Maintaining Healthy Peristomal Skin

For your patients living with an ostomy, chances are at some point, they might experience problems with peristomal skin or the skin around their stoma.

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:

Candidiasis Description/Causes: Often caused by leakage, perspiration, antibiotic therapy, warm climates, broken skin. Symptoms: Itchy, bumpy red skin. Also, infection of vagina, armpit, mouth, or any area of skin folds (i.e., buttocks, groin).

Allergic Contact Dermatitis Description/Causes: 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). Symptoms: Redness, itching, broken skin. Yeast irritation in the area covered by a part of the pouching system. A history of allergies.

Irritant Dermatitis

Description/Causes:

Inflammation of peristomal skin resulting from contact with stool or urine, usually from leakage under the pouching system.

Symptoms:

• Redness
• Pain
• Weeping areas of skin

Pseudoverrucous Lesions

(Hyperplasia commonly called PEH)

Description/Causes:

Often caused by chronic exposure of the skin to urine due to an excessively large opening in the skin barrier.

Symptoms:

• Pain
• 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.

Folliculitis

Description/Causes:

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).

Symptoms:

• Reddened, pinpoint, or infected areas at the base of the hair follicles around the stoma.

Pressure Ulcer Description/Causes: 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. Symptoms: Pain or bleeding Irregularly shaped ulcer Pouch leakage Decreased wear time

Psoriasis Description/Causes: A common skin disorder that can occur underneath ostomy pouching systems. Symptoms: Whitish scaly patches of various sizes Itching Broken skin

Pyoderma Gangrenosum Description/Causes: An inflammatory skin disease often seen with inflammatory bowel disease (IBD) such as Crohn's disease or ulcerative colitis. Symptoms: Irregularly shaped, red, painful, bloody, infected ulcers, with red-to-purple rolled margins; appear on legs, buttocks, face, and peristomal area.

Caput Medusae

Description/Causes:

Refers to a bluish-purple discoloration of the skin caused by dilation of the cutaneous veins around the stoma (peristomal varices).

Symptoms:

• 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.