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“IAD presents as inflammation of the skin and can also cause blistering and swelling to the affected area. Typically, the anal area, buttocks, and inner thighs, as well as the labia of women and penis/scrotum of men, are affected. While the mechanisms of IAD are not entirely understood, incontinence alters the microbiome of the skin. When urine and feces have prolonged contact, not only does skin over hydration occur, but the normally acidic skin pH becomes alkaline. In turn, this creates inflammation and breakdown of the stratum corneum, disrupting the protective nature of skin by changing its permeability. Maceration of the skin due to over hydration increases the risk for friction-related skin injuries. Fecal matter adds to hyper-hydration of the skin due to chemical, bacterial, and mechanical aggravation, as well as enzymes in the stool, all of which contribute to skin breakdown (Wound, Ostomy and Continence Nurses Society. Therefore, prevention, treatment, and management of incontinence are crucial to maintain skin integrity.” This article is useful for my change proposal as it related to skin conditions of multiple types. Many condition cause skins issues, this article gives an example of two types. It may be a weakness that it only focuses on urologic nursing and not nursing in gerneral. The strength is that it reminds the reader that pressure injury can come from an applicance that the patient uses for incontinence.