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December 2006, Volume 36 Number 12 , p 22 - 23


  • Karen Zulkowski RN, CWS, DNS
  • Catherine Ratliff GNP, CWOCN, PhD


Zulkowski, Karen RN, CWS, DNS; Ratliff, Catherine GNP, CWOCN, PhD

UNRESPONSIVE, REX NOLAN, 70, is in your unit from the ICU after suffering a closed head injury in a motor-vehicle crash. He's incontinent of stool and has an indwelling urinary catheter. When you assess him, you see perianal redness (see Figure 1 ). A moisture barrier cream is ordered and Mr. Nolan is placed on a low-air-loss mattress. Within 5 days, despite treatment with the barrier ointment, he develops an open area on his buttocks (see Figure 2 ). Did he have perineal dermatitis on admission or had a pressure ulcer been developing? Or both?

Figure 1. No caption available. Figure 2. No caption available.

Distinguishing skin conditions can be challenging, even for an expert. But a correct diagnosis is crucial to treating the condition promptly and appropriately. Perineal dermatitis and early signs of a pressure ulcer can both appear as nonblanchable redness around the coccyx. Both conditions ...

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