Dear Dr. Timm

Urinary incontinence is a well-known source of skin breakdown, not only in children, but in adults as well. Although wetness alone macerates the skin, moisture from urinary incontinence softens the stratum corneum and greatly increases skin susceptibility to friction injury. Urine has the additional impact on skin integrity because of its effect on skin pH. While studies show that ammonia alone is only a mild skin irritant, when urea breaks down in the presence of fecal urease it increases skin pH, which in turn promotes the activity of fecal enzymes such as protease and lipase. These fecal enzymes increase the skin's permeability to bile salts, and act as irritants in and of themselves. In adults wearing pads, urine leaking onto a pad or diaper can come into contact with fecal flora around the anus, setting off the enzymatic reactions described above. Moisture trapped in the intertriginous areas of the groin and perineum provides an ideal environment for fungal overgrowth.

The ActiCuf minimizes urinary incontinence by mechanical compression of the urethra, and if there is breakthrough leakage from the urethra, the moisture is confined to the contained pad. The surrounding skin of the inner thigh, scrotum, perineum and perianal areas does not come into contact with the irritating urine.

Sincerely,

Claire C. Yang, MD
University of Washington
Associate Professor

July, 18 2007.

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