I have a patient with stage 3 ulcers on the coccyx and diarrhea burns covering her perineal area, vaginal area, inner thighs, and buttocks. Should therapy be the same as that for a regular burn patient?
—Bonnie Shipferling, PhD(c), MSN, RN, Friendswood, Tex.

A stage 3 pressure ulcer has full-thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to—but not through—underlying fascia. The ulcer presents clinically as a deep crater with or without undermining of the adjacent tissue. Moisture, skin pH, colonization with microorganism, and friction are factors related to skin breakdown secondary to fecal incontinence. Removing feces, urine, and other irritants from the skin regularly, preventing or minimizing additional exposure to damaging irritants and bacteria, and establishing a local environment conducive to healing are some of the goals of perineal skin therapy in an incontinent patient.

Cleansers, moisturizers, and skin protectants (moisture barriers, such as powders, pastes, and liquid-barrier films) can be used to manage the affected perineal skin (Adv Skin Wound Care. 2000;13:244-246 and 2002;15:170-175).
—Philip R. Cohen, MD (108-6)

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