. Mimo częstości występowania IAD bywa mylnie rozpoznawane jako odleżyny. Ma to związek z brakiem powszechnie przyjętych kryteriów diagnozowania tego rodzaju ran, nie ma także jednolitych danych odnośnie zapadalności i chorobowości IAD. Jakie czynniki mogą więc pomóc w rozpoznaniu tego schorzenia?

Przyczyna powstania rany

W przypadku odleżyn rany powstają na skutek długotrwałego działania siły nacisku i sił poprzecznych na jedną część ciała (najczęściej pięty, pośladki, biodra). Zapalenie skóry związane z nietrzymaniem moczu jest natomiast skutkiem ekspozycji skóry na wilgoć i tarcie. W wyniku działania moczu lub kału funkcja barierowa skóry zostaje naruszona. Dochodzi do nadmiernego nawodnienia, co skutkuje obrzękiem, przerwaniem warstwy rogowej skóry i wykształceniem zmian (np. maceracji) i stanów zapalnych. Skóra staje się bardziej podatna na tarcie i łatwo ulega kolejnym uszkodzeniom.

Lokalizacja rany

Zapalenie skóry związane z nietrzymaniem moczu lub kału będzie się rozwijało wyłącznie na tych obszarach skóry, które są wystawione na bezpośrednią ekspozycję tych substancji. Najczęściej schorzenie obejmuje okolice krocza – u kobiet wargi sromowe większe, u mężczyzn natomiast mosznę i pachwiny. Może jednak także rozwinąć się na podbrzusze, przyśrodkowe i tylne części ud, pośladki i okolicę okołoodbytniczą.

Lokalizacja zmian wyraźnie odróżnia IAD od odleżyn, które zazwyczaj występują nad wystającymi elementami kostnymi.

Cechy kliniczne rany

Zapalenie skóry związane z nietrzymaniem moczu nie przybiera wyraźnie odgraniczonego kształtu, jest rozlane i rozproszone, w przeciwieństwie do odleżyn, które w większości przypadków mają bardziej regularne, wyraźne kształty. Zaczerwienienie na obszarze zmian chorobowych jest w przypadku IAD nierównomierne, a brzegi rany są rozmyte i nieregularne.

Zmiany skórne w przebiegu IAD są płytsze, obejmują zazwyczaj powierzchowne warstwy skóry. Odleżyny mogą natomiast osiągać pełną głębokość i drążyć aż do tkanki kostnej.

Co istotne, w przypadku zapalenia skóry związanego z nietrzymaniem moczu nie dochodzi do niedotlenienia tkanek, a w konsekwencji do rozwoju tkanki martwiczej w łożysku rany. Jeżeli w ranie zaobserwowano martwicę, wskazuje to jednoznacznie na odleżynowy charakter.

Źródło:

L. McNichol, E. Ayello, L. Phearman i in., “Incontinence-Associated Dermatitis: State of the Science and Knowledge Translation”, “Advances in Skin & Wound Care” 2018, 31(11): 502-513.

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