Maintaining Healthy Peristomal Skin
Patient Support Information
What You Need to Know: Skin Care for Patients
Prevention is a crucial part of a successful peristomal skin care regimen. You can help your patients living with an ostomy prevent peristomal skin issues by providing them with helpful skin care tips.
Common Causes of Peristomal Skin Damage
Leakage: Healthy skin exposed to fecal or urine output under the skin barrier can break down fast.
Pressure: Belts and some clothing may cause pressure on the stoma area.
Stoma size: Ensure the skin barrier is cut to the right size. It should always fit closely around the stoma (1-2mm larger) to protect against leakage.
Skin folds or creases may prevent the skin barrier from sticking securely to the stomach and result in leakage. A different shaped product may be required if the stoma is flush or retracted.
Skin stripping or friction by removing a skin barrier too quickly can pull the top layers of skin away. The more frequent it happens, the more the skin can be irritated.
Pouching system: If the red or irritated area of the skin is the same shape as the skin barrier, the patient may have developed an allergy or sensitivity.
Tips for Peristomal Skin Care Routine
- Change the pouch routinely.
- Gently remove the skin barrier from top to bottom – an adhesive remover may help.
- Clean the skin around the stoma with a wipe soaked in warm water.
- Use all-natural products. Make sure to use a soap that is oil and residue-free.
- Dry the skin thoroughly before applying the next bag.
- Inspect the skin with every skin barrier change.
- Apply a skin barrier foam or spray if needed.
As a general rule, healthy peristomal skin should look the same as skin anywhere else on the body. Often times, when the barrier is removed, the may notice some redness from the adhesive. This is normal. If the redness does not go away, however, it could be a sign of a peristomal skin issue. Discomfort is another sign that the peristomal skin is not healthy.
Help Your Patients Scale their Peristomal Skin - Questions to Ask:
- Does your peristomal skin feel itchy or sore under your ostomy pouching system?
- Does your skin feel moist, warm or have a wet appearance?
- Compared to your full body skin tone, does your peristomal skin look pink, red or inflamed? Blistering or weeping?
- Does the colour return to its usual tone when you remove your pouching system after a short time?
Remember: It does not take much time or a large amount of effluent touching the peristomal skin for it to be damaged. The damage is not always easy to detect. That's why you should have your patients familiarize themselves with the importance of their peristomal skin. This way, they will know the warning signs and how to manage the skin issue.
Ensure your patients receive the support, information and resources they need.
Managing Peristomal Skin Issues
At some point, you may encounter a patient who has unhealthy peristomal skin. Identifying the skin issue is the first step in management. Here are some common peristomal skin issues and general information about them, including description, causes and symptoms:
Often caused by leakage, perspiration, antibiotic therapy, warm climates, broken skin.
Allergic Contact Dermatitis
Often caused by exposure to materials and compounds that irritate or sensitize the skin on contact (e.g., tape, skin barriers, soap, adhesives, powders, pastes, or pouch material).
Inflammation of peristomal skin resulting from contact with stool or urine, usually from leakage under the pouching system.
- Weeping areas of skin
(Hyperplasia commonly called PEH)
Often caused by chronic exposure of the skin to urine due to an excessively large opening in the skin barrier.
- Wart-like, gray or purple-coloured thickened areas next to the stoma.
- Frequent leakage or bleeding
- White, sandy, or gritty granules on stoma or around base.
An inflammation within a hair follicle caused by traumatic hair removal (e.g., "ripping" skin barrier from skin, shaving too closely, or excessive rubbing or cleaning of peristomal skin).
- Reddened, pinpoint, or infected areas at the base of the hair follicles around the stoma.
An ulcer in the peristomal area caused by excessive pressure from an ostomy appliance belt, tight clothing, rigid faceplate, peristomal hernia, or work-related habits.
A common skin disorder that can occur underneath ostomy pouching systems.
An inflammatory skin disease often seen with inflammatory bowel disease (IBD) such as Crohn's disease or ulcerative colitis.
Refers to a bluish-purple discoloration of the skin caused by dilation of the cutaneous veins around the stoma (peristomal varices).
- Blue/purple area surrounding the stoma that when blanched, displays irregular, small blood vessels.
Help Your Patients Choose the Right Pouching System
Whether your patient chooses a one-piece or two-piece ostomy system depends on their lifestyle and personal preferences. The chart below is a useful tool to help your patients understand the advantages and limitations of the various pouch types and systems. Proper fit of the skin barrier around the stoma is important to prevent peristomal skin problems:
- For one-piece ostomy pouching systems, a thin, flexible adhesive will protect the skin and allow for more frequent pouching system changes.
- For two-piece ostomy pouching systems, special moldable skin barriers designed to hug the contours of the stoma and eliminate gaps provide a snug fit that may help minimize peristomal skin problems.
- Moldable Technology™
- Choosing the Right Adhesive
- Flat vs Convex
ConvaTec Moldable Technology™ Skin Barriers
How to create a secure fit
This innovative mold-to-fit skin barrier eliminates the need for scissors, and can be shaped with fingers to create a customized stoma opening. It gently hugs the base of the stoma for optimum security.
- Flexible adhesive expands and contracts, moving with the stoma.
- Easy and simple to use.
- Lets the patient create an ideal fit while helping to protect their skin.
Cut-to-Fit Skin Barriers
With cut-to-fit skin barriers, your patient needs to trace a template of their stoma opening to the back of the skin barrier and cut out the opening.
- Trace the outline and use scissors to cut.
- Be sure to leave a 1/8" gap around the stoma.
- Use of paste is recommended to close any gaps.
Durahesive® (extended wear) Skin Barriers
Durahesive® skin barriers are designed for liquid output. Unlike other skin barriers that may break down around liquid output, Durahesive® skin barriers swell up to protect the stoma. This special effect, called turtlenecking, creates a more secure seal without harming the skin.
- Liquid Output
Stomahesive® (standard wear) Skin Barriers
Stomahesive® skin barriers provide an additional option for people with urostomies. This reliable skin barrier provides excellent security because of a special formula that enables the skin barrier to adhere to both dry and moist skin. It holds firmly to skin while protecting against irritating output.
Flat Skin Barrier
Flat skin barriers tend to be less noticeable under clothes and are the more flexible option. They are ideal for stomas that protrude more than 1/2".
- Protruding stomas
Convex Skin Barrier
Convex skin barriers use a specially designed ring to create a convex shape to help fit stomas that are flush, retracted or protrude less than 1/2". They are available in pre-cut or moldable convexity.
- Flush or retracted stomas
- Stomas in a skin fold or crease